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4.  15-G 


ii{  ii|f 
Cornutu 


.1..  - 


THE  C 


Vol.  XV. 


ICAL  RECORD. 


MO 


AL,  OCTOBER,  1886. 


No.  1. 


O  OaSTTIEl^rTS. 


ORIGINAL  COMMUNICATIONS. 

Some  Points  Connected  with  <Jvarian- 
Uterinc  Operations 1 

SOCIETY  Pr.OCEEDINGS. 

Medico-Cbirurgical    Society    of    Mon- 

tr.'al 3 

CORRESPONDENCE. 

Letter  fiom  Viruua 10 

PROGRESS  OF  SCIENCE. 
The  Te&t  for  Albumen  in  the  Urine. ...    13 
The  Treatment  of  Gonorrhoea 15 


The  Treatment  of  Epilepsy 17 

Boracic  Acid  Powder  in  the  Treatment 

of  Granular  Lids 18 

Chorea 19 

The  Treatment  of  the  Ring- worm 19 

Local  Remedy  for  Neuralgia  19 

The  Treatmelit  of  Paronychia 20 

Epileptiform  Tic  Cured  by  Nitro-Gly- 

cerine 

Iodide  of  Potassium  in  the  Treatment 

of  Infantile  Broncho-Pneumonia.. 

A  New  Remedy  for  Warts 

On  the  Early  Diagnosis  and  Treatment 


20 


of  Syphilis 21 

Internal  Administrations  of  Chrysaro- 

bin  for  Infantile  Eczema 22 

Pruritus  of  tbf  Anus 22 

Extract  of  Calabar  Bean  in  Epilepsy. . .  22 

Leister's  Latest  Antiseptic  Dressing.. . .  23 

EDITORIAL. 

Climate  of  Florida 23 

Artificial  Quinine  23 

Medical  Incomes  in  C:mada 23 

A  New  Haemostatic 23 

Reviews 24 


$n6inal  6ommunkaUQn6. 


SOME  POINTS  CONNECTED   WITH 

OVARIAN-UTERINE  OPERATIONS. 

By  E.  H.  Trenholme,  M.D. 

Professor  of  Gynecology  in  the  Medical  Faculty  University 

of  Bishop's  College,  Montreal. 

(Readbefore  the  Canadian  Medical  Association,  Quebec,  19th 

August,  1886.) 

In  this  brief  paper  it  is  my  desire  to  refer  to 
some  of  the  details  connected  with  operations  for 
the  removal  of  the  uterus,  or  its  appendages. 

It  is  not  my  intention  to  refer  to  the  diagnosis 
of  uterine  ovarian  disease,  nor  deal  with  the  after 
treatment,  to  any  great  extent. 

With  regard  to  the  preparing  of  the  patient  for 
the  operation,  I  would  advise  you  not  to  resort  to 
purgatives,  especially  avoid  aloes  and  castor  oil, 
both  of  which  favor  congestion  of  the  hemorr- 
hoidal vessels,  and  consequently  renders  the  patient 
more  liable  to  inflammatory  action.  The  bowels 
should  be  brought  into  gentle  action  by  diet  and 
mild  laxatives;  avoid  emptying  the  bladder,  es- 
pecially in  extirpation  of  the  uterus,  its  presence 
being  easily  recognized  when  full  and  not  so  liable 
to  be  injured ;  the  legs  should  be  wrapped  in  cotton 
wool,  especially  in  cold  weather,  and  the  tempera- 
ture of  the  operating  room  not  less  than  85°.  The 
cotton  wool  can  be  removed  after  reaction  has 
been  established. 

There  should  be  ready  for  use,  a  couple  of  dozen 
of  hot  towels,  which  are  to  be  applied,  as  need 
may  arise,  around  the  body  and  over  the  abdomen 


during  the  operation  ;  the  temperature  of  the  ex- 
posed boweh  and  surface  of  the  body  can  in  this 
way  be  easily  maintained.  It  also  protects  the 
patient  from  escaped  fluid  and  blood. 

I  prefer  to  stand  on  the  right  side  of  the  table, 
which  is  placed  diagonal  to  the  window,  so  as  to 
allow  the  light  to  fall  directly  upon  the  abdomen 
of  the  patient. 

The  instruments  required  for  these  operations 
need  not  be  very  numerous  nor  complicated ;  gen- 
erally speaking  a  scalpel,  scissors,  director,  half  a 
dozen  Keberly's  forceps,  three  or  four  sponges, 
silver  wire,  shoemakers'  thread,  and  horse  hair,  a 
needle-holder  and  needles  will  suffice.  I  would 
press  the  importance  of  having  clean  sponges, 
instruments  and  hands,  and  allow  no  explorations 
of  the  parts  during  the  operation  by  other  hands 
than  your  own.  Not  only  must  the  sponges  be  clean, 
but  they  require  careful  washing  during  the  opera- 
tion in  plain  water,  and  then  squeezed  out  of  car- 
bolized  water  before  handing  back  to  the  operator. 
This  part  of  the  work  should  be  entrusted  to  a 
competent  assistant ;  abundance  of  boiling  water 
and  water  that  has  been  boiled  only  should  be  used. 
If  this  is  attended  to  it  matters  little  whether  or  no 
carbolic  acid  is  used.  It  is  well,  however,  to  have 
all  instrimients,  at  the  time  of  operation,  kept  in  i 
to  20  solution  of  carbolic  acid. 

For  ligating  the  pedicle  and  all  vessels,  No.  20 
shoemakers'  white  thread,  single  or  double,  well 
carbolized,  is  all  that  is  needed.  My  reasons  for  pre 
ferring  this  ligature  to  all  others  are,  that  it  is  quite 
strong  enough,  even  single,  to  secure  all  the  vessels 


~>    ^^  ^^    £:^  rf---\ 


THE  dAIJADA   MEDICAL   RECOftD. 


that  should  be  enclosed  in  one  ligature,that  it  affords 
a  safe  knot,  is  easily  disintegrated  and  removed 
by  absorption.  This  ligature  should  be  soaked  at 
least  24  hours  in  pure  carbolic  acid  before  using, 
and  not  allowed  to  come  in  contact  with  water,  and 
for  convenience  it  may  be  cut  into  lengths  of  about 
15  inches  and  allowed  to  stand  in  pure  alcohol. 
For  closing  the  abdominal  wound  there  is  nothing 
better  tlian  silver  wire  for  the  deep,  and  carbolized 
horse  hair  for  the  superficial  sutures.  Great  care 
should  be  taken  when  closing  the  wound  to  have 
the  divided  structures  carefully  coapted,  while  at 
the  same  time  avoiding  the  inclosure  of  any  muscu- 
lar tissue — as  advised  by  Dr.  Goodell. 

By  attention  to  this  last  point  v,-e  avoid  suppur- 
ation in  the  track  of  the  sutures,  and  save  the  pa- 
tient a  great  deal  of  suffering.  There  can  be  no 
advantage  from  effecting  union  between  the  recti 
muscles.  It  cannot  possibly  strengthen  the  ab- 
domijial  wall,  and  must  interfere  with  the  proper 
action  of  these  muscles. 

In  removing  the  silver  sutures  cut  the  wire  close 
to  the  skin,  with  the  blades  of  the  scissors  length- 
wise of  the  body.  In  this  way,  pain  and  injury  of 
the  tissues  in  the  track  of  the  wire  are  avoided.  In 
all  my  operations  I  use  horse  hair  for  the  superfi- 
cial sutures,  and  never,in  any  instance,  has  it  slipped 
or  caused  the  slightest  irritation.  As  to  the  abdom- 
inal wound  there  is  much  need  for  good  judg- 
ment in  selecting  the  best  place  and  mode  of 
making  the  incision. 

It  is  most  important  to  confine  the  wound,  as 
nearly  as  may  be,  to  the  medium  line  midway  be- 
tween the  umbilicus  and  the  pubis.  In  no  case 
should  the  incision  be  extended  toward  the  pubis 
nearer  than  one  and  a  half  inches.  The  reason  for 
this  is  that  the  lower  parts  of  the  abdominal  wall 
are  the  most  important  for  sustension  of  the  bowels, 
and  also  because  the  ligamentous  structures  of  that 
part  when  once  divided  are  diflicult  to  co-apt  and 
retain  in  juxtaposition  till  union  takes  place.  A 
small  incision  of  iji  to  2}4  inches  is  all  that  is 
needed  in  most  cases  of  ovariotomy  or  removal  of 
the  uterine  appendages,  and  when  this  wound  is 
properly  made,  it  unites  pelrfectly  and  becomes  al- 
rndst  obliterated  ^fter  a  few  months. 

The  abdominal  incision  should  be  made  in  the 
median  line,  so  as  to  divide  the  sheath  of  the  recti 
muscles  without  cutting  a  single  muscular  fibre,  for 
the  reasons  already  given.  The  division  of  the 
skin  and  adipose  tissue  should  be  made  at  one 


stroke  of  the  scalpel ;  it  is  worse  than  mere  waste 
of  time  to  divide  the  structures  upon  a  director 
layer  by  layer  ;  it  is  a  bungling  way  to  operate,  and 
leaves  the  edges  of  the  wound  in  such  a  state  as  to 
interfere  with  primary  union.  Care  is  needed  in  • 
entering  the  peritoneal  cavity  ;  but  be  sure  you  are 
in  the  cavity  before  proceeding  further  with  your 
operation — I  have  seen  more  than  one  operator 
attempt  to  enucleate  the  cyst  before  cavity  had  been 
reached. 

In  ovariotomy  or  spaying,  having  reached  the 
pedicle,  it  should  be  ligated  in  small  segments, 
taking  care  to  avoid  wounding  any  vessel,  and 
when  possible  ligating  the  larger  vessels  by  them- 
selves^use  the  linen  thread,  tie  firmly  and  cut  off 
short — you  need  not  fear  hemorrhage.  Always 
divide  the  distal  end  of  the  pedicle  with  the  scissors, 
and  at  least  }^  of  an  inch  from  the  ligature.  I 
need  not  refer  to  the  importance  of  thoroughly 
cleansing  the  cavity,  and  introducing  a  drainage 
tube  when  necessary  or  a  piece  of  carbolized  lint. 
It  is  not  advisable  to  allow  a  drainage  tube  to  re- 
main longer  than  ^6  hours. 

We  have  already  referred  to  the  closure  of  the 
wound  and,  therefore,  speak  of  external  sup- 
ports. I  advise  the  use  of  carbolized  gauze  to  the 
wound,  a  pad  of  6  or  7  thicknesses,  3  inches  wide, 
placed  on  the  wound,  and  kept  in  place  by  2  or  3 
straps  of  rubber  plaster,  not  more  than  10  inches 
long.  I  allow  no  other  dressing,  except  in  those 
cases  where  the  tumor  removed  was  of  enormous 
size  and  the  parieties  flabby,  when  an  abdominal 
bandage  is  applied  for  24  or  ^^6  hours. 

Bandages  are  of  no  use,  they  greatly  inconven- 
ience the  patient,  and  interfere  with  the  use  of  hot 
water  fomentations  which  are  of  great  comfort  and 
service  in  almost  all  cases  for  the  relief  of  pain  and 
arrest  of  threatened  inflammatory  action.  Another 
point  is,  that  I  allow  my  patients  to  move  in  the  bed 
so  as  to  secure  the  most  comfortable  position.  If  the 
vessels  are  properly  secured  there  is  no  danger  of 
hemorrhage,  and  the  relief  from  a  constrained  posi- 
tion, long  maintained,  is  of  great  value  in  securing 
nerve  and  muscular  rest.  I  also  believe  such  move- 
ment favors  the  restoration  of  the  natural  position 
of  the  bowels,  which  sometimes  become  deranged 
during  the  operation.  Anyway,  I  have  never  seen 
any  ill  effects  from  such  movements. 

With  regard  to  removal  of  uterine  fibroids  I 
have  been  led  to  vary  the  operation  a  good  deal. 
When  the  growth  is  large,  I  think  it  well  to  divide 


TIIK    CANADA    MKDICAL    RECORD. 


the  mass  in  a  vertical  line,  having,  of  course,  con- 
stricted the  i)cdiclc  to  prevent  bleeding,  and  then 
having  enucleated  the  growths  I  form  the  stiinij) 
of  the  uterine  tissue  only,  making  the  V  incision, 
•  referred  to  in  a  former  paper  upon  this  subject. 
This  mode  of  forming  the  pedicle  has  been  used 
by  myself  for  some  years  ;  yet  inasmuch  as  Augustc 
Martin  has  adopted  the  same  procedure,  I  am 
unable  to  say  which  of  us  is  entitled  to  priority. 
One  great  advantage  in  thus  operating  is  that  a 
pedicle  can  always  be  secured,  and  the  vascular 
connection  of  the  flaps  with  the  pelvic  circulation 
need  not  be  completely  cut  off.  By  this  procedure 
the  roof  of  the  pelvis  is  maintained  for  the  support 
of  the  abdominal  viscera.  The  quilting,  or  shoe- 
makers' stitch,  used  by  me  to  co-apt  the  flaps  suflSce 
to  control  all  hemorrhage  after  the  ligation  of 
the  uterine  arteries.  The  advantage  of  this  mode 
of  dealing  with  the  pedicle  requires  no  special 
pointing  out.  Another  thing  to  which  I  would 
refer  is  the  value  of  linseed  tea  enemata ;  they 
greatly  facilitate  the  passage  of  flatus,  and  give 
much  comfort  to  the  patient,  while  they  are  valua- 
ble for  the  sustentation  of  the  patient  at  a  time 
when  but  little  nourishment  can  be  administered 
by  the  mouth.  The  value  of  hot  water  fomenta- 
tions in  threatened  peritonitis  and  cellulitis  is 
worthy  of  more  attention  than  is  generally  sup- 
posed to  be  necessary.  To  be  useful,  however, 
they  must  be  efficiently  applied,  and  here  I  would 
say  trust  no  one  to  do  the  work  without  you  have 
seen  that  they  can  do  it  well. 

As  to  medicinal  treatment  I  hold  but  little  to  it. 
Aconite  in  solution,  in  2  or  3  drops  doses 
every  4  hours,  is  of  some  value  when  the  pulse  is 
wiry  and  quick,  and  the  skin  hot  and  dry. 

For  the  distress  arising  from  flatulence  I  have 
foiuid  caraway  tea  frequently  do  good  service. 
When  possible  avoid  using  the  catheter,  allow  the 
patient  to  pass  her  urine  voluntarily. 

There  are  many  points  connected  with  uterine 
ovarian  operations  which  I  have  not  alluded  to, 
but  have  briefly  referred  to  some  things  that  I 
deem  to  be  original,  and  to  others  that,  perhaps, 
are  not  generally  known.  My  main  object,  how- 
ever, has  been  to  elicit  a  discussion,  and  if  in  this 
respect  my  hopes  are  realized  I  shall  be  satisfied. 

An  interesting  discussion  followed  upon  the 
reading  of  the  paper,  a  report  of  which  will  appear 
in  the  "  Transactions  of  the  Canadian  Medical 
Association. 


iSo'ttekj'  J^iit^teedin^^, 


MEDICO-CHIRURGICAL  SOCIETY  OF 

MONTREAL. 

Stated  Meetings  June  wth,  1886. 

T.  G.  Roddick,  M.D.,  Prksident,  in  the 

Chair. 
Lupus  of  the  Feet.—V>x.  R.  J.  B.  How.^rd  again 
exhibited  the  boy,  shown  at  a  previous  meeting,  to 
show  the  effect  of  treatment.  The  history  of  the 
case  is  as  follows: — Boy,  aged  12,  good  family 
history,  was  brought  to  the  Dispensary  on  account 
of  a  cough.  He  was  found  to  have  bronchitis, 
which  improved  under  treatment.  Dr.  Howard 
was  asked  to  see  his  feet,  which  were  said  to  be 
"breaking  out"  on  the  skin.  He  has  angular 
curvature,  involving  the  lower  dorsal  region.  First 
noticed  when  3^^  years  old.  His  feet  were  first 
affected  in  his  sixth  year.  A  small  "  scurfy  "  spot 
appeared  on  the  right  foot,  spreading  steadily,  and 
healing  at  centre.  When  seen,  it  appeared. as  a 
serpiginous  patch,  about  4  inches  across.  On  the 
right  ankle  and  instep,  smaller  similar  patches  were 
seen,  also  on  outside  of  right  little  toe  and  left 
great  toe  at  metatarso-phalangeal  joint.  The 
patch  was  covered  with  a  crust  or  scab  of  some- 
what papillary  appearance.  No  pain  or  tender- 
ness, and  never  ulcerated.  Such  was  the  condi- 
tion when  brought  before  the  Society  on  May  ist. 
Following  the  advice  then  given,  he  ordered  poul- 
tices to  remove  the  crusts,  when  the  appearance 
presented  was  that  of  a  typical  cutaneous  lupus. 
The  acid  nitrate  of  silver  was  then  applied  to  each 
tubercle.     Great  improvement  was  evident. 

Extirpation  of  the  Uterus  per  Vaginam  for 
Epithelioma. — Dr.  Perrigo  related  the  case  as 
follows:  R.  B.,  aged  31,  unmarried,  but  had  an 
illegitimate  child  ten  years  ago.  Family  history 
good.  Father  dead  from  cardiac  disease.  Mother 
is  still  living.  Has  four  brothers  and  four  sisters, 
all  living  and  healthy.  Patient  began  to  menstru- 
ate at  13  years  old,  was  always  regular.  Felt  per- 
fectly well  after  her  confinement.  Four  years  ago 
had  an  illness  which  kept  her  in  bed  for  two  or 
three  weeks,  the  most  prominent  symptoms  of 
which  were  severe  pains  in  both  legs,  from  the 
hips  downwards.  While  convalescing,  had  some 
uterine  hemorrhage,  occurring  in  the  interval 
between  the  menstrual  periods.  About  two  years 
after  this  illness  she  began  to  menstruate  more 
profusely  and  more  frequently  until,  during  the 


THE   CANADA   MEDICAL   RECORD. 


last  year,  she  was  "  unwell  all  the  time."  Con- 
sulted several  physicians,  without  receiving  any 
benefit.  No  examination  had  been  made  by  them. 
Never  complained  of  any  pain  in  connection  with 
the  hemorrhagic  discharge.  During  last  winter 
her  health  and  strength  suddenly  began  to  fail.  In 
the  spring  she  entered  the  Western  Hospital. 
When  examined,  the  presence  of  epithelioma  was 
discovered,  involving  the  cervix  and  a  very  small 
portion  of  the  vagina  next  to  the  anterior  portion 
of  the  cervix.  Pacquelin's  thermo-cautdre  was 
thoroughly  applied  on  two  occasions,  but  with 
only  temporary  benefit.  It  was  then  decided  to 
extirpate  the  uterus  per  vaginam,  as  there  was  a 
capacious  vagina,  and,  besides,  the  whole  disease 
could  be  removed.  Drs.  Kingston,  Kennedy  and 
Rowell  were  the  assistants.  A  horizontal  incision 
was  made  in  Douglas's  pouch,  enlarged  by  the 
finger,  the  uterus  retroverted,  after  which  a  liga- 
ture was  placed  around  the  organ  at  the  junction 
of  the  cervix  with  the  body.  This  was  done  for 
the  purpose  of  traction.  The  after  steps  of  the 
operation  consisted  in  taking  up  a  certain  portion 
of  tissue  with  a  threaded  aneurism-needle,  tying, 
and  then  dividing  with  scissors.  Both  Fallopian 
tubes  were  divided  in  the  same  way.  After  re- 
moval, a  circular  opening  was  left  at  the  upper 
end  of  the  vagina  through  which  a  small  loop  of 
intestine  could  be  seen,  but  which  did  not  come 
down.  Three  sutures  were  put  in  to  draw  the 
edges  of  the  vagina  together,  and  rubber  tubing  to 
faciHtate  drainage.  The  bladder  was  uninjured, 
and  there  was  hardly  any  hemorrhage  during  the 
operation.  Excepting  home  vesical  catarrh,  re- 
covery was  uninterrupted.  The  patient  left  for 
home  six  weeks  after  the  operation. 

Dr.  Rowell  exhibited  the  uterus. 

Dr.  Cameron  said  the  patient  came  to  him  at 
the  out-door  department  of  the  Western  Hospital. 
She  complained  of  hemorrhages  lasting  over  a  year. 
An  examination  revealed  this  malignant  disease. 
She  did  not  suffer  any  pain. 

Dr.  Gardner  said  that  hemorrhage  was  a  very 
constant  symptom  of  malignant  disease.  He, 
however,  mentioned  a  case  he  had  seen  with  Dr. 
McCallum,  where  the  only  symptom  was  leucorr- 
hoea.  Menstruation  was  normal,  and  there  was 
absence  of  pain.  On  examining,  a  rapidly-growing 
mass,  the  size  of  an  egg,  involving  the  cervix,  was 
found.  This  was  removed  with  the  knife  and 
scissors,  and  chloride  of  zinc  applied.  He  had 
never  removed  a  uterus  per  vaginam.    Dr.  Schroder 


has  good  success,  but  it  was  not  yet  decided  which 
operation  was  best  for  prolonging  life. 

Dr.  R.  J.  B.  Howard  said  that  absence  of 
symptoms  in  these  cases  was  remarkable.  He 
knew  of  a  case  where  a  woman  consulted  a  doctor  • 
for  bleeding  piles,  and  it  was  found  she  had  a 
large  cancerous  mass  involving  the  uterus.  She 
had  no  symptoms  whatever. 

Dr.  Kingston  said  the  practical  question  was, 
should  we  operate  or  not  ?  He  was  in  favor  of 
operating  if  the  disease  be  confined  to  the  uterus 
or  involving  as  much  vagina  as  can  easily  be 
removed.  If  the  broad  ligaments  are  diseased,  or 
if  the  vagina  be  much  infiltrated,  he  would  not 
operate.  He  was  in  favor  of  removing  per  vaginam, 
because  the  shock  was  less  and  hemorrhage  less. 

Dr.  Shepherd  said  the  operation  in  a  suitable 
case  was  as  justifiable  as  removing  the  rectum  or 
tongue. 

Successful    Ovariotomy  in  a  Pregnant   Phthisical 

Woman. 
Dr.  Gardner  related  the  case  :  Mrs.  A.,  mother 
of  two  children,  has  suffered  for  many  years  with 
cough,  haemoptysis,  and  purulent  expectoration, 
together  with  the  physical  signs  of  phthisis.  A 
tumor  was  diagnosed  five  years  ago  by  her  family 
physician.  Was  seen  a  year  ago  last  March  by 
Dr.  Gardner  ;  at  this  time  an  operation  was  not 
recommended,  for,  besides  the  patient's  general 
health  being  bad,  the  tumor  felt  as  if  there  were 
adhesions  in  the  pelvis.  Her  menses  ceased  last 
February,  and  symptoms  of  pregnancy  came 
on.  She  suffered  much  from  nausea  and  vomiting, 
and  also  orthopnoea.  Something  had  to  be  done  to 
relieve  this  last  symptom.  Dr.  Gardner  considered 
his  best  course  was  to  operate,  and  not  to  induce 
premature  labor,  as  some  recommended.  Two 
weeks  ago,  with  Drs.  Roddick  and  Bell  assisting, 
he  performed  ovariotomy.  On  opening  the 
abdomen,  the  dark  brownish-red  uterus  contrasted 
strongly  with  the  pearly  glistening  tumor.  No 
adhesions  existed,  and  there  was  a  good  pedicle. 
Convalescence  was  perfect.  The  temperature  never 
got  above  99° F.  There  was  very  little  vomiting, 
and  the  ether  did  not  affect  the  lungs.  The  stitches 
were  removed  on  the  seventh  day.  Her  breathing 
became  easier,  and  the  cough  and  expectoration 
lessened. 

Three  Cases  of  Cysts  of  the  Broad  Ligaments. 
— Dr.  Gardner  briefly  related  three  operations 
he  had  recently  performed   for  cysts  of  the  broad 


THE   CANADA   MEDICAL   RECORD. 


ligaments.  The  first  case  was  that  of  an  ordinary 
cystoma,  which  he  enucleated,  a  good  convales- 
cence following.  The  second  case  was  one  where 
he  intended  opening  a  deep  abscess  ;  but,  after 
getting  into  the  abdomen,  found  a  cyst  above  it 
this  he  opened,  and  stiched  its  walls  to  the  abdo- 
minal opening.  Through  drainage  was  maintained 
by  tubing  through  the  abdominal  opening,  cyst, 
abscess  cavity,  and  out  through  Douglas's  pouch 
and  the  vagina.  In  this  case  convalescence  was 
slow.  The  third  case  was  a  large  sessile  cyst, 
which  was  incised  and  stitched  to  the  sides  of  the 
abdominal  opening,  and  a  glass  drainage-tube  in- 
serted.    Patient  did  well. 

Dr.  HiNGSTON  then  read  a  short  paper  entitled 
"  Some  Remarks  on  Ovariotomy  P 


Stated  Meeting,  September  24///,  1886. 
J.  C.  Cameron,  M.D.,  ist  Vice-President,  in 
THE  Chair. 
Case  0/ Congenital  Wry-Meek. — Dr.  Lapthorn 
Smith  exhibited  a  case  of  congenital  wry-neck  in 
an  unmarried  female,  26  years  of  age.  Her  father 
and  mother  are  alive  and  well,  and  she  is  one  of  a 
large  family,  all  of  whom  are  alive  and  (except 
herself)  in  good  health.  Before  her  birth  her 
mother  received  a  severe  fright,  to  which  she 
attributed  the  girl's  deformity.  Ever  since  her 
birth  she  says  she  has  been  troubled  more  or  less 
with  a  spasmodic  condition  of  the  right  sternomas- 
toid  muscle.  During  the  last  few  years  the  muscles 
of  the  face  and  throat  have  become  involved,  and 
now  even  the  muscles  of  the  lower  extremities  are  in 
a  state  of  clonic  contradiction,  which  gives  her  a  gait 
similar  to  that  seen  in  locomotor  ataxia.  The 
patellar  reflex  is  markedly  increased  ;  were  it  not  for 
this  fact,  and  also  for  the  fact  that  it  was  of 
congenital,  one  might  think  that  the  disease  was  of 
an  hysterical  nature  ;  for  it  completely  disappears 
when  she  is  asleep,  diminishes  very  much  when  she 
s  not  observed  by  anyone  ;  while,  when  .she  comes 
to  see  the  doctor,  spasms  of  her  face  and  neck  be- 
come so  very  severe  that  her  features  are  frightful- 
ly distorted,  and  she  appears  to  be  in  imminent 
danger  of  suffocation  ;  and,  indeed,  feels  as  if  she 
could  not  get  another  breath.  The  muscles  of  the 
tongue  are  also  affected,  rendering  her  speech 
stammering.  The  muscles  at  the  back  of  the  neck, 
ojjposite  to  the  affected  side,  have  become  enor- 
mously hypertrophied  in  their  efforts  to  oppose  the 
contractions  of  the  sterno-mastoid.  With  regard 
to  the  prognosis,  Dr.  Smith  said  it  was  not  favora- 


ble in  these  cases,  operative  interference  being 
contra-indicted  ;  for  as  soon  as  the  stemo-mastoid 
is  cut,  the  disease  invades  some  other  muscle. 
The  treatment,  therefore,  is  nearly  entirely  medical. 
This  patient  has  greatly  improved  under  20-grain 
doses,  three  times  a  day,  of  the  mixed  bromides  of 
ammonium,  sodium  and  potassium ;  but  nearly  the 
whole  list  of  narcotics  have  been  recommended, 
such  as  chloral,  chloroform,  ether,  morpliia  and 
atropine  ;  also  tonics,  such  as  iron,  stychnine  and 
arsenic.  He  was  alternating  the  bromides  with 
iron  and  strychnine  in  the  case,  bromism  having 
shown  itself.  Dr.  Hammond  reports  two  cures  with 
bromide  of  zinc,  on  which  he  mainly  depends, 
electricity  having  failed  in  every  case  in  which  it 
was  tried. 

Ulcerative  Endocarditis. — Dr.  Sutherland  ex- 
hibited the  heart,  and  a  portion  of  the  right  lung, 
from  a  case  of  ulcerative  endocarditis.  Patient,  a 
man  aged  35,  came  to  the  out  door  department  of 
the  Hospital,  complaining  of  being  out  of  sorts,  and 
said  that  three  months  ago  he  had  been  on  a  spree, 
and  had  slept  on  a  bench  in  Central  Park,  and  there 
caught  cold.  At  the  hospital  he  was  found  to  be 
slightly  feverish,  and  was  persuaded  to  go  to  bed. 
While  the  nurse  was  getting  a  bath  ready  he  fell 
back  and  died  immediately.  On  the  endocardium 
of  the  left  ventricle  was  a  cauliflower  excrescence, 
one  inch  long,  and  projecting  about  a  quarter  of  an 
inch.  There  was  also  a  similar,  but  older,  looking 
excrescence  on  one  of  the  aortic  valves.  Through- 
out the  lungs  were  several  small  ulcerating  cavities. 

Ovariotomy  ;  large  Tumor. — Dr.  Trenholme 
exhibited  an  ovaraian  sac,  removed  from  a  lady  at 
Levis,  on  the  31st  August.  The  sac  and  its  con- 
tents weighed  over  70  lbs.  This  is  the  fourth  opera- 
tion since  the  last  Society  meeting  ;  all  the  three  pre- 
vious patients  made  a  good  recovery.  There  was 
excessively  firm  adhesions  of  the  sac  to  the  abdo- 
minal parietes,  intestines,  diaphragm  and  liver,  so 
strongly  adherent  that  the  sac  had  to  be  peeled  off 
by  reaching  the  posterior  part,  and  then  working  it 
off  toward  the  front.  The  sack  was  also  very 
friable,  and  in  great  part  had  to  be  removed  piece 
by  piece.  This  multilocular  tumor  had  been  re- 
peatedly tapped,  and  was  a  good  illustration  of  the 
bad  effects  of  such  treatment.  The  patient,  though 
very  feeble  and  exhausted,  bore  the  operation  well ; 
and  when  Dr.  T.  left  her,  thirty  hours  after  the 
operation,  her  pulse  and  temperature  were  almost 
normal,  and  she  was  feeling  well  and  cheerful. 
There  was  very  little  tympanitis  ;  but  on  the  fifth 


THE   CANADA   MEDICAL   RECORD. 


day  vomiting  set  in,  and  inability  to  take  nourish- 
ment. Though  the  vomiting  was  not  severe,  the 
patient  gradually  failed,  and  died  on  eighth  day. 

Dr.  C.  A.  Wood  then  read  the  following  paper 
on  a 

CASE  OF  CEREBRAL  SURGERY. 

I  have  made  the  presentation  of  a  case  of  brain 
wound  occurring  in  my  practice  the  excuse  for  say- 
ing something  to  you  about  those  recent  advances 
in  cerebral  surgery  that  have  excited  so  much  inter- 
est both  in  this  country  and  abroad.  For  example, 
it  was  generally  admitted  that  Prof.  Victor  Hor- 
sley's  paper  on  this  subject,  to  which  I  shall  refer 
later  on,  was  the  most  valuable  contribution- made 
to  the  surgical  section  of  the  British  Medical 
Association  during  its  late  meeting  in  Brighton, 
and  we  have  also  daily  evidence  of  the  increasing 
interest  in  the  surgery  of  the  brain  from  the  con- 
tinual reference  to  it  in  our  periodical  medical 
literature.  Of  course,  I  need  hardly  say  that  those 
with  hospital  and  other  extensive  opportunities  are 
most  competent  to  give  opinions  of  value  in  this 
department  of  surgery  ;  and  I  trust  my  paper  will 
at  least  be  the  means  of  eliciting  expression  of 
opinion  from  gentlemen  present  who  have  the  best 
right  to  speak.  For  the  notes  of  the  case,  I  am  in- 
debted to  my  friend,  Dr.  Hutchison,  who  had 
charge  of  the  patient  during  my  absence  from  the 
city,  and  who  saw  him  almost  daily  during  the 
entire  illness  : 

R.  R.,  aged  4  years  and  2  months,  was  running 
across  the  street  with  a  pea-shooter,about  1 8  inches 
long,  and  ^  inch  in  diameter.  He  fell,  and  struck 
his  head  against  the  end  of  the  tube  held  upright 
in  his  hand.  The  hollow  cylinder  passed  through 
the  left  lower  eyelid,  and  entered  the  orbit  about  a 
quarter  of  an  inch  from  the  margin,  inflicting  an 
injury  to  the  brain  itself.  The  tube  entered  2^ 
inches,  and  was  with  difficulty  withdrawn  by  a 
neighbor,  who,  we  afterwards  learn,  noticed  upon 
the  end  of  it  some  putty-like  substance,  mixed  with 
blood.  The  accident  occurred  on  the  loth  May, 
about  10  o'clock,  and  he  was  first  seen  a  few 
minutes  afterwards.  Child  unconscious  ;  extensive 
contusion  of  tissues  surrounding  wound  ;  left  pupil 
dilated,  with  no  response  to  light.  Right  pupil  is 
normal,  and  responds  to  light.  Pulse  very  weak 
and  slow,  and  vomiting  almost  constant.  Respira- 
ation  slow  and  labored.  Dr.  Wood  took  charge 
of  patient  at  10.30  a.m.  There  was  then  no  res- 
ponse to  light  in  either  eyes,  the  left  pupil  dilated 
and  immovable,  child   pale  and  restless,  and   the 


vomiting  had  ceased.  There  is  slight  proptosis. 
There  was  complete  motor  and  probably  sensory 
paralysis  of  right  side,  and  convulsive  movements 
of  upper  and  lower  limb,  these  movements  being 
chiefly  marked  in  right  arm.  The  convulsions 
continued  all  day,  and  for  a  short  time  before  they 
ceased  tiiere  was  simply  spasm  of  right  arm.  At 
9  p.m.,  right  eye  responsive  to  light  ;  no  convul- 
sions; no  return  to  consciousness;  temperature 
100  °  F. 

May  \'^th. — Patient  has  remained  in  about  the 
same  condition  since  last  note,  but  now  shows  signs 
of  returning  consciousness.  Takes  food  with  some 
difficulty,  and  when  asked  will  protrude  tongue, 
whose  deviation  to  right  side  is  marked.  Bowels 
moved  by  enemata. 

May  i6th. — Eyes  examined  by  Dr.  Proudfoot. 
There  is  a  slight  serous  and  bloody  discharge  from 
the  wound;  the  conjunctiva  is  much  inflamed,  and 
protrudes  over  the  margin  of  the  partially  everted 
lid ;  the  soft  parts  about  the  eye  are  greatly  swollen 
and  discolored.  The  apparent  protrusion  of  the 
eyeball  about  the  same  as  day  of  injury.  Morning 
temperature  loi  j^  °  F.  The  inflamed  conjunctiva 
was  incised,  and  the  wound  kept  open  by  cotton 
drain.  A  week  after  the  accident,  there  is  a  slight 
return  to  consciousness;  pulse  150,  temperature 
ioii^°F. 

May  18M. — Temperature,  9  a.m.,  103  °  F. 
pulse  1 50.  There  is  no  discharge  from  the  wound. 
No  vision  in  right  eye.  Child  partially  comatose. 
Requested  permission  to  have  wound  opened  for 
purpose  of  drainage,  but  it  was  refused.  Child's 
condition  worse. 

May  \<)th. — Morning  temperature  103  °  ;  even- 
ing 104  °  .  Restless,  head  extended  and  drawn  to 
right  side,  muscular  spasm  being  so  great  as  to 
prevent  its  being  drawn  forward. 

May  20th. — Temperature  at  noon  105°. 
Ordered  5  grs.  quinine.     Patient  unconscious. 

May  21st. — Dr.  Proudfoot  again  saw  the 
patient;  made  an  incision  over  site  of  wound,  in- 
troduced drain,  and  applied  poultice.  On  the 
22nd,  there  was  a  slight  discharge  of  sero-pus  from 
the  wound,  temperature  fell  to  103,  and  child  be- 
came more  conscious. 

Alay  2^th. — The  discharge  continues,  but  the 
temperature  is  104°,  and  child's  condition  unim- 
proved. This  state  of  things  continued  until  the 
29th,  when  the  child  died  comatose.  To  the  great 
regret  of  Dr.  H-,  he  was  unable  to  obtain  a  post- 
mortem. 


THE   CANADA   MEDICAL   RECORD. 


There  seems  to  me  to  be  little  doubt,  however, 
that  the  track  of  the  wound,  after  piercing  the  left 
lower  lid,  extended  from  a  point,  midway  between 
the  outer  and  inner  angles  across  the  floor  of  the 
orbit,  injured  and  possibly  destroyed  the  optic 
nerves,caused  protrusion  of  the  ball, passed  through 
the  roof  of  the  orbit  c'ose  to  the  sphenoidal  fissure, 
and  entered  the  brain  at  a  point  in  the  frontal  lobe, 
at  its  base,  close  to  the  fissure  of  Sylvius.  With 
the  exception  of  the  monobrachial  spasm,  one 
could  hardly  further  localize  the  injury.  To  sup- 
pose that  the  point  of  entry  was  through  the 
sphenoidal  foramen  would  be  to  admit  injuries  to 
the  middle  cerebral  arteries  and  other  structures  at 
the  base  of  the  brain,  inconsistent  with  the  course 
which  the  injuries  effect  subsequently  pursued.  As 
Gowers  points  out  violence  to  the  cerebral  sub- 
stance in  the  region  of  a  motor  centre  will  produce 
symptoms  which  are  usually  referable  to  lesions 
of  the  centres  themselves.  That  the  child  died  of 
septic  meningitis  appears  to  me  to  be  also  probable. 

The  question  that   naturally  arises  in  a  serious 
brain-wound  of  this  sort  is,    "Will any  operative 
procedure  be  of  use  ?  "     When  Dr.  Proudfoot  first 
saw  the  case   with  me  I  urged   the  propriety    of 
treating  this  injury  as  I  would  have  done  any  other 
deep  puncture.     Here  we  had  a  penetrating  wound 
of  the  orbit  involving  the  brain,  and  my  idea  was  to 
remove  the  useless  eyeball,  and  to  attempt  to  set  up 
at  once  direct  drainage  from  the  deeper  parts  of  the 
wound  after  it  has  been  thoroughly  cleansed  and  in- 
jected with   a  fairly  strong  antiseptic  solution.     I 
would  then  have  dressed  it  after  the  strictest  anti- 
septic style  and  waited  results.  The  parents, however, 
refused  to  permit  this,  and  Dr.  Proudfoot  was  not, 
I  think,  very  enthusiastically  in  favor  of  the  scheme. 
And  yet,  while  I  am  not  given  to  talk  about  what 
might  have  been,  I  am  now,  knowing  the  results 
which  followed  the  wound,  perfectly  satisfied  that 
such  a  course  would,  under  the  circumstances,  not 
only  have  been  justifiable,  but  that  in  the  light  of 
recent  knowledge  have  been  the  proper  course  to 
pursue.     As    in   other  situations,    the    dangers  of 
deeply  penetrating  wounds  are  sepsis  and  inflamma- 
tion.    Here  we  had  a  case  where  the  patient  lived 
nearly  three  weeks  after  the  injury,  so   that  death 
was  not  caused  by  the  first  and  direct  shock,  but 
probably  by  the  train  of  evils  brought  on  by  septic 
material  conveyed  into  the   brain  and  along  the 
whole  track  of  the  wound,  causing  inflammation  of 
the  meninges,  and  possibly  of  the  nervous  matter  it- 
self.    Septic  absorption  soon  took  place,  the  pro- 


ducts of  the  inflammatory  process  were  unable  to 
find  vent,  and,  further  absorption  occurring,  death 
was  of  course  inevitable.  That  the  plan  of  ample 
and  direct  drainage  with  antiseptic  dressings  in 
brain  injuries  is  crowned  with  success  in  apparent- 
ly hopeless  cases,  and  that  recovery  would  not 
otherwise  have  taken  place  seems,  to  me  to  have 
been  amply  illustrated  m  recent  years.  This  disre" 
gard  of  the  noli  me  tangere  rule  which  has  so  long 
obtained  with  most  of  the  internal  organs,  is  now 
affecting  the  chief  nervous  centres,  and  no  one  can 
place  limits  upon  the  extent  to  which  it  may  yet  be 
carried. 

As  the  subject  is  one  of  great  interest  to  me,  I 
should  like  to  make  a  part  of  the  paper  the  test  for  re- 
marks which  will  bring  out  a  discussion  of  these  re- 
cent advances  in  cerebral  surgery, and,if  you  will  per 
mit  me,  I  will  say  something  about  them.  Of  course, 
as  everybody  knows,  bold  and  successful  deeds  in 
brain  surgery  were  not  unknown  to  the  older  sur- 
geons ;  but  they  were,  when  they  occurred,  classical 
exceptions  to  the  rule  that  such  treatment  of  the 
cerebral  structures  was  in  the  nature  of  things  fatal. 
From  the  time  when  Dupuytren  plunged  his  knife 
into  the  brain  and  opened  a  cerebral  abscess,  giving 
relief  to  the  symptoms  and  leading  to  the  ultimate 
recovery  of  the  patient,  many  surgeons  have  suc- 
cessfully imitated  him.  So,  too,  do  we  find  many 
cases  of  severe  brain  lesions  doing  well  under  the 
older  surgeons  ;  but  there  are  just  two  factors  in 
these  cases  which  make  the  chief  differences  be- 
tween the  older  procedures  and  the  surgery  of  the 
present  day — ist,  more  accurate  diagnosis,  and, 
2ndly,  antisepticism.  A  better  definition  of  the 
situation,  extent  and  character  of  a  cerebral  wound 
abscess,  tumor  (whatever  it  may  be),  is  possible  in 
our  time,  chiefly  because  of  the  works  of  men  Hke 
Frevost,  Brown-Sequard,  Hughlings  Jackson, 
Gowers  and  others. 

All  observers  agree  as  to  the  special  value  of 
the  antiseptic  method  in  dealing  with  lesions  of 
the  brain.  Packard  says  that  wounds  of  the  brain 
heal  readily  when  secondary  inflammation  does  not 
set  in ;  and  in  speaking  of  their  treatment,  places 
great  stress  upon  the  employment  of  antiseptic 
dressings.  Hughes-Bennett's  celebrated  case  of 
brain  tumor,  reported  in  the  British  Medical 
Journal,  for  May,  1885,  would  have  done  better, 
said  the  operator,  Mr.  Rickman  Godlee,  if  stricter 
antiseptic  measures  had  been  preserved.  In  a 
very  clearly  written  article  upon  trephining  (see 
Annals  of  Anatomy    and  Sufgery,  No.    3,    Vol. 


THE   CANADA   MEDICAL   RECORD. 


VIII),  Dr.  H.  B.  Sands  thus  insists  upon  the 
special  value  of  antisepticisra  when  the  brain 
is  involved  :  "  Aside  from  those  cases,"  says  he, 
"in  which  the  brain  has  suffered  irreparable  dam- 
age, I  think  that  in  future  many  successes  will 
be  obtained  by  careful  antiseptic  treatment  of  the 
wound,  such  as  recommended  by  iJster  in  the 
management  of  compound  fracture  of  the  bones  of 
the  extremities.  The  most  scrupulous  cleansing 
of  the  wound,  the  arrest  of  the  hemorrhage, 
the  removal  of  foreign  bodies,  loose  fragments 
of  bone,  and  of  detached  portions  of  brain  matter, 
if  present,  followed  by  proper  drainage  and  dress- 
ings, is,  in  my  judgment,  the  only  means  which, 
with  our  present  knowledge,  promises  any  benefit 
in  this  nearly  desperate  class  of  cases." 

After  one  has  borne  in  mind    that   trephining 
is  now  commonly  resorted  to  for  the  opening  of 
cerebral  abscesses,  for  epilepsy —  of  the  Jacksonian 
variety  usually — where  a  traumatic  cause  can  be 
assigned,    that    it    was    proposed    by    Gross,   in 
1873,  and  I  think  has  been  resorted  to  since  then, 
for  the  relief  of  purulent  meningitis,  there  remains 
another  modern  occasion  for  its  performance  which 
I  shall  close   by  speaking   of.     The  attempt   to 
remove  a  cerebral  tumor  by  cutting  down  upon 
it  after  trephining  was  first  made  in   November) 
1885.     From  the  article  on  brain  tumors  in  Pep- 
per's System,  written  by  C.  K.  Miles  and  Hendrie 
Lloyd  (the  most  concise  treatise  on   the    subject 
that  I  know  of),  a  short  account  is  given  of  this 
remarkable  case,  which  may  be  taken  as  a  type 
of  hundreds  of  others  known  to  medical  readers, 
''  Four  years  previous  to  death   patient  received 
a  blow  on  left  side  of    the  head.     A  year  later, 
twitching  in  tongue  and  left  side  of  face.     Later, 
twitching  of  left  arm.     Twitching  increased,  par- 
oxysmal spasm,  and  general  convulsions,  with  loss 
of  consciousness.     Paresis,  and  then  slowly-devel- 
oped paralysis  of  the  fore-arm  and  arm.       Some 
paresis  of  left  leg.      Double  optic  neuritis  and  vio- 
lent headache."     This  patient  was  under  the  care 
of  Hughes-Bennett,  at  the  London  Hospital,    for 
Epilepsy  and  Paralysis.     He  diagnosticated  brain 
tumor,  and  suggested  its  removal.     Rickman  God- 
lee  trephined  over  suspected  region,  and  removed 
a  glioma,  the  size  of  a  walnut.     The  patient  did  well 
until  a  month  after,  when  hernia  cerebri  superven- 
ed, and  he  died. 

Mr.  Victor  Horsely,  the  Prof.  Supt.  of  Brown 
Institute,  in  his  paper,  told  how  the  brain  was 
searched  in  a  similar  way  in  three  instances,  all  of 


which  recovered  with  distinct  relief  from  the  symp- 
toms. The  patients,  who  had  epileptic  attacks  of 
varying  degrees  of  intensity  and  frequency,  were, 
in  consequence  of  them,  absolutely  unable  to  do 
any  kind  of  work,  and  their  lives  were  made  miser- 
able. 

The  chief  points  of  interest  lay  in  the  attempt 
to  simulate  the   symptoms  in  monkeys  by  irrita- 
tion of  their  motor  centres.     The  epileptic  seiz- 
ures, the  muscular  spasms,  the  convulsions,   the 
paresis, — all  were  successfully  imitated  by  vivisec- 
tion so  as  to  demonstrate,  by  a  plan  not  likely  to 
be  called  in  question,  the  exact  situation  of  the 
human  cerebral  lesion.     The  wound  in  the  scalp 
was  made  by  a  semi-circular  sweep  of  the  knife, 
as  opposed  the  crusial  incision  usually  made,  Mr. 
Horsley  thinking  that  healing  took  place  more 
quickly  afterwards,   and  better  drainage  was  in 
this  way  obtained.     He  laid  considerable  stress 
on  the  advisability  of  cutting  through  the  brain 
structures  parellel  to  the  direction  of  the  sulci, 
and  said  that  hemorrhage  was   best  arrested  by 
filling   the  wound  with  a  soft  antiseptic  sponge. 
To  secure  success,    it   was   advisable   to   adhere 
strictly   to  the   antiseptic    plan  throughout.     The 
patients   were  exhibited,  and  in  every  case   the 
motor  and  sensory  disturbances   were  either  en- 
tirely cured  or  so  relieved  that  they  were  able  to 
live  comfortable  and  to  do  work.     As  Dr.  Broad- 
bent  remarked,  in  his  address  before  the  medical 
section  of  the  British  Medical  Association,  medi- 
cine and  surgery  are  brought  into  specially  close 
relations  in  these  matters  of  celebral  tumors  and 
lesions,  which  are  medical  as  regards  diagnosis, 
but  surgical  as  far  as  effective  treatment  is  con- 
cerned.    So  far  as  we  yet  know,  brain  tumors  and 
other  irritants  of  the  cerebral  centres,  to  be  capa- 
ble of  sufficiently  accurate  diagnosis  as  to  permit 
of  their  removal   with  success,  must   be  situated 
in  the  motor  zone ;  they  must  not  be  too  large, 
must  be  single,  must  not  be  too  deep-seated,  and 
must  not  be  malignant.     This  may  narrow  the  field 
down  to  a  small  array  of  cases;  but,  in  the  mean- 
time, while  a  more  extended  study  of  the  cerebral 
-functions  will  probably  make  diagnosis  more  easy 
and  certain,  it  is  something  to  have  made  worth 
living  even  a  few  lives,  otherwise  doomed  to  hope-, 
less  misery.     It  may  fairly  be  claimed,  also,  that 
the  chief  bugbears  of  the  surgeon  are  secondary 
inflammation  and  sepsis — insurmountable  obstacles 
they  would  be  even  if  we  could  localize  cerebral 
tumors  with  the  nio.st  positive  accuracy  >  tiiese  are 


THE   CANADA  MEDICAL  EECORD. 


now  guarded  against,  as  we  guard  against  them  in 
other  departments  of  surgery,  by  followuig  the 
common-sense  rules  of  the  antiseptic  system. 

Dr.  Shepherd  said  that  McEwen  of  Glasgow 
had  implanted  again  the  piece  of  bone  removed 
by  the  trephine,  previously  breaking  it  into  frag- 
ments, a  good  recovery  following.  Dr.  Shepherd 
mentioned  a  case  under  his  care  in  the  hospital, 
where  a  man  had  been  kicked  by  a  horse,  fractur- 
ing the  bones  of  the  skull  in  such  a  manner  that 
one  piece  was  overriding  another;  no  symptoms 
following,  he  sewed  up  the  external  wound,  a  slight 
pad  and  bandage  being  placed  over  all.  In 
about  ten  minutes  the  man  had  an  epileptiform 
convulsion  ;  pressure  being  removed,  he  got  well 
and  recovered  completely.  Another  case,  a  man, 
had  his  frontal  bone  crushed  in  from  a  fall  of  40 
feet.  He  remained  insensible  for  a  few  days,  but 
got  perfectly  well.  The  wound  was  cleansed  with 
solution  of  bichloride  of  mercury  and  iodoform 
gau^e  applied. 

The  Ch.4IRman  said  that  Horsley  laid  great 
stress  upon  removing  brain  substance  where  it  ap- 
peared to  be  affected,  particularly  in  removing 
brain  tumors. 

Aneurisms  of  the  Aorta. — Dr.  Kennedy  said 
he  had  been  recently  asked  to  be  present  at  a 
post-mortem  examination  of  a  man  who  died  sud- 
denly. The  skin  was  yellow.  There  was  fatty 
degeneration  of  the  liver.  The  right  lung  was 
collapsed,  and  that  side  of  the  chest  filled  with 
blood  from  the  bursting  of  a  large  aneurism  of  the 
descending  aorta.  A  second  aneurism  also  e.visted 
of  the  abdominal  aorta.  Dr.  Kennedy  understood 
that  aneurism  had  never  been  diagnosed  during  life. 

Dr.  Geo.  Ross  said  that  nearly  eighteen  months 
ago  he  had  treated  this  man  for  aneurism,  and 
with  relief  to  the  symptoms.  He  gave  him  iodide 
of  potassium,  with  rest.  When  first  seen,  the 
man  complained  of  rheumatism  of  left  shoulder- 
blade  ;  the  pain  was  severe  and  neuralgic.  He 
made  out  no  bruit  from  the  aneurisms,  but  down- 
ward a  double,  soft  basic  murmur.  When  last 
seen  by  Dr.  Ross  (last  spring),  the  man  was  taking 
morphia  for  the  relief  of  the  intense  backache. 

A  case  of  true  Scurvy ;  death,  loith  obscure 
brain  symptoms  ;  a  targe  blood-clot  found  in  the 
right  temporo-sphenoidal  lobe. — Dr.  R.  L.  Mac- 
Donnell  related  the  case  as  follows  :  W.  P.,  a 
farm-laborer  from  the  Eastern  Townships,  was  ad- 
mitted to  the  Montreal  General  Hospital.Sept.  i8th, 
1886,  complaining  of  general  debility  and  of  the 


incsence  of  an  eruption  on  his  face,  and  the  upper 
part  of  his  body.  Two  years  ago  he  had  rheuma- 
tism, and  for  several  years  has  had  a  slight  cough. 
For  the  last  12  months  his  diet  has  consisted 
exclusively  of  bread  and  butter,  milk,  tea,  sugar, 
no  vegetables  except  potatoes,  and  no  meat 
whatever,  either  fresh  or  salt.  About  the  15th 
of  July  last  he  began  to  feel  weak,  drowsy,  and 
indisposed  for  work.  A  slight  cough  was  present, 
with  blood-stained  expectoration  and  frequent 
epistaxis.  The  gums  then  became  soft,  tender, 
and  prone  to  bleed  easily ;  some  slight  ulceration 
being  also  present.  Spots  and  patches  of  "  black- 
land'blue"  like  bruises  appeared  first  upon  the 
egs,  subsequently  over  the  whole  body,  more 
especially  on  the  chest,  where  the  largest  patch 
was  about  three  inches  in  diameter,  the  smallest, 
the  size  of  a  pin's  head.  At  this  time  his  general 
strength  was  fair  and  his  appetite  good.  There 
had  been  but  one  syncopal  attack,  and  that  oc- 
curred the  day  after  his  admission   to    hospital. 

Present  condition. — Emaciation  considerable  ; 
his  usual  weight  being  160  lbs.,  he  weighs  at  present 
but  133  lbs.  Skin  dull  and  pasty  ;  eyes  sunken  ; 
mucous  membranes  anjemic.  In  the  mouth,  more 
especially  upon  the  palate,  there  are  several 
petechial  extravasations  under  the  mucous  mem- 
branes. The  gums  are  pale,  spongy,  receding, 
and  ulcerated  at  the  edges.  Over  the  body  gener- 
ally there  are  numerous  small  purplish  patches, 
but  no  large  bruise-like  surf;rces  as  were  formerly 
said  to  exist.  Examination  of  lungs  negative. 
There  was  a  well-marked  systolic  murmur  heard 
with  maximum  intensity  at  ape.x,  also  at  base,  and 
for  a  short  distance  towards  the  left  axilla.  The 
urine  was  pale  in  color,  with  little  or  no  deposit  on 
standing  ;  no  albumen,  no  sugar.  The  blood  cells 
number    2^    millions    to    the    cubic   millimetre. 

Treatment. — The  patient  was  kept  in  bed  and 
placed  upon  the  full  hospital  diet,  with  extra 
vegetables,  lemons  and  other  fresh  fruit.  An  iron 
and  quinine   mixture    was   ordered. 

tiept.  22. — Patient  fainted  this  morning,  and 
afterwards  had  a  slight  chill.  Severe  frontal  head- 
ache set  in,  accompanied  by  obstinate  vomiting. 
At  mid-day  the  pulse  was  66,  and  weak;  extremi- 
ties cold  j  rather  stupid,  but  not  comatose ;  no 
paresis  perceptible.  Ordered  hot  bottles  and  a 
stimulant.  For  the  rest  of  the  day  the  condition 
did  not  improve,  and  at  2.30  a.m.,  on  the  following 
day,  died  without  showing  any  evidence  of  unila- 
teral disease. 


10 


TOE    CANADA   MEDICAL   RECORD. 


Pest-motiem  appearances. — Large  hemorrhage 
into  the  right  cerebral  hemisphere,  mider  the 
aternal  ventricle.  Hemorrhagic  infarcts  in  both 
lungs,  especially  the  right.  Sub- pericardial  hem- 
orrhages, especially  over  the  left  ventricle.  A 
few  subcutaneous  hemorrhages.  Body  well 
nourished,  warm,  rigor  mortis  commencing ;  a 
number  of  commencing  petechise  and  vibices 
chiefly  on  the  front  of  the  chest,  belly  and  legs. 
There  was  nothing  abnormal  found  in  the  ab- 
dominal cavity  beyond  that  the  bladder  was  very 
much  distended.  Thorax — Heart :  Left  chambers 
empty  and  contracted  ;  the  right  full  and  dilated. 
The  natural  heart  muscle  can  hardly  be  seen,  owing 
to  the  many  extensive  hemorrhages  under  the 
pericardium.  Lungs  :  The  right  shows  many 
infarcts,  which  appear  recent,  the  largest,  at  the 
base  of  the  lung,  measures  i^  inches.  The  whole 
posterior  part  of  the  lung  is  cedematous  and  pas- 
sively congested.  The  left  is  in  a  similar  condition, 
but  there  are  fewer  infarcts.  No  subpleural 
effusions,  and  very  htde  serous  fluid  in  the  pleurae 
and  pericardium.  The  aorta  in  no  place  blood- 
stained. Brain  :  In  removal,  the  saw  opened  a 
cavity  in  the  right  hemisphere,  whence  blood  and 
broken  down  brain  matter,  in  no  way  altered  or 
decomposed,  made  its  escape.  There  was  no 
subdural  or  subpial  hemorrhages,  and  a  careful 
dissection  showed  that  the  ventricles,  though  full 
of  blood  and  serum,  had  escaped  ;  but  under  the 
right  lateral  ventricle  there  is  a  large  cavity,  with 
ragged  walls,  occupying  the  whole  of  the  right 
temporo-sphenoidal  lobe,  extending  forward  into 
the  frontal  and  back  into  the  occipital  lobe  ;  the 
lower  part  of  right  hemisphere  is  reduced  to  a 
mere  shell ;  the  upper  part  above  the  ventricle 
intact.  All  parts  of  the  brain  are  unusually  vas- 
cular. 

Dr.  R.  J.  B.  Howard  exhibited  the  heart,  right 
lung,  and  brain,  and  described  the  post-mortem 
appearances. 

Dr.  GuRD  asked  if  this  could  not  be  a  case  of 
simple  purpura  hemorrhagica. 

Dr.  Smith  said  it  was  unusual  to  see  scurvy  in 
a  person  living  upon  the  diet  said  to  have  been 
used  by  this  patient.  Sailing  vessels  were  not 
bouqd  by  law  to  carry  lime-juice  if  they  had 
potatoes. 

Dr.  R.  L.  MacDonnell  thought  the  whole 
history  of  the  case  pointed  to  its  being  scurvy ; 
and  Dr.  Howard  said  that  the  post-mortem 
examination  gave  evidence  of  this  disease. 


BoUtS^o^ndeme. 


LETTER  FROM  VIENNA. 
EdUors  Canada  Medical  Record. 

Dear  Sirs  : — In  a  previous  letter  I  spoke 
rather  enthusiastically  in  favor  of  that  centralizat- 
ing  system  of  teaching  which  one  finds  in  Berlin  as 
contrasted  with  the  divided  clinical  opportunities 
to  be  met  with  in  London.  This  characteristic  of 
the  Berlin  Faculty  is  even  more  plainly  marked  in 
the  University  of  Vienna,  and  in  just  so  far  it  is 
superior  to  any  other  medical  teaching  centre  with 
which  I  am  acquainted.  Partisans  of  other 
schools  and  systems,  while  admitting  the  advantages 
of  a  practically  unlimited  supply  of  material  for 
clinical  purposes,  deny  the  superior  excellence  of 
such  didactic  teaching  as  is  comprised  in  the 
courses  of  the  Wiener  Universitat.  I  am  not  in  a 
position  to  give  an  opinion  upon  that  question;  but 
it  seems  to  me  that  the  value  of  a  course  of  lec- 
tures is  largely  determined  by  the  presence  or 
absence  of  such  illustrations  as  may  be  drawn  from 
the  wards  or  dead-house  of  a  large  hospital.  With- 
out going  further  into  this  question  it  will  be  sufii- 
cient  to  indicate  the  advantage  of  producing  in  a 
set  course  of  lectures  upon,  we  will  say,  eczema, 
examples  of  the  many  varieties  of  this  disease,  only 
to  be  done  in  such  immense  institutions  as  the 
Vienna  hospitals  by  lecturers  possessed  of  power 
held  by  the  professors  in  the  German  and  Austrian 
universities.  The  Allgemeine  Kraukenhaus  is  a 
group  of  two-storied,  old,  and  unimposing  build- 
ings, arranged  about  the  four  sides  of  several 
courts,  and  containing  about  3000  beds.  Within 
the  grounds  of  this  immense  hospital  are  the  med- 
dical,  surgical,  obstetrical,  special  and  private 
wards,  the  buildings  devoted  to  the  administration, 
the  lecture  rooms  of  the  different  professors  and 
assistants,  rooms  appropriated  by  privat  docents 
kliniks  of  attendants,  the  pathological  institute, 
museums,  refreshment  department  and  all  the  par- 
aphernalia of  teaching  the  divine  arts  of  medicine 
and  surgery. 

It  is  practically  a  State  Hospital,  for  the  outly- 
ing municipalities  send  patients  to  it;  and  they, 
with  the  central  government,  furnish  the  large  sums 
necessary  to  keep  it  in  efficient  working  order.  I 
have  said  that  the  buildings  are  old  ;  I  must  add 
that  from  a  sanitary  point  of  view  they  are  not 
specially  healthy,  but  in  these  days  of  antisepti- 
cism  the  grosser  forms  of  "  dirt  "    do    not    cause 


THE   CANADA   MEDICAL   RECORD. 


11 


that  aiiiotint  of  apprehension  which  tlicy  formerly 
dill.  One  inHtiencc,  however,  must  not  be  over- 
looked both  here  and  in  Berlin,  and  that  is  the 
privilege  possessed  by  convalescent  patients  of 
goi'.ig  out  into  the  court-yard  garden  to  meet 
their  friends.  This  continual  out-door  communion, 
in  a  tree-covered  garden,  with  those  the  patient 
most  loves,  and  the  chance  of  doing  it  as  soon  as 
he  can  walk  or  be  carried  out,  is  an  influence  not 
to  be  despised.  How  far  the  further  privilege  of 
buying  beer  (to  be  drunk  upon  the  premises) 
from  the  refreshment  booth  close  at  hand  operates 
for  good  to  the  patient  it  is  not  easy  for  an  out- 
sider to  judge.  To  these  cafes  in  the  court-yard 
repair  patients,  nurses,  students  and  visitors  ;  beer 
and  light  wines  are  bought  and  drunk  just  as  in 
any  other  cafe  of  the  city ;  and  all  is  lovely.  It 
must  be  remembered  that  the  Austro-German  ap- 
pears to  live  mainly  for  beer.  He  does  other  things 
besides  the  drinking  of  beer,  but  he  does  noth- 
ing else  with  the  same  thoroughness  and  the  same 
complete  satisfaction.  One  must  understand  this 
before  he  wonders  greatly  at  the  existence  by  au- 
thority of  a  beer  garden  attached  to  the  largest 
hospital  in  the  world.  In  a  general  way  what  I 
have  said  in  a  previous  letter  with  reference  to  the 
Berhn  Medical  Faculty  is  also  true  of  Vienna. 
The  professor  of  each  branch  exhibits  the  didactic 
course  proper  to  his  chair  ;  his  assistants  prepare 
his  illustrations,  assist  him  at  his  lecture  or  demons- 
tration, and  in  his  absence  deliver  his  lectures  for 
him.  The  institution  of  the  privat  docent  is  in 
special  force  in  Vienna,  and  here,  I  think,  mainly 
lies  the  difference  between  Berlin  and  Vienna 
which  constitutes  the  special  excellence  of  the  lat- 
ter. There  ak  privat  docents,  as  everybody  knows, 
attatched  to  all  German  universities;  but  it  is  here 
in  Vienna  that  they  are  most  numerous  and  most 
useful.  The  function  of  the  privat  docent  resem- 
bles more  that  of  a  tutor  than  a  professorial  assis- 
tant. He  is  appointed  by  the  University  to  teach 
some  particular  branch  which  he  does  by  the 
formation  of  classes.  In  the  Medical  Faculty  he  has 
certain  teaching  privileges  in  the  Kraukenhaus  ; 
and  may,  for  instance,  set  up  a  klinik  for  that  pur- 
pose. In  this  way  he  establishes  a  claim  upon 
vacant  assistant  professorships  in  Vienna,  or  to  a 
higher  dignity  in  some  minor  faculty.  The  great 
goal  to  which  the  ambitious  privat  docent  aspires 
is  a  Vienna  professorship,  and  I  believe  the  sys- 
tem now  in  vogue  there  ensures,  as  much  as  any 
system  can,  the  appointment  to  professorships  of 


the  men  best  qualified  to  fill  them.  To  return  to 
the  ([ucstion  of  learning  his  art,  the  student  in 
medicine,  having  made  up  his  mind  what  courses 
he  wishes  to  pursue,  will  find  little  difticulty  in 
joining  at  almost  any  season  of  the  year  (except  in 
midsummer)  classes  for  the  study  of  the  chosen  sub- 
jects. It  has  been  stated  to  me,  and  I  have  rea- 
son to  believe,  that  a  man  can  study  by  these 
means  any  subject  whatever  in  the  whole  range  of 
medicine  and  surgery,  and  that  full  instruction 
with  adequate  illustrations  when  feasible  clinical 
demonstrations  can  be  had  at  almost  any 
time  in  Vienna.  That  is  to  say  this  system  of 
semi  private  instruction  is  so  extensive  that  one 
is  practically  independent  of  the  regular  university 
courses  which,  however,  the  wise  and  prudent 
student  will  in  no  wise  neglect.  Here,  as  in  Ber- 
lin, most,  the  best,  tutors  understand  our  lan- 
guage, but  the  English-speaking  student  who 
leanis  German  is  in  a  much  better  position  to  ap- 
preciate the  medical  advantages  of  the  Great 
Austrian  school  and  hospital  than  he  who  rehes 
entirely  upon  his  knowledge  of  English. 

The  Vienna  Faculty  includes  a  brilliant  array 
of  names,  and  among  the  assistants  one  finds  some 
who  are  equally  as  well  known  as  are  the  profes- 
sor themselves. 

Foremost  of  all  stands  Billroth,  the  world  re- 
nowned surgeon,  gifted  apparently  with  perennial 
youth.  I  saw  him  remove  by  a  combination  of 
enucleation  and  incision  several  sub-peritoneal, 
uterine  fibromata,  and  one  large  submucous  fibro- 
ma. The  wounds  in  the  uterus  were  stitched  up, 
the  abdominal  opening  in  the  peritoneum,  the 
muscular  layer  and  the  skin  were  all  separately 
dealt  with,  and  strict  antiseptic  precautions  (no 
spray)  were  observed  throughout.  The  operation 
lasted  an  hour  and  a  half,  the  anaesthetics  employed 
being  a  mixture  of  absolute  alcohol  and  ether,  of 
each  one  part,  and  chloroform  three  parts. 

Although,  on  account  of  the  case  with  which 
special  courses  upon  almost  any  subject  or  any 
department  of  a  subject  can  be  obtained  in  Vienna 
this  city  offers  many  inducements  to  specialists. 
Vienna  is  as  little  the  home  of  specialism  as  Lon- 
don. It  does  not  follow  that  because  a  man  is  a 
surgeon,  teaching  some  special  branch  of  this  im- 
portant subject,  he  should  restrict  himself  to  its 
practice.  It  seems  to  me  that  there  is  no  natural 
distinction  made  in  surgery  between  the  various 
abdominal  organs,  and  why  a  surgeon's  abihty  to 
perform  cholecystotomy  ehpuld  unfit  him  for  the 


12 


THE   CANADA   MEDICAL   RECORD. 


performances  of  hysterectomy  is  one  of  those  mys- 
teries not  to  be  pierced  by  the  average  eye  of 
wisdom.  That  the  ability  to  diagnose  and  treat 
new  growths  present  in  the  female  pelvis  should 
unfit  the  surgeon  for  similar  work  in  the  male 
cavity,  is  another  one  of  those  paradoxes  that  the 
profession  in  the  new  world  is  responsible  for. 
There  does  seem  to  be  many  reasons  why  the  di- 
vision into  surgical  and  medical  departments  of 
our  professioh  should  finally  become  general  in 
America.  It  works  well  in  England,  and  the  lines 
that  divide  the  one  from  the  other  are  natural  and 
not  arbitrarily  placed,  but  it  seems  to  me  that  the 
present  craze  for  emasculated  specialists  is  likely 
to  work  harm  to  the  interests  of  the  public  whose 
trusted  servants  we  are,  and  that  respectable  body 
of  which  we  esteem  it  an  honor  to  form  a  part. 
Of  course  the  subject  is  too  broad  to  be  argued 
here,  but,  as  far  as  I  could  learn,  the  feeling  among 
those  well  calculated  to  speak,  both  in  England 
and  in  the  German  cities  I  have  visited,  the  dis- 
position is  plainly  to  deprecate  that  sub-division 
of  general  work  o'f  which  we  have  had  so  many 
illustrations  in  our  own  country.  The  pathologi- 
cal work  in  which  I  was  particularly  interested  is 
well  conducted.  The  Pathological  Institute  is  a 
large  new  structure,  whose  architectural  arrange- 
ments are  more  in  keeping  with  the  other  beautiful 
and  imposing  University  buildings  of  the  Austrian 
capital  than  with  the  low  and  antiquated  structures 
of  the  Kraukenhaiis  which  surround  it.  Here, 
too,  is  the  bacteriological  laboratory,  by  no  means 
as  complete  or  as  extensive  as  that  of  Koch,  but 
capable  of  accommodating  many  students.  When 
I  left  Berlin  the  classes  of  that  teacher  were  in  full 
blast ;  but  here,  in  common  with  those  in  most 
other  branches,  the  overpowering  heat  is  making 
itself  felt,  and  every  student  and  teacher  who  can 
get  away  is  thinking  of  his  summer  holidays.  We 
were,  shown  a  large  number  of  gelatine  cultures, 
liquified  and  so  rendered  useless  by  the  extremely 
high  temperature,  a  sufficient  reason,  it  appears 
to  me,  for  a  sessional  repose  from  bacteriological 
work. 

I  suppose  it  is  only  right  to  consider  everything 
in  comparing  the  merits  and  demerits,  as  medical 
centres,  of  Berlin  and  Vienna.  With  this  object 
in  view  the  reader  must  be  reminded  that  from  its 
southern  position  Vienna  is  a  much  hotter  city 
than  Berlin  ;  and  a  residence  for  work  in  the  former 
city,  during  the  summer  months,  is  not  usually 
pleasant,  while  in  Berlin  the   summer  is  generally 


delightfully  cool.  They  tell  me,  also,  that  if  the 
student  wilUive  like  an  Anglo-Saxon  christian  and 
not  lead  the  life  of  an  Austrian  barbarian,  it  will 
cost  considerably  more  in  the  southern  capital  than 
in  Berlin. 

Not  only  for  its  bearing  upon  the  subject  of  an- 
tisepticism  in  general,  but  also  on  account  of  its 
special  reference  to  the  obstetric  use  of  antiseptics, 
the  record  of  the  great  lying-in  department  of  the 
Kraukenhaus  is  extremely  valuable.  In  one  of 
the  oldest  and  dirtiest  buildings  ot  this  collection 
of  hospitals  an  immense  number  of  women,  chiefly 
of  the  lowest  class,  are  yearly  confined.  The  pre- 
vious history  of  the  institution  had  been  one  of 
puerperal  fever,  septic  poisoning,  prolonged  con- 
valescence, and  a  high  death  rate — all  attributed 
to  every  conceivable  cause  but  the  correct  one. 
But  now  all  but  the  malhygienic  building  itself  is 
changed.  The  spray  is  not  employed  ;  nor  are 
vaginal  douching,  bandages  or  napkins  permitted  ; 
but  the  linen  is  changed  a  dozen  times  a  day,  if 
need  be,  to  present  always  a  perfectly  clean  and 
absorbent  surface,  to  the  discharges.  Iodoform  is 
blown  over  the  vulva  and  between  the  labia.  The 
patient  gets  up  early,  and  the  results  of  this  treat- 
ment are  simply  surprising.  The  forceps  are  spar- 
ingly used,  but  version  seem  to  be  a  common  oper- 
ative procedure.  Ephemeral  fever  is  uncommon  ; 
and  when  discovered  is  regarded  as  a  proof  of  the 
presence  of  septic  matter  in  the  uterus  or  vagina, 
and  the  patient  is  treated  accordingly,  usually  by 
the  uterine  curette  and  antiseptic  douches.  The 
beds  themselves  undergo  periodical  washings  with 
corrosive  sublimate  and  other  germicide  solutions, 
and  painted  often  enough  to  ruin  any  ordinary  ly- 
ing-in  hospital  ("  supported  by  voluntary  subscrip- 
tions") ;  but  what  matter  as  long  as  a  kind,  pater 
nal  government  pays  the  bill  ?  I  am  aware  that 
there  are  sceptics  who  regard  this  dusting  with  iodo- 
form and  the  impregnation  of  the  wards  by  its  sweet 
odor  as  a  work  of  superarogation  and  of  little  value 
to  the  patient.  These  same  authorities  class  it  with 
the  bell  ringing  and  incense  burning  employed  by 
those  well-intentioned  priests, who  vainly  tried  there- 
by to  drive  out  several  severe  puerperal  plagues, 
and  they  hint  that  there  are  superstitions  in  medi- 
cine. 

Be  that  as  it  may  the  results  in  this  branch  of 
the  Kraukenhaus  are  even  more  decided  than  those 
of  its  other  departments,  and  its  methods  are  at 
least  worthy  of  a  trial  by  such  of  our  own  institutions 
as  can  afford  the  expense. 


THE   CANADA  MEDICAL  RECORD. 


13 


I  must  not  forget  an  encroachment  upon  the  li- 
berty of  the  subjects  possible  only  under  an  auto- 
cratic government  like  that  of  Austria.  Should  the 
temporary  possessor  of  an  "  interesting"  case  de- 
cide to  leave  the  State  hospital  and  obstinately 
persist  in  his  determination  long  enough  to  die  out- 
side of  it;  the  professor  of  pathology  has  the  legal 
right  to  order  his  body  to  be  brought  back  to  the 
post  mortem  room  of  the  Pathological  Institute, 
there  to  be  dealt  with  in  accordance  with  the  dic- 
tates of  his  pathological  conscience.  This  law  is, 
I  think,  to  me,  of  almost  any  case  likely  to  be  of 
special  interest  to  science.  There  are  no  such  ad- 
ditions as  "  the  friends  could  not  be  prevailed  upon 
to  permit  an  autopsy."  "  I  regret  that  I  was  unable 
to  obtain  a  post  mortem"  in  the  report  book  of 
the  Austrian  professor.  "  Once  a  patient  always  a 
patient  "  should  be  the  motto  of  the  Allgemeine 
Kraukenhaus.  Here  as  in  Berlin  the  favorite  ger- 
micide is  corrosive  sublimate,  and  it  is  used  in  large 
quantities  at  all  operations.  Absolute  cleanliness 
as  regards  the  patient  himself,  his  immediate  sur- 
roundings, the  person  of  the  operator,  and  his  assis- 
tants and  dressers,  absolutely  clean  instruments, 
dexterity  in  operation — these  are  among  the  means 
employed  in  operations  ;  and  outside  of  them  I  do 
not  honestly  think  there  is  much  room  to  sing  the 
praises  of  the  murder  of  micro-organisms.  Armed 
with  such  instruments  the  German  surgeons  have 
accomplished  wonders — have  interfered  with 
organs  but  a  short  time  ago  believed  to  be  beyond 
the  reach  of  surgery,  and  have  brought  the  death 
rate  of  the  most  daring  surgical  feats  to  that  of  the 
most  ordinary  operations.  Coincident  with  this 
treatment  of  wounds  antiseptically  is  the  fact  that 
the  name  of  Lister  is  as  well  known  and  revered  by 
the  Southern  Germans  as  one  of  their  own  profes- 
sors. 

I  did  not  intend  to  write  at  such  length  when  I 
first  began ;  but  as  I  cannot  promise  you  another 
Vienna  letter  I  fear  I  must  close  without  more  than 
a  mere  mention  of  names  that  deserve  a  wider 
notice— of  the  veteran  obstetrician,  Carl  Braun — 
of  his  brother  Gustav,  almost  as  well  known  —  of  the 
eminent  syphilographer  Kaposi,  of  Spath,  Noth- 
nagel,  of  Albert  (the  German  with  a  French  name 
who  looks  like  a  western  Yankee),  and  a  dozen 
others — all  professors  in  the  Wiener  Universitat. 
Only  he  who  has  breathed  the  air  of  the  Krauken- 
haus can  understand  the  reverence  (almost  amoun- 
ting to  an  apotheosis)  with  which  the  University 
professors  are  regarded.  No  German  outside  of  the 


charmed  faculty  circle  would  think  of  perpetrating 
an  act  of  familiarity  against  one.  No  one  at  a 
klinik  would  speak  to  one  without  first  being 
spoken  to  by  him.  One  day,  after  Billroth  had 
finished  a  very  tedious  and  very  difficult  operation, 
an  enthusiastic  and  rather  "cheeky"  American 
(a  professor  in  some  small  medical  school  out 
west)  walked  up  to  him  and  clapping  him  on  the 
back  said  in  a  very  audible  tone  :  "  I  say.  Professor, 
you  did  that  real  well."  I  do  not  know  whether  the 
United  States  citizen  is  aware  even  yet  of  the 
enormity  of  his  offence,  but  he  must  have  suspected 
from  the  ominous  silence  that  followed  his  remark 
that  there  was  something  wrong  somewhere.  The 
rage  for  practical  work  and  for  clinical  instruction 
being  the  special  feature  in  the  Viennese  school, 
one  is  not  greatly  surprised  to  find  all  sorts  of  de- 
vices whereby  that  desirable  end  can  be  attained. 
For  example,  on  payment  of  60  krentzers  per  hour, 
one  can  obtain  the  services  of  a  woman  who  has 
lost  or  contrives  to  conceal  the  reflex  irritability 
of  her  larynx,  stomach  and  throat,  on  which  to 
practice  the  various  processes  in  laryngoscopy  and 
pharyngology,  washing  out  the  stomach,  etc.,  etc. 
She  also  carries  a  bag  containing  the  necessary  in- 
struments, and  will  even  aid  the  tyro  in  his  efforts 
to  learn  their  use  !  Many  Canadians  and  other 
Americans  are  here.  I  am  specially  indebted  to 
Dr.  J.  C.  Cameron  and  Dr.  Duncan  for  acting  the 
part  of  cicerones.  I  hope  to  be  sufficiently  revived 
by  the  sea  air  of  Brighton  to  send  you  some  ac- 
count of  the  annual  meeting  there  of  the  British 
Medical  Association. 
WiEN,  23rd  July,  1886. 

3^m.pe6r6  t^f  Scknce. 

THE  TEST  FOR  ALBUMEN  IN  THE 
URINE.* 

In  a  Clinical  Lecture,  delivered  at  the  Philadel- 
phia Hospital,  Professor  James  Tyson,  Physician 
to  the  Hospital,  and  Professor  of  General  Patho- 
logy and  Morbid  Anatomy  in  the  University  of 
Pennsylvania,  says  :  I  shall  to-day  fulfil  a  promise 
made  some  time  ago,  to  devote  a  lecture  to  a  con- 
sideration of  the  test  for  albuminuria,  with  especial 
reference  to  certain  more  delicate  tests  recently 
proposed. 

To  begin,  I  shall  first  show  you  the  ordinary 
heat  test  for  albumen  in  a  specimen  of  urine  which 
contains  a  considerable  quantity.  It  is  a  property 
of  albumen  to  be  thrown  down  by   heat,  provided 

•From  The  Polyclinic,  for  July,  18S6. 


14 


THE   CANADA   MEDICAL   RECORD. 


the  form  in  which  it  is  present  is  neither  acid  albu- 
men nor  alkali  albumen,  which  are  respectively 
combinations  of  albumen  with  a  small  amount  of 
acid  and  alkali.  In  this  urine  a  precipitate  follotvs 
the  application  of  heat.  As  most  of  you  know, 
phosphates  are  also  thrown  down  by  heat  in  a 
neutral  or  alkaline  urine,  but  they  are  redissolved 
by  a  small  quantity  of  any  acid.  Such  addition 
does  not,  however,  in  this  instance,  cause  solution 
of  the  precipitate,  and  it  is  therefore  albumen.  A 
possible  source  of  acid  albumen  is  this — if  it  should 
happen  that  there  is  the  least  quantity  of  acid  in 
the  test  tube,  to  which  albuminous  urine  is  added, 
a  combination  takes  place,  and  acid  albumen  is 
produced  which  is  not  jjrecipitated  by  heat.  While 
heat  does  not  tlirow  down  acid  albumen,  nitric 
acid  always  does ;  and  if  the  test  is  applied  in  the 
way  which  I  shall  show  you,  it  is  not  likely  that 
any  significant  amount  will  be  overlooked. 

Now  let  me  show  you  the  defect  of  the  ordinary 
method  obtesting.  This  urine  is  alkahne  in  reac- 
tion, and  although  it  may  contain  considerable 
albumen,  there  will  be  no  precipitate  on  the  appli- 
cation of  heat,  for  albumen  is  not  precipitated  from 
an  alkaline  solution,  unless  there  be  a  large  amount 
present.  I  apply  heat  to  this  specimen  of  alkaline 
urine,  and,  as  you  see,  there  is  no  change  in  its 
transparency.  I  add  a  few  drops  of  acid  and  still 
there  is  no  precipitate.  We  have,  therefore,  again 
a  urine  which  is  albuminous,  but  in  which  the  ap- 
plication of  heat  and  acid  fails  to  show  the  presence 
of  albumen.  Let  us  not,  however,  conclude  too 
hastily  against  the  delicacy  of  the  test.  The  quan- 
tity of  albumen  in  a  given  specimen  may  be  so 
small  as  to  give  no  immediate  response  to  heat 
and  acid,  when  by  waiting  a  little  while  the  evi- 
dence will  be  plain.  The  quantity  may  be  so  small 
and  the  little  flakes  which  are  precipitated  so  fine, 
that  they  do  not  appreciably  affect  the  transparency 
of  the  urine,  and  cannot,  therefore,  be  at  once 
recognized  by  the  naked  eye,  but  if  time  be  allowed 
flakes  to  aggregate  and  fall  to  the  bottom  they 
can  be  recognized  in  mass.  In  testing  for  such 
small  quantities  of  albumen  it  is  essential  that  the 
urine  should  be  perfectly  clear.  Under  ordinary 
circumstances,  it  will  filter  clear  through  one  paper, 
or,  if  not  then  clear,  the  process  may  be  repeated. 
But  sometimes  you  find  a  urine  that  will  not  filter 
clear  when  thus  treated.  Under  such  circumstan- 
ces, liquor  potassK  or  liquor  sodae  may  be  added, 
the  urine  warmed  and  then  filtered.  The  phos- 
phates are  thus  precipitated  in  such  shape  that 
they  can  now  be  filtered  out,  and  bacteria,  which 
also  contribute  to  the  diminished  transparency,  are 
removed  at  the  same  time.  If  a  perfectly  clear 
urine,  treated  with  heat  and  acid  and  set  aside  for 
six  hours,  is  still  perfectly  clear,  we  may  conclude 
that  there  is  no  albumen  in  it.  But  if  a  precipitate 
is  found,  does  it  necessarily  follow  that  it  is  albu- 
men ?  Not  necessarily.  It  may  be  one  of  the 
three  things :  nitrate  of  urea,  which  may  be  precipi- 
tated from  a  highly  concentrated  urine,  acid 
urates,  or  albumen.     But  if  the  precipitate  consists 


of  nitrate  of  urea  or  acid  urates,  it  will  be  redis- 
solved on  the  application  of  heat.  If  it  is  albumen, 
on  the  other  hand,  the  little  flakes  will  again  be 
diffused  throughout  the  liquid,  but  they  will  not  be 
dissolved.  Used  in  this  way,  the  test  with  heat 
and  acid  is  much  more  delicate  than  is  ordinarily 
supposed.  This  specimen  of  urine,  which  we  have 
just  tried,  and  which  immediately  after  the  appli- 
cation of  the  heat  and  acid  was  perfectly  clear,  is 
even  now  less  transparent  than  it  was  a  few  minu- 
tes ago. 

Another  well-known  test  for  albumen,  which  is 
sufficiently  delicate  for  ordinary  purposes,  and  one 
which  is  very  useful  in  association  with  the  heat 
acid  test,  is  pure  by  Heller's  or  the  contact  method. 
Although  this  is  commonly  believed  to  be  a  very 
delicate  test  for  albumen,  it  is  not  nearly  as  delicate 
as  the  heat  and  acid  test.  When  used  in  connec- 
tion with  this  test,  it  serves  as  an  excellent  control 
test  for  such  albumens  as  although  present  in  large 
amount,  escape  the  heat  and  acid  test  on  account 
of  their  combination  with  an  acid  or  alkali.  In 
applying  this  as  well  as  the  other  contact  tests  for 
albumen,  a  short  and  narrow  tube  should  be 
selected.  If  the  tube  is  large,  it  takes  longer  to 
put  in  sufiicient  quantity  of  urine,  and  if  it  so  long, 
the  urine  which  is  poured  upon  the  acid  acquires 
a  momentum  which  causes  it  to  bury  itself  in  the 
acid.  I  place  a  convenient  quantity  of  acid  in 
the  bottom,  and  carefully  pour  upon  it  a  portion 
of  the  specimen  of  urine,  containing  a  small  quan- 
tity of  albumen,  the  presence  of  which  was  not 
immediately  apparent  by  boiling  and  subsequent 
acidulation.  There  can  now  be  seen  at  the  junc- 
tion of  the  two  liquids  a  white  line,  which  is  pre- 
cipitated albumen. 

Are  there  any  sources  of  error  to  be  guarded 
against  in  using  this  test  ?  There  is  at  least  one, 
based  upon  the  fact  when  a  urine  is  highly  charged 
with  acid  urates,  these  will  be  precipitated  when 
nitric  acid  is  overlaid  with  it.  This  precipitate  is, 
however,  easily  distinguished  from  that  due  to . 
albumen.  The  latter  remains  sharply  defined 
between  the  urine  above  and  the  acid  beneath, 
while  the  former  rises  in  the  course  of  a  minute  or 
two  above  the  contact  line.  Again  the  acid  urates 
are  also  readily  dissipated  by  a  gentle  heat  applied 
at  the  line  of  junction.  More  recently  I  have 
used  almost  exclusively  instead  of  the  nitric  acid 
another  reagent* which  is  at  least  as  delicate  and 
more  pleasant  to  manipulate.  I  refer  to  the  acid 
salt  or  acid  "  brine "  solution  suggested  by  Dr. 
Roberts,  of  Manchester.  This  consists  of  a  satur- 
ated solution  of  common  salt  to  which  five  per 
cent,  of  hydrochloric  has  been  added,  and  the 
whole  filtered.  Using  some  of  the  same  urine,  I 
first  pour  into  the  test  tube  some  of  the  acid  brine 
solution,  and  overlay  it  with  the  urine,  and  again 
you  see  a  perfectly  distinct  white  line.  This  test 
is  valuable  in  association  with  the  heat  and  acid 
test  for  the  same  purposes  as  the  pure  acid  test. 
Neither  i/  nor  the  acid  defect  as  S7nall  quantities 
of  albumen  (is  the  hdlt  and  acid  combined. 


tHE   CANADA   MEDICAL   RECORD. 


15 


During  the  past  two  years  a  number  of  new  test 
have  been  introduced,  or  rather  a  number  of  old 
test  have  been  revived,  by  which  smaller  quantities 
of  albumen  can  be  detected.  Among  them  are 
the  following  : 

Picric  acid,  the  double  salt  of  the  potassio- 
iodide  of  mercury,  picric  acid  with  citric  acid, 
sodium  tungstate  and  citric  acid,  ferrocyanide  of 
potassium. 

As  the  last  is  the  least  delicate  of  these  tests,  I 
shall  speak  of  it.  It  is  more  delicate  than  the 
acid  brine  or  the  pure  acid  test,  but  not  so  delicate 
as  the  heat  and  acid  tests  used  as  I  have  suggested. 
It  is  applied  by  the  contact  method.  It  has  this 
advantage  over  the  other  tests  of  this  class,  that 
it  does  not  precipitate  peptones.  It  does,  however, 
according  to  Dr.  Johnson,  precipitate  mucin. 

One  of  the  most  delicate  of  these  tests  is  picric 
acid.  A  saturated  solution  is  employed,  but  as 
picric  acid  is  very  light  it  is  not  always  easy  to 
use  the  contact  method;  sometimes  the  picric 
solution  will  be  lighter  than  the  urine  to  be  tested, 
while  at  other  times  it  will  be  heavier.  In  order 
to  most  easily  employ  the  overlaying  method,  it  is 
essential  that  one  of  the  liquids  employed  should 
be  decidedly  heavier  than  the  other.  The  difficulty 
referred  to  is  experienced  in  testing  this  sample  of 
urine.  The  picric  acid  is  of  about  the  same  speci- 
fic gravity  as  the  urine,  and  diffuses  itself  rather 
rapidly  through  it ;  but  at  the  same  time  we  notice 
a  distinct  white  line  indicating  the  presence  of 
albumen.  This  difficulty  is  readily  obviated  by 
an  expedient,  which  certainly  does  not  diminish 
the  delicacy  of  the  test ;  while  it  is  held  by  some 
that  it  increases  it,  and  that  is  the  addition  of 
critric  acid  to  the  picric  acid  solution.  This  solu- 
tion is  prepared  by  adding  to  one  ounce  of  a 
saturated  solution  of  critic  acid.  This  makes  the 
test  fluid  heavier  than  albuminous  urine  is  likely 
to  be.  Placing  some  of  the  solution  in  the  test 
tube,  I  pour  on  it  the  urine,  at  opposite  side  of 
the  tube  to  that  on  which  I  poured  the  picric  acid. 
This  is  done  because  the  small  quantity  of  picric 
solution  adhering  to  the  side  of  the  tube  gives  the 
urine  an  intense  yellow,  which  is  not  desirable. 
We  again  have  the  white  line,  which  is  as  distinct, 
if  not  more  so,  as  that  obtained  by  using  pure 
picric  acid.* 

There  are  certain  disadvantages  of  the  picric  acid 
with  or  without  the  citric.  One  of  these  is  that  the 
color  of  the  urine  sometimes  so  closely  approaches 
that  of  the  picric  acid  that  there  is  some  difficulty  in 
determining  the  line  where  the  two  join.  This  is, 
however,  not  a  very  serious  objection.  A  more 
serious  one  is  that  quinine  and  the  vegetable  alka- 
loids generally  are  similarly  precipitated  ;  and  as 
the  former,  at  least,  is  often  administered  in  such 


quantity  as  to  ai>pear  in  the  urine,  the  white  line 
thus  produced  may  be  mistaken  for  albumen. 
Peptones  are  sometimes  found  in  the  urine,  and 
these  are  also  precipitated  by  picric  acid.  Alkaloids 
and  peptones  thus  precipitated  are  promptly  dis- 
solved by  the  application  of  heat.  Finally,  the 
acid  urates  are  precipated  by  picric  acid  as  they  are 
by  nitric  acid;  but  these^  again,  are  redissolved  by 
a  moderate  degree  of  heat. 

The  next  test  to  which  I  shall  refer  is  the  potassio 
iodide  of  mercury,  which,  if  properly  pre])ared,  is 
about  as  delicate  as  the  picric  acid  test.  This  test, 
which  was  discovered  by  Mr.  Charles  Tanrel,  a 
French  chemist,  consists  of  bichloride  of  mercury, 
1.35  grammes  ;  iodide  of  potassium,  3.32  grammes  ; 
acetic  acid,  20  cubic  centimeters,  and  distilled 
water  enough  to  make  100  c.c.  The  double  iodide 
of  mercury  and  potassium  solution  is  perfectly 
colorless  and  transparent,  and  is  used  in  the  same 
manner  as  the  picric  acid.  It  is  subject  to  the 
same  objection  as  precipitating  peptones,  alkaloids 
and  urates,  also  mucin,  which  is  not  precipitated 
by  pure  picric  acid.  It  has  the  advantage  of  be- 
ing colorless,  and  heavier  than  most  urines.  The 
sodium  tungstate  test  consist  of  a  saturated  solu- 
tion of  sodium  tungstate  and  citric  acid.  This 
solution  does  not  precipitate  the  alkaloids,  although 
it  does  throw  down  peptones  and  mucin. 

There  is  no  doubt  but  that  in  the  most  delicate 
of  these  solutions,  we  have  tests  which  will  show 
quantities  of  albumen  so  small  that  they  cannot  be 
recognized  in  any  other  way.  Picric  acid  and  the 
mercuric  iodide  are  the  most  delicate.  But  the 
sources  of  error  which  have  been  named  make  it 
necessary  that  they  should  be  used  with  the  utmost 
precaution.  None  of  the  objections  named  apply 
to  the  heat  and  acid  test,  which,  when  used  in  the 
manner  indicated,  is  extremely  delicate — quite 
sufficiently  so  for  practical  purposes.  For  the  pre- 
sent we  may  regard  the  others  as  practically  most 
useful  for  proving  and  confirming  the  results  by 
heat  and  nitric  acid. 


•The  disadvantage  of  the  combined  citric  and  picric  acid 
solution  exists  in  the  fact  that  mucin  is  precipitated  by  the 
nitric  acid  ;  but  the  same  is  true  of  acetic  and  nitric  acids, 
and,  as  the  result  of  a  large  experience,  I  am  forced  to  con- 
clude that  no  mistake  can  result  from  the  delicate  haze  of 
diminished  transparency  thus  produced. 


THE  TREATxMENT  OF  GONORRHCEA.  * 

By  Sekeca  D.  Powell,  M.D.,  Professor  of  Minor  Surgery. 

As  we  have  a  few  minutes  more,  gentlemen,  I 
will  occupy  the  time  with  a  brief  resume  of  my 
method  of  treating  gonorrhoea.  We  are  all  more 
or  less  familiar  with  this  disease,  whether  we  are 
confined  in  the  narrow  field  of  the  specialist  or  the 
broader  one  of  the  general  practitioner. 

I  hope  to  emphasize  a  few  points  which  have 
been  made  by  others,  and  which  I  have  reason  to 
believe  have  been  overlooked  or  forgotten  by  many 
of  us.  Those  who  are  so  unfortunate  as  to  suffer 
from  gonorrhoea  are,  as  a  rule,  inclined  to  conceal 
their  disgrace  from  their  family  and  their  regular 
physician,  and  this,  combined  with  pecuniary  mo- 
tives in  some  cases,  leads  them  to  look  for  aid  out- 


*  Lecture   delivered    at    the    New    York    Post-Graduate 
Medical  School  and  Hospital,  February  17th,  1886. 


16 


THE  CANADA   MEDICAL  REC0Ri5. 


side  of  the  regular  profession,  wherever  they  are 
promised  a  speedy  cure  for  the  malady.  I  shall 
speak  of  the  treatment  of  gonorrhcea  in  its  different 
stages,  and  endeavor  to  make  plain  what  I  consider 
the  best  course  in  each  stage  to  pursue. 

By  gonorrhoea  I  mean  any  inflammation  of  the 
urethral  tract  which  has  been  produced  either  by  a 
specific  poison  or  by  thtf  menstrual  fluid,  or  by 
leucorrhceal  discharges,  for  I  know  of  no  way  of 
distinguishing  a  urethritis  which  has  for  its  origin 
either  the  one  or  the  other  of  the  above  causes. 
And  it  matters  not  what  the  cause  of  the  urethritis 
may  have  been,  the  fact  remains  that  one  is  as 
contagious  or  virulent  as  the  other. 

In  the  first  or  introductory  stage,  if  I  am  for- 
tunate to  see  the  patient  at  that  period,  I  feel 
moderately  sure  of  giving  speedy  relief  I  begin 
the  treatment  by  giving  a  free  purgative,  preferring 
those  drugs  which  act  upon  the  lower  bowel  rather 
than  a  saline  cathartic.  If  the  patient  has  not  an 
excessively  sensitive  stomach,  an  emulsion  of 
castor  oil,  combined  with  a  small  dose  of  spirits  of 
turpentine,  (  3  i)  acts  well  and  thoroughly  empties 
the  entire  tract.  I  also  order  two  or  three  drachms 
of  the  bicarbonate  of  soda  in  vichy,  to  be  taken  in 
the  twenty-four  hours.  Even  at  this  early  stage  I 
have  found  great  benefit  result  from  frequently 
bathing  the  penis  in  very  hot  water.  As  an  injec- 
tion, a  weak  solution  of  the  salicylate  of  soda,  two 
to  five  grains  to  the  ounce  is  used  ;  but  more  fre- 
quently injections  of  hot  water  without  any  medi- 
cation is  preferable. 

Injections  should  be  hot. 

Latterly  I  have  aborted  gonorrhceal  attacks  in 
the  first  stage  in  the  following  matmer :  After 
washing  the  urethra  thoroughly  with  Harrison's 
urethral  syringe,  I  introduce  a  rubber  canula  down 
below  the  seat  of  inflammation,  and,  as  I  gradually 
withdraw  it,  fill  the  urethra  with  a  dry  powder 
made  up  of  3  i  of  resorcin  and  3  i  boracic  acid, 
which  is  allowed  to  dissolve  in  situ.  I  repeat  this 
each  day  if  there  be  any  discharge,  but  so  far  never 
have  used  it  oftener  than  three  times.  If  the 
urethra  is  comparatively  dry  the  day  after  its  ap- 
plication, a  weak  solution  of  sulphate  of  zinc,  one 
grain  to  an  ounce  of  hot  water,  is  frequently  used 
as  an  injection. 

The  patient  is  ordered  to  remain  quiet,  and,  if 
possible,  in  bed,  while  the  diet  is  cut  down  to  milk 
and  mush.  The  syringe  which  gives  the  most 
satisfaction  is  the  small  rubber  syringe  known  as 
No.  I  «,  and  it  is  always  best  to  have  your  patient 
thoroughly  understand  the  proper  manner  of  using 
it,  for  I  find  very  few  who  are  proficient  in  this  de- 
tail, although  they,  as  a  rule,  claim  to  know  just 
how  it  should  be  done.  I  prefer  this  style  of 
syringe  for  several  reasons : 

The  nib  or  point  is  very  short  and  no  injury  to 
the  sensitive  and  inflamed  mucous  membrane  can 
result  from  its  use  ;  and  again  the  capacity  is  small, 
and  there  is  less  likelihood  of  the  secretions  being 
driven  back  into  the  urethra  by  a  large  volume  of 
water.     An  injection  ought  always  to  follow  urina- 


tion if  possible.  Large  quantities  vichy  or  other 
waters  should  be  taken,  not  only  to  d  li.t:  the  urine 
but  also  to  facilitate  the  more  frequent  use  of  the 
syringe  after  urination. 

The  second  or  inflammatory  stage  follows 
quickly  upon  the  first  if  we  have  been  unsuccessful 
in  aborting  the  disease.  In  this  sta'j:e  we  should 
beextremely  careful  not  to  attempt  too  much,  for  I 
am  positive  that  many  of  the  cases  which  have 
come  under  my  notice  have  been  exaggerated,  and 
much  serious  damage  has  resulted  from  unjustifi- 
able interference  by  the  patient,  under  the  instruct- 
ion of  those  whom  he  has  consulted.  If  a  patient 
comes  to  me  with  his  penis  swollen  and  engorged 
with  inflammatory  products,  the  lymphatics  in- 
flamed, and  the  glands  in  the  groins  painful 
and  swollen,  I  make  no  effort  at  m.d  cation  by 
the  syringe,  but  treat  the  inflammation  iDcally  and 
constitutionally  as  I  would  were  it  in  any  other 
part  of  the  body. 

There  is  always  more  or  less  increase  of  tempera 
ture  and  quickening  of  the  pulse,  and  I  began  my 
treatment  by  giving  the  tincture  of  aconite,  in  two 
or  three  drop  doses,  combined  with  liq.  ammon. 
acetatis,  one  to  four  drachms  every  two,  three  or 
four  hours  as  indicated.  The  penis  is  frequently 
immersed  in  hot  water  or  wrapped  in  borated 
cotton,  and  kejit  wet  with  lead  and  opium  wash. 
The  amount  of  bicarbonate  of  soda  and  alkaline 
waters  is  increased,  and  the  bowels  relaxed  with 
mercurial  purgative.  Just  here  let  me  speak  of 
the  use  of  saline  cathartics..  For  several  years  I 
have  avoided  them  rehgiously,  for  this  reason :  If 
there  be  extensive  inflammation,  and  it  goes  well 
back  in  the  urethra  near  to  the  neck  of  the  blad- 
der, the  mucous  membrane  being  very  much 
thickened,  and  the  calibre  of  the  canal  lessened, 
there  is,  as  a  rule,  more  or  less  spasmodic  retention 
of  urine,  and  the  administration  of  any  saline 
cathartic  will,  in  a  great  number  of  cases,  increase 
this  difticulty.  I  have  seen  this  not  once,  but 
many  times.  Be  as  severe  in  your  restrictions  as  pos- 
sible, confining  your  patient  to  his  bed,  if  need  be, 
and  adhere  firm.ly  to  your  low  diet.  All  exercise 
should  be  forbidden  wherever  possible.  If  it  be 
absolutely  necessary  that  your  patient  attend  his 
usual  duties,  a  well  adjusted  support  for  the  testi- 
cles should  be  ordered.  Any  further  interference 
in  this  stage  of  the  disease  is,  in  my  opinion,  injuri- 
ous, and  especially  would  I  avoid  copaiba.  It  is 
not  only  useless,  but  I  am  positively  certain, 
harmful — increasing  the  discharge,  the  ardor  urinte 
and  the  painful  erections  ;  occasiunally  causing  a 
very  extensive  and  persistent  rash,  to  say  nothing 
of  its  effects  upon  an  irritable  stomach.  When 
complications  arise,  one  must  be  governed  by  cir- 
cumstances. Usually  the  inflammation  is  modified 
in  three  to  five  days,  the  discharge  decreases  and 
becomes  thicker  in  consistency,  the  color  being 
whiter,  the  scalding  upon  urinating  is  gone,  and 
the  disease  enters  into  the  third  stage  or  stage  of 
subsidence. 

A  physician's  assistance  is  oftener  sought  at  this 


THE   CANADA    MEDICAL   RECORD. 


17 


stage  than  in  the  first  or  second,  as  its  period  of 
duration  is  very  much  longer  and  may  extend  over 
many  months  and  even  years  ;  as  in  a  case  which 
recently  came  under  my  care,  the  discharge  hav- 
ng  lasted  four  years.  Not  until  after  all  inflam- 
mation has  subsided  should  we  use  injections 
otherwise  than  as  I  have  cited.  My  first  recipe, 
upon  seeing  a  patient  in  this  stage  of  the  disease? 
is  a  good  cathartic  ;  and  I  usually  select  something 
mild  and  which  can  be  repeated  every  day  if 
necessary,  such  as  rhei  and  soda,  or  compound 
liquorice,  pulverized.  I  also  direct  the  following 
injection  to  be  used  every  two  or  three  hours,  if 
convenient :  Sulph.  zinc,  grs.  viii;  Morph.  sulph., 
grs.  iss.  ;  bicarb,  soda,  3  ss.  to   3  i ;  water,  |  iv. 

I  restrict  his   diet   to   the  plainest  foods.     No 
seasoning  or  condiments  are  allowed.     Coffee  and 
tea  only  in  moderate  amount  and  very  weak.     All 
kinds  of  liquors  stopped,  unless  my  patient  is   an 
habitual  drinker  and  is  very  much  dependent  upon 
his  daily  dram  for  his  usual  appetite  and  digestion. 
Very  moderate  exercise  is  allowable;  but  the  use 
of  tobacco  is  entirely,  or  nearly  so,  prohibited.     I 
see  my  patient  within  the  twenty-four  hours,  and 
if  there  be  no  increase  in  the  discharge  or  change 
in  its  character,  and  there  are  no  evidences  of  in- 
creased inflammation,  1  begin  the  use  of  copaiba ; 
and  this  I   consider  the  only  period   wherein  it  is 
admissible.     If  the   second  stage  has  lasted  any 
length   of  time,  I   much   prefer  cubebs,  given  in 
powder  in  3  ss.  to  3  i  doses,  three  or  four  times 
a  day.     In  other  words,  if  the  mucou.s  membrane 
is  changed  from  frequent  attacks  of  clap,  or  pro- 
longed chronic  inflammation,  cubebs  eives  the  best 
results.     I    have  tried  about  every  drug   suitable 
for  an  injection,  and  believe  that  sulphate   of  zinc 
ranks  them  all.     Next  in  my  estimation  is  tannic 
acid.     I  never  use  nitrate  of  silver  in  any  form  for 
an  injection.     It  has  proven  unsatisfactory  in  my 
hands  so  often,  that  I  have  entirely  discarded  it. 
Injections  should  not  be  strong  enough  to  cause 
any  pain,  and  are  given  not  only  for  their  astringent 
effects,  but  to  keep  the  urethra  clean — this  being 
a  very  important  adjunct  in   my  judgment.   The 
lacunaj,  especially  the  larger  ones  near  the  meatus, 
frequently  give  us  a  great  deal  of  trouble  by  acting 
as  pockets  or  hiding  places  for  the   disease,  and 
time  after  time  it  will  spring  up  after  ceasing  the 
use  of  the  syringe.     I  have  in  many  cases  passed 
a  canula  and  rod  armed  with  cotton,  saturated  with 
the  resorcin   and  boracic  acid,   as  given  before, 
and  wiping  the   urethra  thoroughly  in   its  whole 
pendulous  portion.     The  small  granulations  which 
are  sometimes  present  are  more  rapidly   removed 
in  this  way  than  even  by  the  use  of  the  sound. 

I  do  not  mean  to  imply,  gentlemen,  that  this 
method  of  treatment  is  infallible,  but  I  do  say  that 
it  has  given  me  more  satisfaction  and  more  rapid 
recoveries  than  any' other. —  Quarterly  Bulletin  of 
the  N.  Y.  Post  Graduate  School. 


THE  TREATMENT  OF  EPILEPSY. 

By  W.  M.  Leszvnskv,  M.D.,     Instructor  in  Disease  of  the 
Mind  and  Nervous  System. 

I  see  no  advantage  in  treating  epileptics  as  a 
"  class,"  but  believe  that  they  should  be  managed 
individually  ;  therefore  the  idea  of  not  permitting 
them  to  use  starches,  sugar,  etc.,  seems  unneces- 
sary, excepting  in  patients  where  these  articles  are 
not  easily  digested. 

As  nearly  all  epileptics  eat  excessively,  if  not 
voraciously,  frequently  bolting  their  food,  it  is  of 
greastest  itnportance  that  their  diet  should  be  regu- 
lated with  the  view  to  restrict  the  amount  of  food, 
and  at  the  same  time  to  avoid  any  articles  which 
in  the  experience  of  the  patient  has  been  found  to 
be  indigestible. 

The  use  of  the  homoeopathic  solution  known  as 
glonoin,  one  per  cent.,  has  in  my  han.ls  frequently 
failed  to  produce  any  physiological  effect.  I  have, 
therefore,  discarded  it,  and  when  I  wish  to  prescribe 
nitro-glycerine,  I  do  so  in  the  form  of  Eraser's 
tablets,  each  containing  ^-Jj  of  a  grain. 

In  cases  of  petit-mal, where  the  bromide  alone  has 
failed,  the  addition  of  belladonna  has  proved  of 
unquestionable  benefit.  I  believe  that  in  many 
cases  the  use  of  ergot  is  a  valuable  adjunct,  espe- 
cially in  those  cases  accompanied  by  hallucinations 
or  paroxysms  of  rnania.  In  cases  of  epilepsy  due 
to  inherited  or  acquired  syphilis,  the  use  of  anti- 
syphilitic  remedies  should  not  be  forgotten. 

If  we  remember  that  epileptics  frequently  die 
while  in  the  condition  of  status,  the  importance 
of  suitable  treatment  while  this  state  exists  cannot 
be  over-estimated. 

For  further  information,  regarding  the  causes  of 
death  in  epileptics  from  status,  etc. ,  I  refer  to  a 
paper  on  the  subject  which  is  published  in  the  JVeiv 
\  ork  Medical  Journal,  March,  1885.  During  an 
experience  of  three  years,  in  the  City  Lunatic  Asy- 
lum, I  treated  upwards  of  sixty  patients  in  whom 
the  symptoms  of  ''  status  epilepticus  "  were  mani- 
fested. 

In  a  number  of  instances,  where  previous  attacks 
had  been  known  to  have  occurred,  the  administra- 
tion of  an  emetic,  followed  by  a  brisk  purge,  had 
frequently  proved  successful  in  aborting  the  attack. 
In  some  cases  in  the  beginning  the  convulsions 
may  be  controlled  by  administration  of  large  doses 
of  chloral /^r  anuin  ;  but,  after  the  attack  has  fairly 
started,  chloral  seems  to  have  very  little  influence, 
excepting  to  intensify  the  exhaustion. 

The  inhalation  of  chloroform  controls  the  con- 
vulsions during  its  application,  but  they  are  only 
held  in  abeyance,  to  return  with  apparently  renew- 
ed vigor,shortly  after  the  inlialation  in  discontinued. 
The  use  of  tiiorphine  sub  cutaneously  seems  to 
possess  some  power  in  controlling  the  paroxysms; 
but  it  has  to  be  injected  in  such  large  doses  that 
it  appears  to  have  liasienedthe  death  of  the  patient 
from  exhaustion. 

In  some  cases  pressure  over  the  carotid  arteries 
seems  to  have  temporarily  checked  the  convulsions 
at  their  onset. 


18 


THE   CANADA   MEDICAL   RECORD. 


Where  marked  cyanosis  is  present,  I  have  found 
venesection  of  the  greatest  benefit,  at  once  reliev- 
ing the  passive  cerebral  and  pulmonary  congestion. 
At  the  same  time  the  ice-ca]3  and  counter  irritation 
to  the  nucha  had  been  resorted  to  with  apparent 
advantage. 

Owing  to  the  frequency  of  dysphagia,  and 
occasionally  the  complication  of  severe  vomiting, 
the  nutrition  and  stimulation  of  the  patient,  when 
death  from  exhaustion  becomes  imminent,  are 
very  difficult. 

Our  only  hope  then  remains  in  the  administra- 
tion of  nutritive  and  stimulating  enemata. 

Nitrite  of  amy  1,  in  this  class  of  cases,  has  proved 
ineffectual,  if  not  injurious. 

The  use  of  this  drug  is  undoubtedly  valuable  for 
the  purpose  of  aborting  a  paroxysm  in  cases  of 
ordinary  epileptic  seizures,  where  a  distinct  aura 
is  experienced  ;  but  after  the  convulsion  is  estab- 
lished its  administration  invariably  complicates 
matters. 

"  The  mechanism  of  its  action  is  very  simple  ; 
the  vaso-niotor  spasm  of  the  cerebral  vessels,  which 
is  the  initial  symptom  of  an  epileptic  convulsion, 
is  relieved,  and  the  vessels  become  dilated."  The 
following  are  the  symptoms  produced  by  nitrite  of 
amyl  when  inhaled  :  "  Acceleration  of  the  heart ; 
sudden  flushing  of  the  face ;  dilation  of  the  arteri- 
oles, in  consequence  of  paresis  of  the  muscular 
layers  of  these  vessels  ;  a  sense  of  extreme  fullness 
of  the  brain,  with  vertigo;  fall  in  the  blood-pres- 
sure ;  lowering  of  the  temperature." — Bartholow. 

During  the  condition  of  status,  owing  to  the 
almost  continuous  tonic  contraction  of  the  muscles 
of  the  neck,  the  return  circulation  from  the  brain 
is  obstructed,  and  venous  congestion  follows.  This 
is  the  state  which  is  so  decidedly  relieved  by 
venesection,  and  where  the  inhalation  of  nitrate  of 
amyl  does  positive  harm.  I  should  invariably 
deprecate  its  use  under  such  circumstances. 

Many  patients  have  a  "  succession  of  fits  "  with- 
out going  into  the  condition  oi status,  and  I  regret 
to  say  that  in  many  such  instances  I  have  witnessed 
the  administration  of  amyl  from  the  hands  of  the 
attending  physician,  contrary  to  all  teaching  as  to 
its  physiological  action. 


BORACIC  ACID  POWDER  IN 
THE  TREATMENT  OF  GRANULAR  LIDS 

Dr.  James  L.  Minor,  in  his  paper  on  the  use  of 
boracic  acid  powder  in  granulated  lids,  gives  this 
agent  an  enthusiastic  recommendation  in  the 
treatment  of  certain  forms  of  this  troublesome 
disease. 

Method  of  Applying  the  Powder. — The  lids 
being  thoroughly  everted,  the  pulverized  acid  is 
freely  dusted  over  the  exposed  conjunctiva  with  a 
camel's-hair  brush.  The  amount  will,  of  course, 
vary,  but  in  most  cases  of  granular  lids,  a  quantity 
should  be  introduced  sufficient  to  cover  completely 
the  parts  to  which  it  is  applied.  The  frequency  of 
application  will  vary  from  three  times  a    day  to 


three  times  a  week — this  difference  depending  on 
both  the  individual  and  the  disease.  It  will  be 
safe  to  repeat  the  application  as  soon  as  the  disa- 
greeable symptoms  which  have  been  relieved  by 
the  remedy  begin  to  appear  again. 

Effects  Produced  by  the  Powder. — Its  im- 
mediate effect  is  to  produce  a  burning,  gritty  sen- 
sation, with  some  pain,  lasting  for  five  or  thirty 
minutes,  and  a  free  serous  discharge,  after  which 
relief  is  experienced,  and  the  lids  feel  freer,  lighter 
and  smoother  than  before  its  use.  This  beneficial 
effect  lasts  for  a  period,  varying  from  a  few  hours 
to  several  days.  The  conjunctiva  at  times  shows 
reduction  in  swelling  and  thickening  as  soon  as  the 
irritation  following  its  use  has  passed  off.  This  is, 
however,  more  noticeable  after  the  remedy  has 
been  used  for  a  week  or  more,  when  perceptible 
thiiming  of  the  conjunctiva  is  observed,  and  clear- 
ing up  of  the  cornea  if  ])annus  is  present.  When 
boric-acid  powder  is  applied  to  succulent  tissue  or 
a  swollen  mucous  membrane,  a  free  serous  dis- 
charge quickly  appears,  which  lasts  for  ten  or 
twenty  minutes.  This  discharge  occurs  largely  at 
the  expense  of  tiie  volume  of  the  tissue  to  which  it  is 
applicd,and  it  is  followed  by  a  shrinkage  of  the  same. 
Th's  is  best  illustrated  in  the  nasal  cavities,  when 
they  are  closed  or  nearly  so  from  swelling  of  the  mu- 
cous membrane.  A  short  time  after  the  use  of  the 
acid  tlie  passages  become  clearer  and  freer,  and  this 
is  noticeable  to  the  examiner  as  well  as  to  the  patient. 
This  serous  flux  is  probably  of  an  osmotic  charac- 
ter. Its  escape  relieves  succulent  tissue  of  its 
superabundance  of  serum,  thereby  causing  con- 
traction, which  facilitates  a  healthier  circulation 
and  better  nutrition.  Its  action  as  an  irritant  is  in 
the  same  direction,  and  is  especially  instrumental 
in  the  cure  of  corneal  affections.  The  power  pos- 
sessed by  boric  of  restraining  micrococcal  develop- 
ment, of  diminishing  diapedesis,  of  lessening  the 
ameboid  movement  of  leucocytes,  and  other  tissue 
and  chemical  changes  which  it  produces,  are  factors 
which  enter  into  the  theory  of  its  action.  When 
the  powder  is  applied  to  a  granular  conjunctiva 
it  not  only  covers  the  entire  membrane,  but  enters 
the  cracks  and  crevices  between  the  granulations, 
and  brings  about  the  changes  indicated  upon  the 
conjunctiva  as  a  whole,  and  upon  the  granulations 
individually. 

Cases  suitable  for  and  Facts  governing  its 
Use. —  I  have  used  boric-acid  powder  in  all  forms 
of  granular  lids,  and  in  most  varieties  of  conjunc- 
tivitis, with  benefit.  I  think,  however,  that  the 
papillary  form  of  granular  lids  is  most  amenable 
to  its  influence.  Pannus  in  every  instance  has 
been  markedly  improved,  and  in  many  cases  cures 
have  been  effected.  In  ophthalmia  neonatorum 
some  cases  have  received  benefit,  but  I  rely  but 
little  upon  the  powder  in  purulent  cases.  On  the 
contrary,  it  acts  best  when  the  secretion  is  scanty 
and  serous.  I  have  often  noticed  that  the  con- 
junctiva became  less  tolerant  of  its  action  after  the 
powder  had  been  used  for  three  or  four  weeks,  aud 
in  such  cases  the  treatment  has  been  changed  with 


THE  CANADA  MEDICAL  RECORD. 


19 


success.  Boric  acid  in  this  particular  is  similar  to 
other  agents  in  general  use  for  the  treatment  of 
granular  lids,  for  it  is  often  noticed  that  a  remedy 
will  wear  itself  out,  as  it  were,  and  it  becomes 
necessary  to  substitute  another  agent  for  the  One 
which  has  been  used.  Boric  acid  is  only  one  of 
these  remedies,  and  is  no  more  of  a  specific  than 
others,  yet  it  is  an  important  addition  to  our  list  of 
efficient  remedies  for  a  disease  which  is  often 
rebellious  and  always  obstinate  and  protracted.  It 
is  less  painful  than  other  remedies,  its  effects  in 
this  particular  being  often  recognized  by  the 
patient,  who  will  ask  to  have  the  powder  repeated, 
because  it  is  less  painful  and  more  efficient  in 
affording  relief  than  other  agents  which  have  been 
employed.  Jequirity  has  done  much  toward  sim- 
plifying and  hastening  the  treatment  of  granular 
lids,  but  there  will  always  remain  a  large  contingent 
in  which  the  special  condition  or  the  general  sur- 
roundings of  the  patient  will  debar  its  use,  and  in 
such  cases  as  these  we  must  resort  to  those  re- 
medies that  are  known  to  be  of  value — possibly 
less  brilliant,  but  entirely  free  from  danger. — 
Report  on  opthalmology  in  the  Si.  Louis  Medical 
Review,  Aug.  28th. 


CHOREA. 

By-  Spenxer  M.  Free,  M.  U.,  Baltimore. 
Md.  Med.  four..,  April  24,  1886  : — After  dis- 
cussing the  causes,  Dr.  Free  says  of  treatment, 
that  drugs  have  been  employed  extensively  as  to 
number  and  dosage.  With  few  exceptions  they 
are  valueless. 

The  first  to  be  recommended  is,  as  far  as  pos- 
sible, fresh  air,  out-door  exercise,  avoidance  of  ex- 
citement, proper  bathing,  plain  and  nourishing 
food.  If  the  case  is  severe,  rest  in  bed  may  be  of 
advantage. 

If  a  cause  is  discoverable,  as  worms,  decayed 
teeth,  nasal  catarrh,  etc.,  remove  it. 

Without  a  careful  search  we  have  come  upon 
thirty-nine  forms  of  treatment. 

Strychnia  has  its  warm  advocates.  Trousseau 
probably  is  its  best  exponent.  He  uses  a  solution 
of  the  sulphate.  He  gives  it  in  a  dose  ■^\-^  of  a 
grain  t.  i.  d.,  gradually  increasing  the  amount  to 
I  gr.  per  day.  He  cautions  concerning  the  great 
danger,  and  enjoins  care  and  watchfulness. 

West  and  Bouchut  oppose  its  use  on  account 
of  the  danger,  as  a  number  of  deaths  have  been 
produced  by  it. 

In  all  anajmic  cases  tonics  are  called  for.  Iron 
in  some  form  is  preferred  by  nearly  all  writers. 
Radcliff  uses  the  iodide  ;  J.  Lewis  Smith  the  ammo- 
nio-citrate.  The  mur.  tinct.  is  generally  used. 
The  emulsion  of  cod-liver  oil  with  the  hypo- 
phosphites  of  lime  and  soda,  has  been  used  with 
good  effect. 

Dr.  Young  of  Philadelphia  prefers  cimicifuga. 
Dr.  West,  sulphate  of  zinc. 
Drs.  Sieiner  and  Hufland,  oxide  of  zinc. 
Dr.  Weir,  Mitchell,  salicylate  of  soda,  especially 
in  cases  of  rheumatic  diasthesis. 


Dr.  J.  H.  Carstens,  propylamine. 

Dr.  Goodheart,  rest. 

Drs.  C.  L.  Dana,  Mills,  Webber,  Rockwell,  and 
Beard,  galvanization  of  brain. 

Drs.  Baunsi  and  Burnheim  regard  hypnotism  a 
specific.     Only  a  few  seances  are  necessary. 

Applications  of  cold  to  the  spine,  by  means  of 
the  wet  pack,  a  jet  of  cold  water,  or  the  ether  spray, 
have  been  used  quite  extensively  and  with  good 
effect.  Some  advocate  the  cold  bath,  or  cold 
shower  bath.  I  have  used  the  cold  wet  pack  in 
several  cases  with  excellent  results.  I  follow  the 
packing  by  rubbing  with  olive  oil.  These  cold 
applications  are  used  in  conjunction  with  internal 
medication. 

The  one  remedy  which  is  the  main  reliance  of 
the  great  majority  of  practitioners  is  arsenic.  It 
is  usually  given  in  the  forivi  of  Fowler's  solution, 
in  a  gradually  increasing  dose.  Of  those  who 
rely  chiefly  upon  it  are  Smith  (J.  Lewis),  Leesse, 
Rayer,  Martin,  Gregory,  Latter,  Babington, 
Hughes,  Begbie,  Romberg,  Dieudonne,  Barthez, 
Aran,  Edes,  Hammond  and  Seguin. 

Dr.  Hammond  strongly  advocates  its  use  hypo- 
dermically. 

Dr.  Gelie  says  that  it  fails  in  nervous  and  san- 
guine patients. 

Drs.  Romberg  and  Bourguignon  agree  with  him. 

In  a  series  of  cases,  reported  by  Dr.  Chapin  of 
N.  Y., treated  entirely  by  arsenic,  in  which  he  com- 
pares his  results  with  those  obtained  by  Drs.  Gray 
and  Tuck  well,  who  uses  the  expectant  plan,  the 
result  was  twelve  days  in  favor  of  the  arsenic  treat- 
ment. 

Some  few  are  doubt''-'l  as  to  the  value  of  any 
treatment ;  but  the  results  obtained  show  a  shorten- 
ing of  the  diseases  by  judicious  management  and 
medication. 


THE  TREATMENT   OF  RINGWORM. 

■  Dr.  Searlis  recommends  oil  of  turpentine  for 
the  cure  of  ring-worm  of  the  scalp  i^Medicina  Com- 
temporanea).  The  hair  should  be  closely  cut 
over  the  effected  part,  and  for  a  short  distance 
around,  and  then  turpentine  is  to  be  liberally  ap- 
plied, and  rubbed  in  well  with  the  finger.  This  is 
allowed  to  remain  for  about  five  minutes,  and  is 
then  washed  off  with  carbolic  soap,  and  afterward 
with  hot  wat*r,  and  the  patch  is  then  painted  with 
dilute  tincture  of  iodine,  or  with  a  two-per-cent. 
solution  of  iodine  in  turpentine.  The  application 
is  to  be  made  once  or  twice  a  day,  and  is  not  pain- 
ful, though  it  causes  a  slight  smarting.  The  writ- 
er asserts  that  he  has  cured  in  ten  days  by  this 
method  cases  of  ring-worm  that  have  resisted  all 
other  modes  of  treatment. 


LOCAL  REMEDY  FOR  NEURALGIA. 

A  mixture  of  one  part  of  iodoform,  to  ten  or  fif- 
teen of  collodion,  if  spread  repeatedly  upon  a  neu- 
ralgic surface  until  it  attains  a  thickness  of  one 
to  two  millimetres,  is  said  to  be  quite    effective  in 


20 


THE   CANADA   MEDICAL   RECORD. 


the  treatment  of  certain  neuraleias.  If  the  first 
application  does  not  speedily  terminate  the  neural- 
gia, those  who  have  used  this  mode  of  treatment 
direct  that  its  appHcation  sliould  be  continued.  It 
seems  especially  valuable  in  the  relief  of  neural- 
gias of  the  trigiminus.  It  also  seems  of  value  to 
be  applied  along  the  spine,  particularly  at  painful 
points  in  what  is  called  spinal  irritation.  These 
observations  are  by  no  means  new,  and  yet  they 
seem  worthy  of  further  consideration. — Neurologi- 
cal Review. 


THE  TREATMENT  OF  PARONYCHIA. 

Dr.  Sellden  writes  in  the  Eira  Ihat  he  has  for 
years  made  a  special  study  of  this  subject.  The 
greater  number  of  his  patients  have  been  miners, 
smiths,  machine  laborers,  servants,  and  others 
whose  fingers  are  exposed  to  injury.  The  disease 
commences  in  the  subcutaneous  tissue,  and 
spreads  to  the  periosteum.  There  are  differences 
of  opinion  as  to  the  varieties  of  this  disease,  some 
authors  asserting  that  there  are  four  others  that 
there  are  only  two — the  deep  and  the  superficial 
inflammation.  Dr.  Sellden,  after  a  series  of  trials, 
found  the  following  method  most  efficacious  in 
the  treatment  of  paronychia.  When  the  patient 
will  consent  to  incision,  the  finger,  after  it  had 
been  opened,  is  instantly  plunged  in  a  tumblerful 
of  hot  water  which  is  then  allowed  to  cool  till  it  is 
nearly  lukewarm.  Half  a  teaspoonful  of  arnica  is 
poured  in,  and  a  teaspoonful  of  the  usual  lo  per 
cent,  solution  is  added.  This  mixture  is  highly 
anaesthetic ;  the  finger  is  held  in  it  for  fifteen  min- 
utes, wl'.en  the  ''bad  matter"  comes  out.  This 
expression  is  very  characteristic  of  the  phenome- 
non. The  blood  and  pus  exude  in  a  thin  stream 
about  the  size  of  a  knitting  needle,  which  forms 
circles  in  the  alkaline  liquid,  and  finally  settles  in 
a  thick  mass  at  the  bottom  of  the  glass.  Fifteen 
minutes  or  half  an  hour  after  the  finger  is  dried 
it  is  rubbed  with  vaseline  ointment  containing  lo 
per  cent,  of  sulphide  of  potassium.  The  finger 
is  then  immediately  enveloped  in  a  poultice 
which  continues  warm  till  the  next  finger  bath, 
and  thus  hastens  the  cure.  These  finger  baths  are 
taken  from  two  to  four  times  daily,  and  ihe  wound 
is  covered  during  the  earlier  days  with  sulphur 
ointment,  and  later  with  aboracic  ointment.  The 
finger  is  then  bound  up  with  a  wadding  compress 
and  a  bandage.  Carbolic  acid  may^  be  used  in 
the  finger  bath,  but  Dr.  Sellden  gives  thij  prefer- 
ence to  arnica,  which  he  finds  particularly  useful 
in  all  sorts  of  injuries. — Lancet,  Aug.  28, 


"  Nine  months  ago,  I  was  seized  with  pain  in 
the  back  of  the  head,  which  came  round  by  the 
joint  of  the  jawbone  on  the  right  side,  then 
spread  over  the  face,  chiefly  the  right  cheek  and 
temple.  The  muscles  of  my  jaw  were  then  fixed  ; 
to  open  my  mouth  was  inpossible.  Any  attempt 
to  take  food  brought  on  a  paroxysm  of  this  kind. 
These  turns  lasted  from  five  to  six  minutes,  and 
went  on  without  intermission  for  five  montns. 
The  attacks  came  on  sometimes  as  often  as  twelve 
times  in  the  twenty-four  hours;  during  the  night 
they  were  oftener  and  more  violent,  my  head 
being  often  pulled  back  with  violence.  I  could 
not  wash  my  face  without  bringing  on  a  parox- 
ysm, and  a  touch  of  my  finger,  a  puff  of  cold  air, 
or  even  a  mental  emotion,  produced  the  same  ef- 
fect. Things  went  from  bad  to  worse.  I  then 
called  in  Dr.  Bramwell,  who  prescribed  for  me 
bromide  of  potassium  and  croton  chloral-hydrate, 
but  only  with  partial  relief.  Solution  of  nitro- 
glycerine (o.  I  per  cent.)  was  given  in  drop-doses 
three  times  a  day.  The  effect  of  this  was  almost 
immediate,  and  in  four  days  all  my  morbid  symp- 
tons  had  gone.  I  have  since  then  been  four 
months  in  perfect  health;  there  has  been  no  re-, 
turn  of  the  fits. 

I  publish  this  case  in  the  hope  that,  in  nitro- 
glycerine, we  may  possibly  possess  a  remedy  for  a 
malady  which  embitters  life,  and  is  indeed  often 
quite  intractable.  I  am  fully  aware  what  good 
results  have  accrued  from  nerve-stretching,  or  even 
the  removal  of  Meckel's  ganglion ;  but,  before 
resorting  to  this  somewhat  formidable  measure,  it 
might  be  we.l  to  see  if  the  use  of  the  nitro-glycerine 
might  not  obviate  such  a  necessity. 


EPILEPTIFORM  TIC  CURED  BY  NITRO- 
GLYCERINE. 

Dr.  James  P.  Bramwell  reports  this  case  in  the 
Brit.  Mcil.  Jour.,  September  27,  1884. 

The  patient  was  80  years  of  age,  and  enjoyed 
good  health  till  nine  months  ago,  when  he  was 
attacked  by  the  disease  in  question.  I  shall  give 
the  history  of  the  ca^e  in  the  patient's  own  words  : 


IODIDE  OF  POTASSIUM  IN  THE  TREAT- 
MENT OF  INFANTILE  BRONCHO- 
PNEUMONIA. 

Dr.  Zinnis,  of  Athens,  Greece,  says  that  potas- 
sium iodide  in  the  broncho-pneumonia  of  children, 
from  one  to  five  years  of  age,  especially  in  the  sub- 
acute form,  as  nearly  approaches  a  specific  as  can 
be.  It  is  most  useful  in  the  early  stages.  He 
says  it  lowers  the  temperature,  reduces  the  frequen- 
cy of  respirations,  and  improves  the  local  condi- 
tions rapidly.  It  is  given  in  doses  of  eight  to 
twenty  grains,  according  to  age,  three  times  daily. 
— M.  V.  Medical  Journal. 


A  NEW  REMEDY  FOR  WARTS. 

Under  this  head  a  Russian  physician.  Dr.  Sub- 
tschanioff"  state.s,  in  Rusk.  Mediz.  that,  warts 
washed  with  the  tincture  of  thuya  occidcntalis  will, 
in  the  course  of  two  or  three  days,  dry  up  and  fall 
off'.  Tills  is  by  no  means  a  new  remedy,  as  the 
expressed  juice  of  the  thuya  occidcntalis  or  Amer- 
ican arbor  vita;,  has  been  used  for  this  purpose 
time  out  of  mind.  This  does  not  alter  the  fact 
that  the  remedy  is  a  good  one,  and  deserves  to  be 
better  known. 


THE   CANADA   MEDICAL   REDORD. 


51 


ON  thp:  early  diagnosis  and  treat- 
ment OF  SYPHILIS. 

By   FeSSENdicn   N.   Otis,    M.I).,    Ntw   York,   Clinical 

Professor  of  Gcnito-Urinary  Diseases  of  the  College 

of  Physicians  and  Siuijeons. 

Syphilis  is  not  necessarily  of  venereal  origin. 
From  the  intimate  contact  which  occurs  in  the 
sexual  relations,  and  from  the  fact  that  abrasions 
are  most  common  on  mucous  membranes,  it  is 
usually  communicated  through  se.xual  contact,  but 
syphilis  may  be  and  is  frequently  conveyed  through 
what  is  termed  mediate  contngio/i — tliat  is,  by 
means  of  any  substance,  fluid  or  solid,  in  or  upon 
which  has  been  deposited  the  contagium  or  disease 
germ  of  syphilis.  Thus  the  blood  of  a  person  may 
be  the  medium  of  the  contagion  afber  the  second 
month  of  its  acquirement  or  inoculation.  Pencils, 
cups,  spoons  or  fjipes,  or  dentists'  instruments, 
defiled  by  the  saliva  of  a  person  who  has  sypliilitic 
lesions  on  the  lips  or  in  the  mouth  or  throat,  may 
be  the  medium  of  communicating  syphilis  to  an  in- 
nocent person,  provided  only  that  such  articles 
are  brought  into  contact  with  an  abrasion  or  cut  on 
such  person.  Fortunately  this  open-lesion  on  the 
healthy  is  essential  to  the  acquirememt  of  sy- 
philis. 

The  site  of  inoculation  of  syphilis  is  called  the 
initial  lesion  or  chancre.  This  does  not  necessa- 
rily present  any  characteristic  features  when  first  ob- 
served. It  may  be,  to  all  appearance,  a  simple 
abrasion, a  crack,  a  wart,  a  vesicle,  a  pustule,  or  a 
papula,  and  yet  prove  to  be  just  as  much  an  initial 
lesion  of  syphilis  as  if  it  presented  the  characteris- 
tic induration  and  saucer-shaped  excavation  of  the 
typical  Hunterian  chancre. 

It  is  true  that  induration  of  a  sore  is  always 
suggestive  of  syphilis,  that  there  are  indurations 
associated  with  venereal  lesions  which  enable  one 
to  claim,  at  once,  with  positiveness,  a  syphilitic 
cause,  and  these  are  such  as  are  of  a  cartilaginous 
hardness  ;  but  in  the  majority  of  cases  the  indura- 
tion is  not  a  sure  guide,  because  often  not  present 
is  sufficient  degree  to  be  characteristic,  and  fre- 
quently not  present  at  all.  Sores,  however,  which 
indurate  even  s\lg,hl\y  a/hr //ea/i>ig  are,  as  a  rule, 
syphilitic. 

Diagnosis  of  syphilis,  as  a  rule, is  impossible  before 
the  third  week  from  tlie  date  of  exposure.  Abra- 
sions or  indurations,  which  are  first  discovered  two 
or  four  or  even  eight  weeks  after  a  suspicious  con- 
nection, if  not  otherwise  distinctly  accounted  for, 
are  usually  initial  lesions  of  syphilis. 

And  often  no  positive  diagnosis  can  be  made 
before  as  many  months  or  more.  This  fact  makes 
it  necessary  to  give  a  guarded  prognosis  in  regard 
to  any  and  all  lesions  about  the  genito-urinary  ap- 
paratus, whether  abrasions,  apparently  simple  or 
accidental  scratches,or  even  points  of  redness, in  ev- 
ery case  when  an  illicit  sexual  contact  has  taken 
place,  and  to  keep  the  individual  under  observation 
for  at  least  seventy-five  days,  and  no  suspicious  le- 
sions appearing,  before  a  positive  assurance  should 
be  given  that  the  danger  of  subsequent  develop- 


ment of  syphilis  is  past.  Even  if  nothing  abnor- 
mal is  discovered  after  an  illicit  connection,  mar- 
riage should  not  be  entered  into,  nor  marital  rela- 
tions resumed  until  at  least  that  period  had  passed, 
and  the  result  of  a  careful  re-examination  has  given 
assurance  of  probable  escape  from  syphilitic  in- 
fection. Fournier  cites  a  case  where  the  apparent 
incubation  was  seventy-five  days,  Bumsfead  and 
Taylor,  one  of  fifty  days.  The  average  is  stated 
to  be  about  twenty-four  days. 

Initial  lesions  of  syphilis  on  the  integument  do 
not  exhibit  a  characteristic  induration,  as  for  ins- 
tance on  the  finger  or  on  the  body  of  the  penis. 

In  every  case  when  the  possibility  of  having  ac- 
quired syphilis  is  under  consideration,  an  exami- 
nation of  die  person,  with  whom  coniact  has  oc- 
curred, should  be  insisted  on  when  praticable,  and 
in  such  examination  not  only  the  genital  apparatus, 
but  the  mouth,  throat  and  anus  should  receive  care-, 
ful  scrutiny.  Examine  not  only  the  body  for  erup- 
tions, especially  the  scalp— not  only  the  lymphatic 
glands  in  the  groins,  but  in  the  neck  and  in  the 
epitrochlear  spaces.  In  all  cases  it  should  be 
borne  in  mind  that  recent,  painless  glaod  enlarge- 
ments are  almost  certainly  due  to  a  syphilitic  infec- 
tion. 

In  such  examinations  it  must  be  remembered 
that  the  late  or  so-called  tertiary  lesions  of  syphi- 
lis are  not  inoadable,  and  that  the  presence  of  such 
lesions,  whether  as  eruiJtions  or  ulcerations,  do  not 
indicate  a  capacity  to  communicate  syphilis.  On 
the  contrary,  if  well  authenticated  as  tertiary  le- 
siotis  or  sequelse,  they  go  to  prove  that  the  person 
bearing  such  manifestations  has  not  been  the 
source  of  a  fresh  infection. 

In  the  examination  of  a  person,  having  had  con- 
nection or  contact  with  a  person  suspected  of  hav- 
ing syphilis,  note  not  alone  the  date  of  such  expo- 
sure as  claimed,  but  also  the  date  of  preceding 
exposures,  whether  believed  to  be  suspicious  or 
otherwise,  bearing  in  mind  the  fact  that  no  feature 
characteristic  of  a  syphilitic  infection  is  likely  to 
be  present  under  fifteen  or  twenty  days  from  the 
date  of  such  contact.  Observe  not  only  the  condi- 
tion of  lymphatic  glands  adjacent  to  any  suspected 
lesion,  but  also  those  of  the  neck  and  epitrochlear 
spaces,  -and  any  enlargement  should  be  marked 
and  noted  for  future  reference. 

In  the  absence  of  positive  evidence  of  syphilis, 
in  any  lesion  following  illicit  contact,  710  internal 
treatment  is  necessary.  Local  measures  based 
upon  local  conditions  alone  are  advisable.  If  an 
abrasion  is  present,  or  an  inflamed  point  or  patch, 
or  an  herpetic  vesicle,  or  a  scratch,  the  apphcation 
of  a  weak  solution  (2  grs.  to  oz.)  of  the  acetate  of 
lead,  or  of  ferric  alum  in  rose  water,  or  a  little 
powered  oxide  of  zinc,  is  suflScient.  If  the  lesion 
is  pustular  it  should  be  cauterized  and  treated  as 
a  chancroid,  until  healing  has  taken  place,  or  until 
satisfactory  evidences  of  syphilitic  infection  are 
present.  Every  lesion,  of  whatever  size  and  des- 
cription, following  a  suspicious  venereal  contact, 
should  be  subjected  to  frequent  observation,  and 


22 


fnt   CANADA  MEDICAL  RECORO. 


its  progress  minutely  noted  with  reference  to  its 
possible  syphilitic  nature.  If  it  heals  without  in- 
duration and  without  marked  enlargement  of  adja- 
cent lymphatic  glands,  and  if  for  a  period  of  twen- 
ty five  days  no  induration  develops  on  the  site  of 
the  lesion,  and  no  enlargement  of  glands  has,  after 
close  observation,  been  discovered,  then  the  escape 
from  infection  may  be  fairly  assumed;  but  it  is  not 
absolutely  safe  to  give  a  positive  opinion  that  the 
lesion  has  been  non-syphilitic  until  the  full  period 
of  seventy-five  days  (previously  noted  as  the  ex- 
treme known  limit  of  incupation)  has  been  reach- 
ed, without  the  occurrence  of  local  pathological 
changes.  On  the  other  hand,  if  the  lesion  is  a  pa- 
pule, from  its  first  discovery,  or  an  erosion  situated 
on  a  papule — insensitive,  shiggish,  persistent — or 
if,  after  healing,  it  is  easily  abraded,  or,  if  open,  its 
secretion  is  serous  and  scanty,  and  its  base  more 
or  less  indurated,  or  if,  when  on  the  integument  it 
becomes  boggy  and  red,  or  stiffened  and  scaling, 
and  if  in  addition  the  lymphatic  glands  in  connec- 
tion with  it  become  enlarged,  there  is  here  no  rea- 
sonable doubt  but  that  the  disease*  is  an  initial  le- 
sion of  sypliilis,  and  it  should  be  treated  accord- 
ingly. It  is  the  coincidence  of  a  number  of  evi- 
dences of  the  syphilitic  nature  of  the  local  lesion 
upon  which  an  early  decision  is  based,  and  not 
upon  any  one,  although  the  occurrence  of  any  one 
of  the  above-named  evidences  should  compel  a 
postponement  of  a  positive  decision,  until  the  full 
period  during  which  secondary  symptoms  might 
develop  has  passed  ;  and  this  is  not  less  than  six 
months.  A  well-grounded  suspicion  of  the  syphil- 
itic origin  of  any  lesion  should  be  a  bar  to  mar- 
riage for  at  least  three  years,  or  to  the  resumption  of 
marital  relations  for  a  period  of  at  least  six  months. 
This  apparently  excessive  caution  becomes  es- 
sential from  the  fact  that  if  by  any  means  the  sus- 
pected lesion  subsequently  proves  to  be  syphilitic 
the  blood  in  such  case,  through  an  accidental 
scratch  or  abrasion  coming  in  contact  with  a  sim- 
ilar breach  of  surface  on  a  healthy  person,  may  be 
the  means  of  communicating  syphilis.  The  failure 
to  appreciate  such  danger  as  the  foiegoing  has  re- 
sulted (in  recorded  and  well-authenticated  cases) 
in  the  communication  of  syphilis  to  innocent  wives 
by  husbands  who,  after  careful  examination  by 
their  medical  advisers,  had  received  permission  to 
resume  marital  relations. — N.Y.  Medical  Monthly. 


INTERNAL   ADMINISTRATIONS   OF 

CHRYSAROBIN  FOR  INFANTILE 

ECZEMA. 

Stoeguart  reports  several  cases  of  infantile 
eczema  treated  by  small  doses  of  chrysarobin.  It 
is  given  from  a  thirteenth  to  a  tenth  or  even  a 
grain  daily.  The  periods  of  cure  did  not  exceed 
ten  days.  Theoretically,  the  drug  is  sujjposed  to 
exert  a  constricting  action  on  the  capillaries  of  the 
skin. — N.  V.  Medical  Jourtial. 


PRURITUS  OF  THE  ANUS. 

Dr.  J.  B.  Johnson  of  Washington,  D.  C.  {Med. 
and  Surg.  Reporter,  April  24,  1886),  says  that 
the  local  treatment  should  be  commenced  by  the 
institution  of  the  most  perfect  cleanliness.  The 
patient  should  be  instruc.ed  to  wash  his  anus  well 
with  a  cloth  and  cold  water  after  each  action  of 
the  bowels,  and  then  to  bathe  his  anus  with  the 
following  wash  : 

IJ.  Hyposulphite  of  soda  5  ss.  Carbolic 
acid,    3  ij.     Aqua  distil.,  5  'v-     Glycerine,  3   ij- 

Mix.  Sig. — Shake  the  wash  well,  and  use  freely, 
after  first  thoroughly  washing  the  anus  with  cold 
water. 

In  addition  to  this  treatment,  the  patient  must 
every  night  or  two,  after  undressing  for  bed  and 
washing  and  drying  his  anus,  lie  upon  his  face  ; 
and,  with  his  hands  behind  him,  separate  his  nates 
as  widely  as  possible,  and  be  instructed  to  strain 
as  at  stool  ;  and  while  thus  straining  the  anus  will 
protude,  and  while  the  anus  is  protruding,  in  con- 
sequence of  the  strong  effort,  five  or  ten  grains  of 
pulv.  iodoform  must  be  sprinkled  upon  the  anus 
from  a  knife  or  spatula,  by  an  assistant.  The 
minute  eruption  which  causes  this  most  distress- 
ing itching  will  be  found  most  abundant  at  the 
junction  of  the  mucous  membrane  of  the  rectum 
and  the  skin  of  the  anus ;  and  it  is  at  this  situation 
that  the  application  does  the  most  good.  The 
patient  should  allow  the  iodoform  to  remain  in 
the  position  of  its  application  during  the  night, 
repeating  during  the  day  his  ablutions  of  the  anus 
after  each  action.  The  probability  is  that  after 
two  or  three  nightly  applications  of  the  iodoform 
all  pruritus  will  disappear  ;  but  the  patient  should 
be  directed  to  have  the  application  ot  the  iodo- 
form continued  three  or  four  times  a  week,  until 
he  is  entirely  relieved. 


EXTRACT   OF     CALABAR    BEAN 
EPILEPSY. 


IN 


Dr.  Rusche  recommends  the  exhibition  of  cala- 
bar bean  in  epilepsy  and  allied  affections,  and  says 
he  found  it  to  render  great  service  in  cases  in  which 
the  bromides  and  atropine  have  been  ineffectual 
{Deutsche  Medicinal-Zeitung,  May  10,  1886). 
He  notes  the  curious  circumstance  that  better  results 
are  obtained  by  alternately  increasing  diminishing 
doses  that  when  the  same  quantity  is  given  con- 
tinuously. The  drug  is  to  be  given  in  the  follow- 
ing preparation  :  Extract  of  calabar  bean,  7^ 
grains;  spirits  of  sulphuric  ether,  75  minims; 
peppermint-water,  5  drachms.  Dose:  5  to  10  drops 
for  children,  8  to  16  drops  for  adults,  three  times  a 
day.  The  smaller  dose  is  commenced  with  the 
first  day,  and  one  drop  added  each  day  until  the 
maximum  is  obtained,  and  then  the  quantity  is 
diminished  by  a  drop  each  day  until  the  minimum 
is  reached.  The  writer  reports  a  number  of  cases 
in  which  excellent  results  were  obtained. — Med. 
Record. 


THE  CANADA  MEDICAL   RECORD. 


^3 


LEISTER'S  LATEST  ANTISEPTIC 
DRESSING. 

Leister's  latest  antiseptic  dressing  is  known  as 
salalembroth.  He  uses  it  exclusively  in  his  wards 
with  fine  results.  It  is  a  double  mecurial  salt, 
made  by  the  sublimation  of  a  mixture  of  per- 
chloride  of  mercury  and  chloride  of  ammonium.  It 
is  very  soluble,  and  has  not  been  used  in  medi- 
cine since  the  time  of  the  alchemists.  All  dress- 
ings— gauze,  cotton,  wool,  bandages,  lint,  beddmg, 
patients'  underclothing,  etc., — are  soaked  in  a  i 
to  100  solution  and  dried.  He  colors  these  dress- 
ings with  aniline  blue,  i  to  10,000,  so  that  when 
an  alkaline  discharge  comes  in  contact  with  the 
dressings,  the  blue  is  removed  and  turns  reddish, 
enabling  him  to  see  where  the  discharge  has  been 
and  its  quantity,  however  small  or  large,  moist  or 
dried. 


The  Canada  Medical  Record. 

A  Monthly  Jom-nal  of  Medicine  and  burgery- 
EDITORS  : 

FRANCIS  <.y,  CAMPBELL,   M.A.,  M.D.,  L.K.C.P.  LOND. 
Editor  and  Proprietor. 

B.  A.  KENNfiDY,  M.A.,  M.D.,  Managing  Editor. 

ASSISTANT  EDITORS: 
CASEY  A.  "WOOD,  CM.,  M.D. 
GEORGE  E,  ARMSTRONG,  CM.,  M.D. 

SUBSCRIPTIO.N    TWO    DOLLARS    PER    ANNDM". 

AH  coniiimitications  and  Exchanges  must  be  addressed  to 
the  Editors,  Orawer356,  Post  Office,  Montreal. 

MONTREAL,  OCTOBER,  1836. 

CLIMATE  OF  FLORIDA. 

A  Canadian  medical  man,  writing  to  us  from 
Ocala,  Florida,  says:  "Florida  is  very  disappointing. 
It  is  very  hot,  very  moist  and  full  of  Malaria,. 
Anaemic  men,  women  and  children  meet  the  eye 
everywhere." 


ARTIFICIAL  QUININE. 
According  to  a  report  which  appeared  in  the 
Morning  Post  a  short  time  ago.  Dr.  Cresswell  Hew- 
ett,  of  Lincoln'sinn-fields,  has  discovered  the  syn- 
thetical or  artificial  mode  of  making  quinine,  by 
which  the  price  of  that  drug  will  be  reduced  to 
something  like  3d.  per  ounce.  The  importance  of 
this  discovery  (which  was  made  two  or  three  weeks 
ago,  through  the  accidental  breaking  of  a  medicine 
bottle)  is  rendered  greater  by  the  fact  that,  while 
hitherto  we  have  been  depending  for  our  quinine 


on  the  cultivation  of  the  chichona  tree,  from 
whose  bark  only  about  2  per  cent,  of  good  quinine 
can  be  extracted,  98  per  cent,  being  valueless,  the 
drug  can  now  be  manufactured  without  limit  by  a 
very  simple  process,  from  an  article  which  can 
always  be  got  in  abundance  in  any  part  of  the  world. 
Dr.  Hewett  has  submitted  a  sample  of  his  prepara- 
tion to  Messrs.  Howard  &Sons,  quinine  munufac- 
turers,  Stiatford,  who  had  expressed  surprise  at  the 
result  of  their  analysis,  the  sample  being  equal  to 
the  best  quinine  in  the  market.  The  discoverer  is 
about  to  communicate  with  the  British  Govern- 
ment, who  annually  spend  in  India  alone  about 
^60,000  in  the    cultivation  of  the  chichona  tree. 


MEDICAL  INCOMES  IN  CANADA. 
The  Toronto  Globe  (quoted  by  the  New  York 
Medical  Journal)  says  :  "  There  is  only  one  medical 
man  in  this  city  who  last  year  earned  $5,000  from 
profession,  combined  with  the  interest  he  received 
on  his  previous  savings.  There  is  not  one  man  on 
the  list  who  had  $4,000,  and  only  four  who  touched 
$3,000.  When  we  come  to  the  comparatively 
modest  and  moderate  $2,000  we  naturely  conclude 
that  we  shall  have  a  full  legion.  But  no,  we  have 
only  fourteen  all  told  who  come  up  to  this  figure. 
AVhen  we  come  to  between  $2,000  and  $1,000  the 
number  becomes  encouragingly  large.  As  many 
as  fifty-one  of  the  best-known,  and  greatly  sought) 
after  doctors  of  our  city  are  put  down,  under  their 
own  hands  and  seals  as  having  last  year  lived  on 
from  $1,000  to  Si,8oo.  Some  of  these  are  professors. 
There  remain  only  the  unfortunates  who  worry 
along  with  from  $800  down  almost  to  zero. 
Of  these,  we  are  sorry  to  say,  there  were  last  year 
thirty-six." 


A  NEW  H.^MOSTATIC. 

Dr.  Spaak,  in  the  Journal  de  Bnixelles,  des" 
cribes  a  ha3mostatic,whi'ch  he  accidently  discovered 
and  which  he  has  used  for  some  months.  It  con- 
sists of  two  parts  chloroform  and  a  hundred  parts 
water,  and  presents  the  following  advantages  : — 

1.  It  acts  with  remarkable  promptness. 

2.  It  has  not  the  least  unpleasant  taste. 

3.  It  has  no  escharotic  action. 

4.  It  is  always  to  be  had,  and  costs  almost  noth- 
ing. 

5.  It  has  no  unpleasantness  in  its  action,  and 
does  not  disturb  the  operation. 


24 


THE  CANADA   MEDICAL   RECORD. 


In  all  operations  in  the  cavity  of  the  mouth  and 
neck,  a  simple  washing-out  with  this  remedy  is 
sufficient  to  stop  the  hemorrhage  from  the  larger 
vessels  in  an  instant. 

The  author  does  not  state  the  reason  of  this 
action  ;  he  simply  relates  the  fact. 


REVIEWS. 

The  Medicine  of  the  Future.     By   the    late   Dr. 

Austin  Flint,  New  York,  D.  Appleton  and  Co.; 

Montreal,  Dawson    Brothers,   i8S6. 

The  late  Dr.  Austin  Flint  was  appointed  to 
read  the  address  on  Medicine,  before  the  British 
Medical  Association,  at  its  meeting  this  year;  but 
his  sudden  death  transferred  that  duty  to  Dr. 
Billings  of  Washington.  Among  Dr.  Flint's  papers 
was  found  the  address  which  he  had  prepared, 
and  it  is  now  published  under  the  above  title.  The 
profession  which  held  him  in  such  high  esteem 
will  read  with  a  melancholy  pleasure  this  his  last 
production.  The  little  volume  contains  an  excel- 
lent likeness  of  its  author  which  will  tend  still 
further  to  enhance  its  value. 


The  Principals  and  Practice  of  Medicine.     By 
the  late  Ch.ari.es  Hilton  Fagge,  M.D.,  F.R. 
C.P.     Examiner  in  Medicine  in  the  University 
of  London,  etc.,  etc.,   including  a  section  on 
Cutaneous  diseases,  by  P.  H.  Pye  Smith,  M.D., 
F.  R.   C.  S.      Lecturer  on  Medicine  at  Guy's 
Hospital;  Chapterson  Cardiac  diseases  by  Samuel 
Wilkes,  M.D.,  F.  R.  S.,  physician  to  Guy's  Hos- 
pital, Vol.   2,  Philadelphia,   P.   Blakiston,    Son 
&  Co.,  1 886  ;  Montreal,  Dawson  Brothers. 
The  Medical  practitioner  cannot  complain   of 
lack  of  works  on  the  Practice  of  Medicine,  for 
most  of  the  Lecturers  on  Medicine,  at  all  the  great 
English,  Continental  and  American  Colleges,  have 
put  on  paper  the  result  of  their  large  and  extended 
experience.     The  most  of  practitioners,  from  want 
of  means,  and  often  also  from  want  of  time   for 
their  perusal,  must  discriminate  and  select  those 
which  promise  them  the  largest  amount  of  informa. 
tion  in  the  most  readable  form.     They  can  obtain 
many  which  will  answer  this  description,  and  some 
of  them  comparatively  recent  additions  to  this  de- 
partment of  Medicine. 

To  this  list  must  now  be  added  the  volume 
before  us.  It  is  beyond  a  doubt  a  most  valuable 
addition  to  our  works  on  practice.     Its  lamented 


author  was  well  known  as  one  of  London's  most 
distinguished  physicians,  who,  during  his  life-time, 
was  noted  as  a  keen  observer,  and  a  most  earnest 
worker  in  the  department  of  Pathology.  The 
insight  he  gained  in  this  department,  the  handmaid 
to  practice,  is  noticeable  throughout  his  whole 
work,  the  Patholog}'  of  disease  being  evidently 
from  a  master's  hand.  In  a  volume  so  extensive, 
nearly  nine  hundred  pages,  more  than  a  hurried 
glance  is  impossible,  yet  \^q.  have  read  sufficient 
to  satisfy  us  that  Dr.  Fagge's  work  will  transmit 
his  name  to  posterity.  The  special  chapters  by 
Dr.  Pye  Smith,  and  Dr.  Samuel  Wilks  give  addi- 
tional value  to  the  work,  that  by  Dr.  Wilks  being 
especially  valuable.  The  book  is  printed  on  beau- 
tifully clear  white  paper,  with  clear  type,  and  is 
altogether  produced  in  excellent  style. 


Diseases  of  tht  Nerves,  Muscles  and  Skin,  being 
Vol.  III.  of  Dr.  Hermann  Eichhorst's  Hand- 
book of  Practical  Medicine,  and  Vol.  X.  of 
Wood's  Library  of  Standard  Medical  Authors 
i886,  (consisting  of  12  .vols,  price,  S15.00). 
Sold  only  by  subscription.  William  Wood  & 
Co.,  New  York. 

This  volume  keeps  up  the  reputation  of  Wood's 
Library  of  Standard  Medical  authors .  Those  who 
have  subscribed  for  this  Library  for  several  years 
now  find  themselves  in  possession  of  a  great  many 
works  of  much  value  in  every  department  of  medi- 
cine, and  which  they  never  would  have  obtained 
in  any  other  way.  We  commend  the  Library  to 
all  our  subscribers. 


The  students'  Manuel  of  Venereal  Diseases  being 
a  concise  description  of  those,  affections  and  their 
treatment.     By  Bericley  Hill,  M.D.,  professor 
of  Clinical  Surgery  in  University  College,  Lon- 
don, and  Arthur  Cooper,  M.D.,  formerly  House 
Surgeon  to  the  Lock  Hospital,  London.     Phila- 
delphia, P.  Blakiston  Son  &  Co.,  1886  ;  Montreal, 
Dawson  Brothers,  price  $1.00. 
We  have  read  carefully  the  greater  portion  of  this 
manuel,  and  are  highly  pleased  with  its  clearness  of 
description,  conciseness  of  diction,  and  fulness  of 
treatment.     Its  authors  are  men  well  known  to  the 
Medical  world,  who  follow  the  work  of  the  London 
Hospitals,  and  they  have  done  their  duty  well.    We 
commend  it  not  alone  to  students  but  to  all  who 
desire  to  brush  up  their  knowledge  of  a  very  im- 
portant department  of  Medicine. 


T 


HE  CANADA  MEDICAL  RECORD. 


Vol.  XV. 


MONTREAL,  NOVEMBER,  1886. 


No.  2. 


ORIGINAL  COMMUNICATIONS. 

R«m:\rks  ui>on  .Alexander's  Operation.     25 

SOCIETY  PEOCEEDINGS. 
MedicoCliirurgical    Societv    of    Mou- 

treal .' 29 

PHOGHESS  OF  SCEENCE. 
Treatine--t  for  the  Vomiting  of  Preg- 

naucv 32 

Nasal  Catarrh 34 

The  Dietities  of  Pnlmonary  Phthisis. . .    36 
Chioaic  PiystatitiB 3S 


o  o:^TT:E]^s^Ts. 

The  useful  Administration  of  Arsenic 
in  Disease  of  the  Skin 39 

On  the  value  of  Boric  -Acid  in  Varioos 
Conditions  of  the  Mouth 40 

Some  .\phoriBm6  in  Ophthalmology. ...    41 

Professor  Huxley  on  Smoking 42 

Iodide  Potassitim  in  Spasmc^c  Asth- 
ma   43 

Hydrochlorate  of  Cooa'ne  in  the  Vom- 
itine  of  Pregnancy 43 

The  Diagnosis  of  Organic  Heart 
Troubles 44 


Shall  Patient  eat  what  he  craves 44 

Drops  for  Earache 44 

Urinary  Incontinence  of   Children  by 

Anodynes  per  Rectum 

The  Surgical  Treatment  of  Subinvolu- 
tion     46 

The  Milk  Treatment 46 

The  Treatment  of  Scalp  Wounds  at  the 
Chambers  Street  Hospital 4T 

EDITORIAL. 

To  our  Subscribers 4T 

Personal 48 

Bevlews 48 


t)m4inal  6ommunfcafion-i 

REMARKS  UPON  ALEX.\NDER'S  OPERA- 

TION. 

By  a.  Lapthorn  Smith,  B.A.,  M.D.,  M.R.C.S.E. 

Read  before  the  Canada  Medical  Association  at  Qaebec, 

Atigust  19th,  1886. 

The  attempt  to  shorten  the  round  ligaments  in 
order  to  correct  displacement  of  the  uterus  was  made 
more  than  a  century  ago,  but  failed.  The  opera- 
tion was  revived  about  two  years  ago  by  Dr.  Alex- 
ander of  Liverpool,  and  it  now  bears  his  name.  It 
is  a  very  ingenious  operation,  perhaps  one  of  the 
most  so  in  surger)-,  and  one,  which  if  it  really  does 
what  it  is  claimed  to  do,  will  prove  a  short  road  to 
the  cuie  of  a  numerous  class  of  cases,  the  treatment 
of  which  has  heretofore  been  tedious  and  trouble- 
some.  At  the  same  time  as  the  operation  is  on 
its  trial,  it  is  a  fair  subject  of  criticism,  and  I  have 
therefore  chosen  it  as  the  topic  of  my  paper. 

Before  discussing  the  pros  and  cons  of  the  case, 
it  would  perhaps  be  better  to  give  a  description  of 
the  operation. 

Preparatory  treatment. — The  patient  must  be 
confined  to  bed  for  several  weeks, during  which  time 
the  vagina  should  be  tamponed  with  glycerine 
and  cotton,  interchanged  with  hot  douche  with  the 
Davidson  syringe.  No  patient  can  be  considered 
suitable  for  the  operation  Ln  whom  the  uterus  is  not 
entirely  free  from  adhesion,  and  the  tissues  around 
the  uterus  free  from  tenderness.  The  uterus  must 
be  perfectly  and  freely  movable.  Dr.  Alexander 
thus  describes  the  operation  after  warning  anyone 
who  intends  to  operate,  no  matter  what  their  stand- 


ing, to  perform  the  operation  a  few  times  on  the 
dead  subject  if  they  wish  to  avoid  disappointment, 
"  The  pubic  spine  is  the  first  landmark,  and  can  be 
felt  by  an  intelligent  finger  under  any  depth  of 
superincumbent  fat.  It  does  not  make  any  matter 
whether  the  finger  can  feel  the  spine  clearly  or  not, 
provided  the  primary  incision  is  made  within  a 
reasonable  distance  of  it,  but  there  need  be  no 
serious  difficulty  in  feeling  it." 

'•  From  this  an  incision  is  to  be  made  upwards  and 
outwards,  in  the  direction  of  the  inguinal  canal  for 
one  and  a  half  to  two  or  three  inches,  according  to 
the  fatness  of  the  subject.  A  considerable  thickness 
of  subcutaneous  fat  is  now  to  be  cut  through  by 
subsequent  incision,  until  the  pearly  glistening 
tendon  of  the  internal  oblique  muscle  is  reached. 
Midway  through  the  fatty  tissue  an  aponeurosis 
sometimes  appears  so  firm  and  smooth  as  to  cause 
the  operator  to  think  he  is  deep  enough  ;  and  if  he 
begins  to  poke  about  here  as  I  have  done  and  seen 
done,  it  is  little  wonder  no  ligaments  can  there  be 
found.  The  first  stage  of  the  operation  consists  in 
simply  cutting  down  upon  the  tendon  of  the  exter- 
nal oblique  muscle,  until  it  appears  clear  and  shin- 
ing at  the  bottom  of  the  wound.  If  the  operator 
succeeded  in  hitting  the  spine,  the  internal  ingui- 
nal ring  with  the  intercolumnar  fibres  crossing  it, 
can  also  be  seen.  If  not,  the  aperture  made  down 
to  the  muscles  can  be  dragged  over  an  extensive 
area  by  retractors,  so  that  the  region  can  be  search- 
ed until  the  ring  is  found.  The  finger  passed  to 
the  bottom  of  the  wound  may  be  used  to  detect 
the  spine  and  the  ring  outside,  the  former  by  its 
hardness,  the  latter  by  its  lessened  resistance,  com- 
pared with  that  of  the  aponeurosis  around  it.  The 


26 


THE  CANADA  MEDICAL  RECORD* 


anatomical  knowledge  of  the  operator  should 
always  be  equal  to  the  recognition  of  these  struc- 
tures— that  is  the  spine  and  internal  abdominal 
ring.  There  are  other  apertures,  as  the  aponeu- 
rosis, and  a  depression  filled  with  fat  below  Pou- 
part's  ligaments  that  sometimes  simulate  the  inter- 
nal abdominal  ring.  Poupart's  ligament  below  the 
intercolumnar  fascia  running  across,  and  the  spine 
at  the  inner  side  are  sufficient  landmarks.  When 
in  doubt  a  close  deliberate  survey  of  the  position 
should  be  taken, and  no  gropings  in  the  dark  made, 
as  these  are  certain  to  lead  to  failure." 

"  Having  clearly  isolated  the  internal  abdominal 
wound,  and  tied  or  compressed  any  little  vessels 
necessary  to  be  attended  to,  the  next  step  in  the 
operation  may  be  entered  upon — viz. :  to  find  the 
end  of  the  ligament.  The  intercolumnar  fascia, 
which  is  generally  pushed  forward  by  the  fat  and 
other  structures  beneath,  is  to  be  cut  through  over 
all  the  extent  of  the  internal  ring,  and  in  tl;e  direc- 
tion of  the  longest  diameter,  a  nerve,  some  vessels, 
fat,  some  bands,  and  the  round  ligament  springs 
out  of  the  canal  immediately." 

"In  stout  people  the  quantity  of  fat  conceals  all  the 
other  structures.  No  grabbing  at  the  mass  is  now 
to  be  practised,  as  some  have  recommended.  By 
everting  all  the  structures  upwards  the  round  liga- 
ment can  be  seen  generally  at  the  lowest  part,  and 
the  white,  easily  distinguished,  genital  branch  of  the 
genito-crural  nerve  on  its  anterior  surface  and  close 
to  it.  The  ligament  at  this  stage  is  more  or  less 
rounded  in  shape,  sometimes  rather  delicate,  but 
an  always  easily  recognized  flesh  coloured  struc- 
ture,that  might  be  easily  destroyed  by  forceps  rude- 
ly and  blindly  applied.  Should  the  ligament  seem 
very  frail,  or  the  operator  be  doubtful  whether  he 
has  found  it  or  not,  he  should  take  care  not  to  dis- 
place the  structures  or  to  destroy  them  by  search- 
ing or  pulling.  The  best  plan  in  such  a  case  is  to 
open  up  the  inguinal  canal  a  little,  and  then  re- 
examine what  he  supposes  to  be  the  ligament.  No 
difficulty  in  finding  the  ligament  need  thus  ever  be 
experienced,  provided  the  operator  knows  what  he 
is  about.  When  the  ligament  is  clearly  identified 
the  small  nerve  on  its  surface  is  to  be  cut  through, 
without  cutting  any  of  the  ligament,  then  gentle 
traction  is  to  be  made  ;  either  by  the  fingers  or 
broad  blunt  pointed  forceps.  Care  must  be  taken 
not  to  break  the  ligament  by  such  traction.  Bands 
will  now  be  seen  holding  it  to  the  neighboring 
structure.  These  should  be  cut  through  with 
scissors,  the  greatest  caution  being  used  to  avoid 


notching  the  ligament   itself  at  the    same    time. 
With  a  little  patience  and  perseverance  the  struc- 
ture is  so  far  free  that  all  resistance  is  at  an  end,  and 
it  comes  out  as   easily  as  if  broken  inside,  as  Dr. 
Munde  thought  it  was  in  his  first  case.     As  soon 
as  it  begins  to  peel   out,  and  without    drawing  it 
out  further,   I  leave  that  side,   after   covering  the 
wound  with  a  clean  sponge,   and    operate  on  the 
opposite  side.     To   do    so    my    assistant     and  I 
change  sides,  so  that  I  always  stand  on    the    side 
opposite  to  that  on  which  I  am  operating.     I  can 
look  thus  better  into  the  canal  and  draw  the  liga- 
ment more  conveniently  towards  me  ;  but  of  course 
the   operation   could    be   performed   without  this 
change  of  position.     Having   freed  the  opposite 
ligament,  the  difficulties  of  the  operation  are  at  an 
end,  and 'the  second  stage   is    finished.     I  cannot 
on  paper   give  with   advantage  a   more   detailed 
account  of  how  to   perform  the  second   stage.     It 
must  be  seen  to  be  thoroughly   understood.     The 
third  stage  consists   in  placing  the  uterus  in  posi- 
tion by  the  sound,  and  pulling  out  the   ligaments 
until  they  are  felt  to  control  that  position.      The 
replacing  of  the  uterus   is  first  performed,   and  it 
is  held  in  position  by  a  third  assistant.     The  oper- 
ator pulls  out  both  ligaments  almost  simultaneous- 
ly and  gently,  until  the  sound  is  felt  to  be  slightly 
moved.  He  then  hands  both  to  the  first  assistant  to 
hold,  while  with  the  curved  needle,  threaded  with 
moderately  fine   catgut,  he  stitches  each  to  both 
pillars  of  the  ring  by  two  sutures    on  each  side, 
and  thus  secures  the  closure  of  the  internal  abdo- 
minal   ring    and   the    fixation    of  the    ligaiaent, 
without   injuriously  strangling    the    latter    struc- 
ture as  it  lies  between.     The  assistant  can  now  let 
go,  the  chafed  ends  of  the  ligaments  are  cut    off, 
and  the    remainder  stitched  into  the  wound,  by 
means  of  the  sutures   that   close  the  incision.     A 
fine  drainage    tube  is  inserted,  and    the    wound 
washed  out   with   carbolic  or  other  lotion,  before 
these  sutures  are  tied.     In  hospital  I  perform  the 
operation    under  the  spray,  and  use  gauze  dress- 
ings.    In  private  I  dispense  with  the    spray,  and 
sometimes  use  boracic  lint  or  absorbent  cotton  wool- 
I  always  drain  as  I  believe  it   to   be  much  safer, 
preventing  any  collection  of  pus  or  danger  of  in- 
terfascial   suppuration.     It  may   retard,   in    some 
cases  the  healing  of  the   wound,   but  as  I  never 
allow  my  patients  out  of  bed    under   three  weeks 
this  is  notofnijich  importance.  Before  the  dressing 
is  applied,  in  simple  cases  of  retroversion  and  pro- 
I  lapse,  I  insert  a  Hodge  pessary,  and  keep  it  in  at 


THE  CANADA   MEDICAL  RECOED. 


27 


least  during  convalescence.  When  there  is 
retroflexion  as  well  I  always  insert  a  galvanic 
stem  to  keep  the  uterus  straight  during  the  heal- 
ing of  the  wound.  This  I  look  upon  as 
essential.  By  keeping  the  stem  in  for  a  month  or 
so,  the  cure  may  be  with  certainty  affected.  An 
important  question  with  regard  to  the  third  stage 
of  the  operation  is,  how  far  are  the  ligaments  to  be 
pulled  out  ?  My  reply  is  to  put  the  uterus  in 
position  and  puU  out  the  slack.  The  after-treat- 
ment of  the  operation  consists  in  rest.  The  wound 
I  generally  dress  on  the  second  day,  when  I 
remove  the  tube,  the  small  aperture  left  where  they 
were  removed  being  sufficient  to  maintain  the  nee. 
essary  drainage  in  most  cases.  The  ligaments 
should  be  allowed  time  to  unite  to  the  wound,  to 
the  pillars  of  the  ring  and  to  the  canal,  and  for  this 
purpose  three  weeks  is  quite  short  enough  time. 
Several  of  my  private  patients  have  taken  a  longer 
rest  and  with  benefit,  as  thus  all  the  pelvic  organs 
have  become  accustomed  to  their  new  position. 
The  rest  need  not  be  in  bed — a  sofa  and  the  sitting 
posture  may  vary  the  monotony  of  lying  in  bed ; 
whilst  sewing,  reading,  and  other  feminine  arts  may 
be  indulged  in  after  the  first  few  days." 

Such  is  the  operation,  and  while  all  are  agreed 
that  it  is  a  most  ingenious  one,  there  is  a  great 
difference  of  opinion  among  the  highest  authorities 
as  to  its  harmlessness,  efficiency  and  usefulness. 
I  shall  not  attempt  in  the  time  at  my  disposal  to 
recapitulate  all  that  has  been  said  about  it  by  its 
leading  friends  and  enemies.  Neither  shall  I  ven- 
ture to  say  dogmatically  that  the  operation  may 
not  prove  a  useful  one.  It  has  not  been  on  its 
trial  long  enough  for  that.  I  shall  merely  endeavor 
to  prove  that  Alexander's  operation  is  not  thcjscien- 
tific  or  rational  treatment  for  displacements  of  the 
uterus.  And  I  base  my  contention  on  several 
more  or  less  well  known  facts. 

ist.  The  round  ligament  is  not  really  a  ligament, 
but  a  bundle  of  muscular  fibres  derived  from  the 
transversalis  and  uterine  muscle,  and  it  follows, 
therefore,  that  it  is  capable  of  undergoing  fatty 
degeneration,  like  any  other  muscle.  This  we 
know  it  does,  for  several  of  the  very  ablest  opera- 
tors who  have  performed  the  operation  tell  us  that, 
in  a  certain  number  of  cases,  they  found  the  so- 
called  ligament  so  soft,  so  pliable,  and  so  attenuated 
that  they  did  not  dare  to  draw  on  it ;  or  when  they 
did,  it  broke  in  their  fingers.  And  <hese  are  just 
the  cases  where  the  uterus  is  Hkely  to  be  dis- 
'   placed.    In  a  fine,  previously  healthy  subject  dying 


from  some  acute  disease,  we  will  find  the  round 
muscle  well  developed  and  easy  to  discover.  But 
this  kind  of  woman  does  not  have  displacements ; 
or  if  she  does,  she  does  not  know  it,  because  the 
organ  is  healthy.  So  we  may  conclude  that  when 
ihe  i)atient  has  neither  ache  or  pain,  we  will  find 
the  pelvic  organs  and  the  abdominal  walls  in  a 
healthy  state,  and  there  will  be  no  trouble  in  reach- 
ing the  round  ligament  and  pulling  it  out,  and 
cutting  it  off.  While  in  a  delicate,  badly  nourished 
woman,  where  the  muscular  system  is  ill-developedj 
and  the  circulation  slow,  you  will  find  the  uterus 
congested,  heavy,  displaced,  and  you  will  find  the 
jound  ligaments  thin  and  weak,  if  you  find  them 
at  all. 

Even  supposing  that  you  can  easily  find  the 
round  ligaments  and  cut  half  of  them  off,  and  so 
pull  the  uterus  up  into  place,  I  maintain  that  it  is 
not  the  right  thing  to  do.  If  the  round  ligaments 
were  really  Ugamentous  structures  it  would  be 
rational  to  do  so  ;  but  they  are  small  round  muscles. 
Mr.  Rainey  has  carefully  studied  their  structure, 
and  has  shown  that  they  are  composed  of  striped 
or  voluntary  muscle.  They  arise  by  3  fasciculi  of 
tendinous  fibres ;  the  inner  one  from  the  tendon 
of  the  internal  oblique  and  transversaHs  muscles 
near  io  the  symphisis  pubis,  and  the  middle  and 
external  fasciculi  from  the  inner  and  outer  columns 
of  the  internal  abdominal  ring  respectively,  above 
Gimbernat's  ligament.  From  these  attachments 
the  fibres  pass  backwards  and  outwards,  soon  be- 
coming fleshy ;  they  then  unite  into  a  rounded 
cord,  which  crosses  in  front  of  the  epigastric  artery 
and  behind  the  lower  tendon  of  the  internal 
oblique  and  transversalis  muscles.  They  then 
get  between  the  layers  of  peritoneum,  covering  the 
broad  ligament,  along  which  they  pass  backwards, 
downwards  and  inwards,  to  the  anterior  and 
superior  part  of  the  uterus  into  which  their  fibres, 
spreading  out  a  little,  are  inserted.  Mr.  Rainey, 
reasoning  from  the  structure  of  the  round  ligaments, 
says  that  the  presence  of  voluntary  muscular  fibres 
proves  that  they  do  not  serve  as  mechanical  sup- 
ports to  the  uterus. 

Sappey  and  Cruveillier  say  that  the  round  liga- 
ments are  never  on  the  stretch,  and  cannot  resist 
displacements  of  the  uterus.  Some  authors  state 
that  they  tilt  the  uterus  forwards  during  coition  so 
as  to  deepen  the  seminal  lake  at  the  top  of  the 
vagina. 

Judging  from  the  origin  and  nerve  supply  of  the 
round  muscle,  I  should  say  that  it  was  the  counter- 


28 


THE   CANADA   MEDICAL   RECOED. 


part  of  the  cremaster  muscle  in  the  male.  Now  we 
know  that  the  cremasther,  though  not  so  often  as 
the  round  muscle,  sometimes  becomes  so  weak  or 
the  testicles  become  so  heavy  that  it  is  unable  to 
support  them,  and  then  we  have  the  testicles  hang- 
ing down,  a  very  painful  condition  of  things. 
What  do  we  do  in  these  cases  ?  Do  we  cut  down 
on  the  cremaster  and  pull  out  an  inch  or  two  of 
it  and  cut  it  off?  No,  we  ascertain  why  the  testi- 
cles are  dragging.  If  it  is  because  they  are  per- 
manently too  heavy  from  some  foreign  growth,  we 
remove  it ;  or  if  only  temporarily  too  heavy  from 
acute  or  chronic  inflammation  we  support  them 
for  the  time  with  a  suspensory  bandage,-until  we 
can  reduce  the  inflammation.  But  if  the  testicles 
are  dragging  because  the  cremaster  muscles  are 
in  an  atonic  state,  due  to  the  patient's  general 
health  being  run  down,  we  should  rather  place  him 
on  a  local  and  general  tonic  treatment.  And  just 
as  the  man's  general  health  returns,  so  will  his 
testicles  rise  and  cease  to  pain  him. 

You  all  know  how  the  testicles  may  drop  at  ex- 
amination times.  In  fact  pain  in  the  testicle  is 
almost  as  common  as  diarrhoea  at  that  time.  I 
have  over  and  over  again  known  the  same  thing 
to  occur  to  the  womb,  in  women,  under  similar 
circumstances.  Many  times  women  have  come 
to  me  with  prolapsus,  stating  that  their  womb  had 
come  down  suddenly  as  the  result  of  a  fright; 
while  several  old  stagers  come  to  me  regularly  every 
summer,  during  the  very  warm  weather,  when 
everybody  and  everything  seems  relaxed,  to  have 
their  womb  replaced. 

Should  I  perform  Alexander's  operation  then? 
No,  indeed  I  seldom  ever  introduce  a  pessary,  any 
more  than  I  would  put  sphnts  on  their  legs  to  cure 
the  weakness  in  their  limbs,  which  nearly  always 
accompanies  the  prolapsus  in  such  cases.  On  the 
contrary  I  order  then  to  remain  in  bed  a  few  days 
with  their  hips  higher  than  their  heads,  and  I  give 
them  the  strongest  preparation  of  iron  quinine  and 
strychnine  that  their  stomach  will  bear,  good  air, 
good  food,  and  cold  frictions  to  the  abdomen. 

Besides  it  must  be  remembered  that  the  uterus 
is  not  held  up  by  the  round  ligament  alone,  even 
if  it  is  held  up  by  it  at  all,  which  many  anatomists 
deny.  In  fact,  to  treat  displacements  of  the  uterus 
scientifically,  we  ghould  have  a  very  clear  idea  of 
the  manner  in  which  it  is  held  in  place.  Pardon 
me  if  I  remind  you  that  the  supports  of  the  uterus 


are  very  varied.  First  of  all  there  is  the  vagina 
which  in  a  muscular  well-developed  woman  is  a 
strong  tube  or  column  alone  capable  of  holding  up 
a  healthy  uterus.  But  in  the  miserable  weak  wo- 
man of  modem  education  it  is  very  much  weaker. 

Again  the  vagina  itself  is  supported  by  the  per- 
ineum, and  if  there  is  rupture  of  the  perineum,  there 
will  be  piolapsus  of  the  vagina,  and,  consequently, 
displacement  of  the  uterus.  Perhaps  the  two  most 
important  supports  are  the  anterior  or  utero  vesical 
and  the  posterior  or  utero  sacral  ligaments.  The 
former  contains  bundles  of  fibrous  tissue  only,  but 
no  muscle,  and  hold  the  uterus  fixed  by  its  neck, 
to  the  bladder  The  posterior  or  utero  sacral  liga- 
ments extend  from  the  lower  part  of  the  body  of 
the  uterus,  to  the  other  side  of  the  saecrum,  en- 
veloped by  peritoneum,  and  are  composed  of  non 
striated  muscular  fibres  which  spring  from  the 
uterus.  The  experiments  of  Malgaigne  would  seem 
to  prove  that  these  ligaments  constitute  the  princi- 
pal obstacle  to  the  falling  of  the  womb  towards  the 
vulva.  When  traction  is  made  on  the  cervix  these 
ligaments  are  immediately  seen  to  be  tightened,  and 
when  they  are  divided  the  uterus  sensibly  drops, but 
it  is  soon  arrested  by  the  broad  ligaments  and  the 
resistance  of  the  floor  of  the  pelvis. 

The  broad  ligaments  are  muscles  covered  with 
peritoneum,  and  do  not  support  the  weight  of  the 
organ  but  merely  oppose  flexions  of  the  body  on  the 
neck,  and  resist  lateral  deviations.  In  fact,  as 
Barnes  Senr  says,  "  The  so-called  ligaments  of  the 
uterus  exert  but  a  small  influence  in  preventing 
prolapsus,"  and  he  has  frequently  seen  the  uterus 
in  the  vagina  brought  down  to  the  vulva  by  ex- 
pulsive efforts  at  defecation. 

As  I  have  above  stated,  the  greatest  admirers 
of  the  operation  admit  that  it  is  not  at  all  suitable 
for  displacements  with  adhesion  ;  and  as  these 
are  precisely  the  most  troublesome  cases  to  cure 
by  any  other  means,  they  are  just  the  ones  we  are 
most  in  need  of  an  operation  to  come  to  our  aid. 
But  in  these  we  turn  in  vain  to  Alexander's  oper- 
ation. The  round  ligaments  would  either  break 
before  the  displacement  would  be  corrected,  or  else 
we  would  have  a  severe  attack  of  peritonitis  or 
perimetritis. 

The  only  case  after  Alexanders'  operation  that  | 
I  have  seen,  was  not  a  successful  one  ;  as  in  addi- 
tion to  all  the  troubles  of  which   she  complained 
before  going  to  hospital,  she  had  a  month  aftej  [l  (    i 


THE   CANADA  MEDICAL  RECORD. 


29 


region  was  occupied  by  a  firm  projection,  rightly 
wards  an  immense  inguinal  herina  for  which  she 
will  have  to  forever  wear  a  truss  ;  notwithstanding 
that  she  was  operated  upon  by  one  of  the  best 
gynecologists  in  Canada.  Besides  the  operation 
is  not  without  danger,  in  fact  several  deaths  have 
occurred  from  peritonitis  and  there  may  be  others 
from  haemorrhage.  So  that  unless  the  advantages 
to  be  derived  are  very  certain  and  decided  we 
would  hardly  be  justified  in  exposing  our  patients 
to  any  risk. 

While  I  do  not  doubt  that  Alexanders'  opera- 
tions as  above  described  have  been  sometimes  fol- 
lowed by  good  results,  I  am  inclined  to  think  that 
a  great  deal  of  the  good  results  may  fairly  be 
claimad  to  be  due  to  the  before  and  after  treat- 
ment ;  for  when  you  have  reduced  the  subinvolution 
by  several  weeks  treatment,  and  kept  the  patient 
in  bed  three  or  four  weeks  longer  after  the  opera- 
tion, with  a  pessary  in  her,  you  will  have  in  most 
cases  removed  the  very  necessity  of  the  operation, 
the  uterus  no  longer  being  too  heavy  for  its  sup- 
port. But  even  admitting  that  it  has  sometimes 
or  even  often  been  followed  by  good  results,  I  do 
not  think  the  cure  will  be  permanent,  for  the 
reason  that  the  round  muscles  are  not  inextensible 
fibrous  ligaments  that  will  not  stretch.  If  that 
were  the  case  what  would  happen  in  case  of  preg- 
nancy? The  uterus  would  be  unable  to  rise  and 
abortion  would  surely  follow.  Since  the  shortened 
round  ligaments  are  capable  of  supporting  the 
weight  of  a  heavy  uterus,  and  of  mechanically  pre- 
vent it  from  falling,  surely  they  would  be  equally 
able  to  prevent  it  from  rising  from  the  pelvis  under 
the  expansive  force  with  which  the  impregnated 
uterus  is  endowed.  But  the  advocates  of  Alexan- 
ders' operation  assure  us  that  we  need  have  no 
fearof  the  result  of  conception,  and  that  the  short. 
ened  round  ligament  will  offer  no  obstacle  to  the 
upward  movement  of  the  organ.  And  I  agree 
with  them.  For,  as  I  do  not  admit  the  ability  of 
the  round  ligaments  alone  to  prevent  the  falling  of 
the  organ,  a  distance  of  three  or  four  inches,  I  can- 
not with  any  more  reason  say  that  it  will  keep  it 
from  rising. 

I  therefore  maintain  that  Alexanders'  operation 
does  not  permanently  cure  retro-displacements  and 
falling  of  the  womb,  and  that  even  if  it  does  appear 
to  succeed,  there  are  other  safer  and  more  rational 
means  of  attaining  the  same  result,  and  I  venture 
to  predict  that  the  operation  will  not  last. 


MEDICO-CHIRURGICAL      SOCIETY      OF 

MONTREAL. 

Annual  Meeting,   October    %th,    1886. 

J.C.  Cameron,  M.  D.,  ist  Vice-President,  in 

THE  Chair. 

The  annual  meeting  of  the  Society  was  held  on 
Friday,  the  8th  of  October.  Drs.  J.  H.  Y.  Grant, 
R.  H.  Wilson  and  A.  F.  Schmidt  were  proposed 
for   membership. 

The  treasurer  of  last  year.  Dr.  Perrigo,  and  the 
secretary,  Dr,  Gurd,  handed  in  their  resignations. 

The  election  of  officers  for  the  ensuing  year 
resulted  as  follows  : 

President — Dr.  J.  C.  Cameron. 

ist    Vice-President — Dr.  Geo.   Wilkins. 

2nd    Vice-President — Dr.    Alloway. 

Secretary— T)r.  R.  F.   Ruttan. 

Treasure} — Dr.  A.  Lapthorn  Smith. 

Librarian — Dr.    Reed  (re-elected). 

Council — Drs.  Geo.  Ross,  Rodger  and  Kennedy 

(re-elected). 

Publication  Conunittee — Drs.  Kennedy,  Geo. 
Ross  and   Bell. 

Abdominal  Sarcoma. — Dr.  Geo.  Ross,  showed 
organs  from  a  case  of  abdominal  sarcoma.  The 
patient  was  an  active,  muscular  man,  28  years  of 
age,  and  came  under  observation  three  weeks 
previously.  Six  months  ago  he  began  to  experi- 
ence lumbar  pain,  which  was  called  lumbago,  and 
suggestions  made  of  some  affection  of  the  kidneys  ; 
suffered  much,  and  at  times  pain  was  also  felt  in 
the  abdomen,  not  unfrequently  accompanied  by 
vomiting ;  general  health  had  failed,  and  he  looked 
somewhat  thin  and  anasmic,  although  he  had  kept 
at  his  business  until  the  time  of  his  fatal  seizure. 
Having  suffered  considerably  for  some  days,  he 
was  suddenly  taken  one  morning  with  most  agoniz" 
ing  pain  in  the  epigastrium.  When  seen,  he  was 
collapsed-looking,  with  rapid  pulse  and  cold  per- 
spiration. A  large  quantity  of  morphia  was  requir- 
ed before  any  relief  was  obtained.  The  case  now 
looked  something  like  a  perforative  peritonitis,  but 
the  course  of  events  soon  negatived  this.  From 
this  time  until  death,  twenty  days  later,  it  was 
absolutely  necessary  to  give  frequent  hypodermic 
injections  to  control  the  excessive  pain.  There 
was  great  tenderness   in   the   epigastrium,  which 


80 


THE   CANADA   MEDICAL   RECORD. 


believed  to  be  part  of  the  liver.  Soon  sharp 
stabbing  and  very  distressing  pains  were  complain- 
ed of  in  the  lower  part  of  the  chest — first  on  one 
side,  then  on  the  other.  There  was  no  physical 
evidence  of  pleurisy,  but  fine  and  coarse  rales 
were  heard  over  the  back  and  lateral  regions  of 
both  lungs. 

A  short  cough  set  in,  and,  during  several  days 
small  quantities  of  very  bright  blood  were  frequent- 
ly brought  up.  The  diagnosis  was,  tumor  in  the 
back  of  the  abdomen,  locality  uncertain,  but  press- 
ing upon  the  lumbar  nerves — the  recent  and  fatal 
attack  being  looked  upon  as  due  to  an  acute  intra- 
peritoneal abscess.  The  specimens  were  :  a  mass 
of  sarcoma  as  large  as  two  fists,  which  lay  against 
the  vertebral  column,  and  had  evidently  originated 
in  the  retro-peritoneal  glands.  Several  nodules 
of  secondary  deposit  in  the  liver;  the  left  lobe 
occupied  by  an  immense  clot  of  blood,  entirely 
disorganizing  the  part  and  distending  the  capsule 
of  the  organ  (softening  of  one  of  the  nodules  and  a 
profuse  hemorrhage  into  the  substance  of  the  liver, 
distending  its  capsule  had  caused  the  sudden  attack 
described) .  The  lungs  contained  numerous  nodules 
of  similar  growth,  varying  in  size  from  a  large  pea  to 
a  walnut ;  the  largest  of  them  projected  considerably 
from  the  surface,  and  corresponded  to  the  seat  of 
the  stabbing  pains.  Dr.  Ross  remarked  upon  the 
importance  of  abiding  pain  in  any  part  of  the  dorsal 
or  lumbar  region,  with  deterioration  of  the  general 
health,  as  indicating  the  presence  of  such  growths 
in  the  deep-seated  glands.  Such  hepatic  hemorr- 
hage must  be  a  very  rare  occurrence,  and  could 
not  have  been  diagnosed  during  life. 


Stated  Meeting,  October  22nd,  1886. 
J.  C.  Cameron,  M.D.,  President,  in  the 

Chair. 
Synovitis  of  the  Knee-joint  in  Congenital 
Syp/ii/is. 
Dr.  Lapthorn  Smith  exhibited  a  boy  12  years 
old,  and  read  the  following  notes  : — He  was  brought 
to  me  by  his  mother,  complaining  of  a  swelling  of 
the  right  knee,  which  he  had  had  for  nine  months 
or  a  year.     He  also  had  some  ill-looking  suppu- 
rating sores  on  his  throat  and  chin,  due  to  glands 
which    had   formed   abscesses    and    broken,  thus 
destroying  a  considerable  surface  of  skin.     The 
knee  was   very  much  swollen,  only  slightly  red, 
not    very    painful,    and    not   at  all    hot    to    the 
touch.     As  the  swelling  was  pointing,  I  opened  it, 


and  a  half  ounce  of  thick  yellow  pus  escaped. 
The  peculiar  appearance  presented  by  the  boy's 
nose  and  teeth  enabled  me  at  once  to  diagnose 
congenital  syphilis.  His  nose  is  flattened,  and 
his  teeth  present  the  peculiar  chisel  shape  which 
Mr.  Hutchinson  says  is  pathognomonic  of  congen- 
ital syphilis.  Moreover,  the  disease  of  the  knee- 
joint  was  much  less  painful  than  non-syphilitic 
knee-joint  disease  generally  is.  The  mother  did 
not  know  anything  about  syphilis,  but  I  elicited  the 
following  important  information  :  That  her  first  child 
was  born  dead  ;  her  second  was  born  dead  ;  the 
third  was  this  one,  born  at  full  time,  but  affected 
with  "  snuffles,"  mucous  patches  at  the  anus,  and 
a  copper-color  rash  over  the  body,  for  all  of  which 
he  was  treated ;  the  fourth  child  was  born  at  full 
time,  only  had  a  slight  eruption,  and  is  no^v  alive 
and  well.  The  fifth,  sixth  and  seventh  pregnan- 
cies were  premature.  This  boy  never  had  inter- 
stial  keratitis,  nor  any  other  symptoms  than  those 
mentioned.  She  also  informed  me  that  her  hus- 
band was  over  40  when  he  married — a  suspicious 
circumstance,  I  thought,  so  I  asked  her  to  send 
him  to  me.  On  seeing  him,  I  astonished  him  very 
much  by  telling  him  that  he  had  had  syphilis  in 
his  younger  days,  which  he  at  once  admitted.  I 
placed  the  boy  on  cod-liver  oil,  and  gray  powder 
alternated  with  syrup  of  iodide  of  iron,  generally  ; 
and  Scott's  dressing  locally,  alternated  with  tinc- 
ture of  iodine,  under  which  he  rapidly  improved. 
I  removed  him  from  school,  but  I  did  not  deem  it 
advisable  to  confine  him  to  bed,  nor  even  alto- 
gether to  the  house,  all  of  which  I  would  have 
done  if  I  had  considered  it  a  case  of  ordinary 
disease  of  the  knee-joint,  because  I  considered  it 
of  importance  to  keep  up  his  general  health.  The 
affected  knee  is  now  only  a  quarter  of  an  inch 
larger  around  than  the  other  one,  which  is  now 
perfectly  healthy,  although  it  was  somewhat  full 
when  he  first  came.  Mr.  Clutton  of  St.  Thomas 
Hospital  has  collected  13  of  these  cases,  which  he 
calls  symmetrical  disease  of  the  knee-joint  due  to  he- 
reditary syphilis.  What  is  most  interesting  about 
these  cases  is  the  prognosis,  which  is  very  favorable, 
contrary  to  that  in  ordinary  cases ;  and  what  is 
remarkable  is  that  there  is  little  or  no  pain.  This 
boy  could  hardly  be  prevented  from  running  as 
fast  as  the  other  boys  in  the  street,  although  his 
knee-joint  was  so  full  of  liquid  that  the  patella 
distinctly  floated.  All  of  Mr.  Glutton's  cases  were 
in  children  between  8  and  12  years  of  age. 

Dr.  Bell  considered  the  case  a  marked  one  of 


THE   CANADA   ME0ICAL   RECORD. 


31 


hereditary  syphilis,  and  advised  ijutting  the  affec- 
ted joint  at  rest. 

Laryngeal  Phthisis. — Dr.  Major  introduced 
to  the  notice  of  the  Society  the  treatment  of 
Laryngeal  Phthisis  by  the  injection  of  lactic  acid 
into  the  substance  of  the  larynx. 

He  briefly  referred  to  the  success  that  had,  last 
winter,  attended  the  use  of  that  acid  as  a  pigment 
in  private  and  hospital  practice.  The  discovery 
of  lactic  acid  as  a  means  of  local  cure  was  due 
to  Kausa  of  Berlin,  at  whose  Klinik  during  the 
past  summer  he  had  ample  opportunity  of  observ- 
ing the  excellent  results  attending  this"  remedy, 
when  inserted  beneath  the  mucous  membrane  of 
the  larynx.  Dr.  Major  employed  for  the  purpose 
Dr.  Theodore  Herring's  (Warsaw)  syringe  as  modi- 
fied by  Kausa.  Lactic  acid  when  used  by  the 
latter  method  was  particularly  prompt  in  its  action, 
deposits  of  tuberculous  matter  underwent  rapid 
absorption,  and  the  local  lesion  quickly  disappear- 
ed. It  was  especially  effectual  in  the  early  stage 
of  swelling  and  cedema,  cutting  the  disease  short 
before  ulcerative  changes  had  begun.  Eight  or  ten 
operations,  extending  over  a  period  of  20  days, 
would,  in  the  majority  of  cases,  prove  sufficient  to 
completely  restore  a   tuberculous  larynx. 

Dr.  Major  used  a  20  per  cent,  solution,  and  injec. 
ted  from  10  to  20  minims  at  each  sitting.  The 
use  of  lactic  acid  was  not  particularly  irritating, 
and  did  not  interfere  with  the  carrying  out  of 
other  means  of  a  sedative  nature.  A  case  under 
treatment  was  demonstrated  to  the  members  pre- 
sent, in  which  one  side  only  had  at  first  been 
acted  upon,  and  the  marked  difference  in  the  degree 
of  swelling,  etc.,  was  very  manifest.  Other  cases 
undergoing  treatment  by  injection  were  doing 
equally  well,  and  would  be  shown  at  an  early  day. 

He  considered  that  this  plan  had  already  been 
established  as  more  speedy  and  permanent  than 
any  of  its  predecessors. 

Discussion. — Dr.  R.  J.  B.  Howard  congratu- 
lated Dr.  Major  on  the  marked  effect  of  this  mode 
of  treatment  in  the  case  exhibited.  In  the  earlier 
stages  of  laryngeal  phthisis  he  usually  applied  a 
weak  solution  of  silver  nitrate,  and  later,  iodoform 
and  boracic  acid.  In  all  cases  of  ulceration  he 
found  this  treatment  very  efficacious.  A  relapse 
of  the  disease  was,  in  his  experience,  the  general 
rule. 

Dr.  F,  W.  Campbell  considered  the  tendency 
of  modern  methods  of  treating  phthisis  to  be  direct 
applications  to  the  seat  of  the  lesion,  but  did  not 


believe  in  neglecting  general  treatment  at  the  same 
time. 

Dr.  Geo.  Ross  called  attention  to  the  beneficial 
effect  of  the  treatment  in  the  case  exhibited.  The 
interesting  point  about  the  mode  of  treatment  is 
the  prospect  it  opens  up  of  being  able  to  destroy 
the  tubercular  focus  in  cases  where  pulmonary 
tuberculosis  originates  in  the  larynx.  Patients 
have  escaped  general  tuberculosis  by  excision  of 
an  affected  joint.  Even  in  pulmonary  tuberculo- 
sis, where  the  laryngeal  phthisis  is  secondary,  the 
relief  of  the  intense  pain  and  distress  would  be 
a  great  boon. 

Tumor  of  the  Optic  Nerve.— Tis..  Buller 
exhibited  the  tumor  and  gave  the  following 
particulars  of  the  case  : — This  growth  was  removed 
on  the  1 6th  of  April  from  the  orbit  of  a  little  girl 
7  years  of  age.  The  history  of  the  case  and  the 
objective  signs  were  sufficiently  distinctive  to 
warrant  a  diagnosis  of  tumor  of  the  optic  nerve 
before  the  operation  for  its  removal  was  under- 
taken. The  child  was  well  developed  and  in 
excellent  health.  About  six  months  previously  an 
undue  prominence  of  the  right  eye  was  noticed, 
and  this  had  slowly  increased.  Two  months 
previously  the  vision  was  tested  by  a  physician 
and  thaeye  found  to  be  entirely  blind,  just  as  it 
was  when  I  first  saw  it  on  the  15th  of  April.  The 
amount  and  character  of  the  proptosis  can  be 
pretty  well  estimated  by  a  glance  at  this  photograph 
taken  the  same  day.  The  protrusion  was  con- 
siderable, and  almost  directly  forwards  ;  the 
movements  of  the  eyeball  were  slightly  impaired, 
but  not  more  so  in  one  direction  than  another. 
No  signs  of  any  deep-seated  inflammatory  process 
existed,  nor  was  there  pulsation  or  bruit,  or  change 
in  degree  of  proptosis  from  placing  the  head  in 
such  a  position  as  would  favor  congestion  of  the 
parts.  The  ophthalmoscope  showed  a  greatly 
swollen  optic  nerve — unilateral  choked  disc.  This, 
with  the  complete  and  early  blindness,  were  strong 
points  in  the  diagnosis.  I  hoped  to  be  able  to 
remove  the  growth  and  return  the  eyeball  in 
position.  After  dividing  the  attachment  of  the 
outward  rectus,  and  passing  the  finger  between 
this  muscle  and  the  eyeball,  it  was  easy  to  feel  the 
enormously  swollen  nerve  and  trace  it  to  the  optic 
foramen,  where  it  was  removed  with  curved 
scissors  and  afterwards  separated  from  the  eyeball. 
There  was  only  moderate  bleeding,  and,  as  far  as 
the  manipulative  procedure  was  concerned,  it 
would  have  been  easy  to  return  the  eyeball ;  but, 


32 


THE  CANADA  MEDICAL  RECORD. 


on  finding  that  the  pulpy  growth  over  the  sheath 
of  the  nerve  extended  right  up  to  the  optic  foramen, 
I  thought  the  chances  of  preventing  a  recurrence 
of  the  tumor  would  be  improved  by  a  free  applica- 
tion of  chloride  of  zinc  paste  to  the  apex  of  orbit, 
and  under  these  circumstances  deemed  it  useless 
to  attempt  to  save  the  eyeball.  Accordingly  the 
eye  was  removed  and  the  zinc  paste  applied.  The 
child  made  a  good  recovery,  and  returned  home 
in  two  weeks  after  the  operation.  The  growth, 
you  will  see,  is  all  contained  within  the  sheath  of 
the  optic  nerve,  and  forms  an  ovoid  mass  about 
25  mm.  in  length  and  15  mm.  in  diameter;  it  was 
tolerably  firm,  and  had  a  pulpy,  semi-transparent 
appearence  when  removed.  I  suspect  it  is  a 
myxo-sarcoma,  but  Dr.  Johnston  has  kindly  made 
an  examination  of  its  histological  structure  under 
the  microscope,  and  will  perhaps  kindly  favor  us 
with  the  result  of  his  investigation. 

Dr.  Wyatt  Johnston  reported  the  result  of 
the  microscopic  examination.  No  trace  of  nerve 
tissue  was  found.  The  growth  was  fibrous,  and 
was  characterized  by  a  fine  meshwork  resembling 
a  glioma. 

In  reply  to  Dr.  Bell,  Dr.  Buller  stated  that 
there  was  no  recurrence  of  the  growth. 

J^'m^'l^S  of  Smnce. 

TREATMENT  FOE  THE  VOMITING  OF 

PREGNANCY. 

By  Geo.  J.  Engelmann,  M.D.,  St.  Louis,  Mo. 

The  question,  "  How  do  you  treat  vomiting  of 
pregnancy  ?  "  is  one  often  asked,  and  one  which 
almost  as  often  receives  a  varying  answer.  The 
question  is  full  of  interest  and  importance,  and 
although  frequently  occurring  to  the  practitioner, 
it  has  not  rceived  proper  attention.  For  various 
reasons  the  trouble  is  an  annoying  one,  and  it  is  as 
frequent  as  it  is  annoying.  The  remedies  recom- 
mended or  the  treaments  advocated  differ  -nndely, 
yet,  odd  as  it  may  seem,  there  is  good  reason  for 
this.  Physicians  who  have  obtained  good  results 
with  some  remedy  or  method  of  treatment  naturally 
favor  that  and  thoughtlessly  recommend  it  for 
vomiting  of  pregnancy  in  general.  It  is  tried,  and 
and  it  fails.  Others  succeed  with  methods  differing 
widely,  hence  we  come  to  no  understanding,  nor 
do  we  arrive  at  any  satisfactory  conclusion  as  to 
the  method  of  treament.  To  do  this  we  must  con 
sider  the  nature  and  cauft  of  the  disorder. 

The  vomiting  of  pregnancy  is  not  a  disease,  but  a 
tymptom,  and  a  symptom  varying  greatly  in  charac- 
ter as  determined  by  the  underlying  cause.  From 
the  moment  that  we  cease  to  look  upon  this  dis- 
turbance as  a  disease  to  which  a  certain  line  of 


treatment  is  applicable,  and  view  it  merely  as  a 
tymptom  arising  sometimes  from  one  disorder  and         ., 
sometimes  from  another,   the  plan  of  treatment  to        / 
be  adopted  will  be  reached  more  readily  and  with 
greater  certainty. 

We  must  distinguish  between  the  vomiting  of  ear- 
ly pregnancy  and  the  vomiting  in  the  later  months 
of  pregnancy  ;  the  vomiting  of  the  early  months 
of  pregnancy  is  always  a  neurosis,  due,  either  to 
the  distention  of  the  uterus,  or  to  reflex  nervous  in- 
fluences dependent  upon  the  recently  established 
gestation — that  is  upon  physiological  causes  and 
physiological  conditions,  or  in  other  cases  upon 
pathological  conditons,  such  as  narrowing  of  the 
cervical  canal ;  erosion  of  the  cervix  by  friction 
upon  some  part  of  displayed  organ.  In  the  later 
months  of  pregnancy  the  vomiting  is  not  always  a 
neurosis,  a  gastric  hystero-neurosis  ;  but  may  be 
due  to  a  local  irritation,  to  pressure  upon  the  stom- 
ach by  the  enlarged  uterus  or  to  some  disturbance 
in  the  gastro-intestinal  canal  or  its  nerves,  brought 
about  by  the  very  much  enlarged  uterus. 

TREATMENT  OF  VOMITING  INTHE  EARLY  MONTHS. 

In  those  cases  in  which  the  vomiting  is  merely  a 
reflex  neurosis  due  to  physiological  changes  in 
the  uterus,  we  must  attempt  to  quiet  the  irritated 
gastric  nerves  and  give  tone  to  the  system.  I 
then  advise  the  use  of  some  of  the  mild  remedies 
so  frequently  recommeded ;  there  are  many  ef- 
fective and  well  known,  but  I  will  merely  mention 
those  which  I  use  and  upon  which  I  have  learned 
to  rely,  never  having  cause  to  seek  for  others.  I 
generally  give  a  powder  composed  of  lactopeptine 
60  gr.,  bicarbonate  of  soda,  60  gr.,  sugar  with  oil  of 
peppermint,  60  gr.,  a  little  rhubarb  10  to  20  gr.,  with 
gentian  or  ginger  5  to  10  gr.,  giving  a  knife-point  full 
before  and  after  meals.  When  the  Stomach  feels  faint 
I  give  a  teaspoonful  ot  a  mixture  of  bitter  almond 
water  i  oz.,  with  orange  flower  water  i  oz.,  and  a 
little  hyosciamus  2  to  6  gr.  In  case  this  treatment 
is  not  followed  by  speedy  improvement  I  give  a 
teaspoonful  of  a  one  per  cent,  solution  of  carbolic 
acid  in  water,  but  never  fail  to  quiet  the  stomach 
with  ten  drops  of  a  four  per  cent,  solution  of  cocaine 
(cocaine  hydrochloral  2 J  gr.:  aq.  dist.  60  drops). 

In  many  instances,  however,  we  will  find  some 
slight  local  disturbance,  some  displacement  of  the 
uterus,  and  eroded  cervix,  an  endocervicitis,  and 
in  these  cases  the  local  condition  must  be  looked 
to.  In  rare  cases  only  have  I  used  the  strong 
remedies.  I  generally  succeed  with  mild  applications 
a  ten  per  cent,  solution  of  carbolic  acid  to  an 
inflamed  cervical  canal,  or  with  the  dry  treatment 
of  an  erosion,  dusting  the  surface  with  bismuth 
or  iodoform  and  retaining  the  uterus  in  place  and 
dressing  the  part  with  a  tampon  of  tannated  or  bo- 
rated  cotton.  I  have  never  been  obliged  to  resor- 
to  dilatation  of  the  canal,  which  was  quite  the  fash- 
ion at  one  time.  It  was  spoken  of  a  great  deal- 
highly  reeommended,  but  now  seems  to  have  been 
forgotten,  and  justly,  because  it  is  dangerous  and 
rarely  necessary.      Where  we  succeed  with  dilata- 


THE   CANADA    MEDICAL   RECORD. 


33 


tion  of  the  canal  we  will  succeed  as  well,  if  not 
better,  by  a  mild  astringent  application,  the  nar- 
rowing of  the  canal  being  often  due  to  a  swelling 
of  the  tissues,  whether  physiological  or  pathological 
and  by  reducing  this  we  widen   the  canal   more 
safely  than  we  do  by  distention.    Possibly  there  are 
some  cases  in  which  it  is  called  for,  but  milder 
means   and  safer  ones,  will  generally  answer — I 
may  say  always,  if  the  disorder  is  not  allowed  to 
progress   and  treatment   is  at   once  inaugurated. 
Applications    of  a  four  per  cent,    solution  of  co- 
caine, or  pure  salt  to  the  canal  and  to  the  eroded 
cervix,  I  have  found  useful  as  a  means  of  afford- 
ding  immediate  relief.      It  is  desirable  to  stop  the 
vomiting  for  the  time  being  and  immediately.     As 
a  rule  I  have  followed  the  use  of  cocaine  by  the 
application  of  a  mild  astringent  or  the  ten  per  cent, 
carbolic  acid  solution.     Cocaine  quiets  the  nerv- 
ous irritability  and  prevents  an  injurious  action  of 
the  drug  itself,  whilst  the  astringent  affords  per- 
manent relief.     But  whatever  treatment  is  adopt- 
ed, the   physician  must   not  fail  to  see  that   the 
bowels  are  well  regulated  and  that  proper  diet  is 
observed.     In  mild  cases  when  medication  is  not 
desired  or  feasible,  I  am  very  fond  of  following 
an  old  German  custom.     I  advise  the  patient  to 
take  a  small  cup  of  strong  coffee  upon  awakening 
in  the  morning — best   without  sugar  or  cream — 
then  to  remain  quietly  in  bed  for  an  hour  before 
getting  up. 

TREATMENT  OF  VOMITING  IN  THE  LAST  MONTHS  OF 
PREGNANCY. 

In  the  last  months  of  pregnancy  the  nausea  and 
vomiting  are  not  so  persistent  as  in  the  early  months 
and  less  often  due  to  pathological  conditions  of  the 
uterus.  It  is  caused  by  pressure  of  the  enlarged 
organ  either  upon  the  stomach  or  some  of  the 
sympathetic  centers  or  as  in  the  early  months,  it  is 
a  hystero-neurosis — is  due  to  the  physiological 
condition  of  the  uterus  or  to  pathological  changes 
will  afford  relief.  I  have  invariably  succeeded  with 
the  use  of  mild  astringent  applications  about 
the  cervix.  When  the  latter  is  the  case,  lo- 
cal treatment  is  called  for  as  in  the  earlier  months  ; 
I  would  emphasize  this,  as  the  local  treatment  in 
the  vomiting  of  the  last  months  of  pregnancy  is 
altogether  too  much  neglected.  I  have  succeeded 
in  checking  most  persistent,  almost  fatal,  vomiting 
in  the  last  months  of  pregnancy,  after  all  possible 
methods  of  treatment  had  been  tried  by  homcepath 
and  allopath,  by  local  applications  to  the  cervix. 

Vomiting  at  this  time,  if  from  local  causes,  is 
generally  to  due  to  tension  upon  the  nerves  by 
the  swelling  of  the  cervical  tissue ;  astringent 
and  anodyne  applications  will  afford  relief.  I  have 
juvariably  succeeded  with  the  use  of  mild  astrin- 
gent applications,  and  the  continuous  use  of 
such  remedies  applied  by  means  of  the  tam- 
pon, either  in  powder  or  in  solution  with  glycerine. 

Tannin,  carbolic  acid  and  iron  may  be  used 
alone  or  in  a  variety  of  combinations  applied  with 
the  glycerine  tampon.     The  mild  application  of  a 


galvanic  current  to  the  cervix  sometimes  affords 
speedy  relief  if  other  means  fail.  A  strong  current, 
however,  must  not  be  used  ;  and  in  case  ofgreat  gas- 
tric irritation  the  positivepole  of  thegalvanic  current 
upon  the  stomach,  the  negative  pole  upon  the 
spinal  cord,  will  allay  this  aggravating  gastric 
irritation.  A  faradic  current  may  also  be  tried, 
I  have  never  been  obliged  to  resort  to  electricity, 
by  reason  of  the  failure  of  other  methods,  but  have 
tested  it  succesfully  in  cases  which  I  did  not  resort 
to  my  usual  treatment. 

The  question  may  be  asked,  how  are  we  to  tell 
what  treatment  to  use  ;  how  are  we  to  know  the 
nausea  and  vomiting?  I  make  it  a  rule  to  ex- 
amine the  patient  and  inquire  into  her  general 
condition,  and  if  a  local  examination  reveals  any 
marked  pathological  change  this  should  be  at  once 
remedied.  If  nausea  and  vomiting  do  not  then 
cease,  internal  medication  may  be  resorted  to, 
but  as  a  rule  it  will  be  found  that  upon  proper 
treatment  of  the  local  disturbance  nausea  will 
cease.  On  the  other  hand,  if  there  be  no  such  disturb- 
ance, we  at  once  resort  to  internal  medication; 
and  if  this  is  not  successful  and  speedily  so,  we 
must  act  upon  the  supposition  that  the  vomiting 
is  due  to  the  physiological  condition,  and  then  we 
may  resort  to  the  use  of  cocaine,  either  internally 
or  applied  to  the  cervix  and  cervical  canal,  or  we 
apply  anodyne  and  astringents  to  cervix  by  tampons 
and  if  necessary  to  the  cervical  canal  itself. 

I  have  never  seen  a  case  that  did  not  yield  to 
treatment,  local  or  general,  if  not  applied  at  too  late 
a  stage  when  the  patient  was  almost  in  collapse. 
And  yet  you  will  say  that  fatal  cases  not  unfrequent 
ly  occur.  This  is  true,  but  it  is  not  because  we  have 
no  certain  means  of  overcoming  the  disorder,  it  is 
because  relief  is  sought  too  late.  For  such  fatal 
results  medical  teachers  and  medical  text-books 
are  to  the  great  extent  accountable.  There  is  a 
wide-spread  belief  among  the  laity,  deeply  rooted 
among  mid-wives  and  knowing  old  women,  that 
the  vomiting  of  pregnancy  is  a  natural  condition 
and  should  not  be  interfered  with  ;  and  I  am 
ashamed  to  say  that  text-books  cultivate  this  belief, 
teach  it  to  the  physician  ;  and  among  the  older 
members  of  the  profession,  graduates  of  early  days, 
it  is  almost  a  universal  rule  not  to  disturb  the 
vomiting  of  pregnancy,  unless  it  becomes  persistent 
and  severe.  Excellent  physicians  pay  no  attention 
to  the  complaints  of  pregnant  women  when  suffering 
from  nausea  and  vomiting,  and  even  the  most 
modern  of  text-books  say  that  we  should  not  or 
need  not  interfere  with  nausea  and  vomiting, 
unless  it  becomes  so  severe  as  to  endanger  life. 
Even  Lusk,  that  excellent  authority,  tells  us  so 
and  quotes  from  an  equally  prominent  German  au- 
thor, the  recipe  of  an  obstetric  authority  who  when 
the  young  wife  told  him  of  her  trouble,  laughingly 
advised  her  to  "  go  upon  a  visit  to  her  mother," 
meaning,  in  other  words,  that  treatment  is  needless 
or  powerless  and  the  best  you  can  do  is  to  have 
a  good  time  and  a  change.  These  are  not  teach- 
ings as  we  should  expect  them  in  the  present  era 


u 


THE   CANADA   MEDICAL   RECORD. 


of  medical  progress.  The  student  should  be  taught 
that  this  is  a  morbid  symptom  due  to  some 
pathological  condition  as  it  is  most  undoubtedly  ; 
which  should  be  overcome  at  once  !  the  sooner  the  at- 
tempt is  made  the  more  likely  it  is  to  prove  success- 
ful. Why  must  the  patient  first  be  weakened  by 
lack  of  food  and  long  suffering,  and  even  in  danger 
of  life  before  we  interfere  ?  If  it  is  right  to  inter- 
fere then,  it  is  right  to  interfere  when  the  trouble 
is  first  inaugurated,  and  it  is  then  most  easily 
overcome.  Mild  remedies,  careful  diet  and  proper 
regime  will  easily  check  the  nausea  and  vomiting 
when  it  first  appears,  and  naturally  so,  as  the 
patient  is  in  a  much  better  condition  to  respond 
to  treatment  than  when  weakened  by  months  of 
suffering.  Should,  perchance,  all  treatment  fail 
the  uterus  must  be  at  once  emptied,  and  we  should, 
under  no  circumstances  fail  to  bring  about  a 
miscarriage.  If  not  delayed  too,  long  relief  is 
instantaneous.  But  unfortunately  this  operation 
is  looked  npon  as  a  desperate  dernier  resort 
put  off  from  day  to  day,  until  the  sufferer  has 
lost  her  vitality  and  succumbs,  when  at  last  it 
is  determined  upon.  If  performed  in  time  the 
operation  is  accompanied  by  very  little  risk  and  is 
sure   to  afford  relief 

If  I  have  succeeded  in  impressing  upon  your 
readers  that  it  is  the  duty  of  the  physician  to  treat 
this  disorder,  and  to  treat  it  when  it  first  appears  ; 
ifl  have  succeeded  in  showing  the  failure  of  the 
old  teaching,  and  the  old  women's  belief  that  we 
must  not  interfere,  unless  it  becomes  dangerous, 
then  I  have  rendered  you  a  far  greater  service  than 
by  recording  any  one  method  of  treatment. 


NASAL  CATARRH. 
By  G.  Q.  Orvis,  M.D. 

seymour,  indiana. 
[Read  to  the  Mitchell  District  Medical  Society,  at  Seymour, 
June  4,  1886.] 

I.'present  to  you  to  to-day  a  short  paper  on  Nasal 
Catarrh,    or  a   more     appropriate   term  Rhinitis. 

This  term  applies  to  the  abnormal  condition  we 
so  often  find  affecting  the  membrane  which  lines 
the  nasal  cavities,  and  may  be  in  the  acute,  sub- 
acute, or  chronic  stage.  As  to  form  we  may  find 
either  the  simple,  the  hypertrophied,  or  atrophic. 

The  latter  being  known  as  oezena,  and  should  be 
treated  as  a  separate  disease.  Rhinitis  in  the 
acute  stage  is  generally  known  as  coryza,  and 
mucous  membranes  continous  with  the  Sch- 
neiderian,  lining  other  cavities,  is  generally  affected 
at  the  same  time.  The  condition  we  know  as  a 
bad  cold,  hay-fever,  and  the  coryza  present  during 
exanthematous  fevers  are  forms  of  acute  rhinitis. 

It  is  from  the  frequent  recurrence  of  this  acute 
trouble  that  the  subacute  and  chronic  forms  appear  ; 
it  is  this  condition  that  is  most  often  seen  by  the 
physician,  and  it  is  the  disease  in  this  stage  with 
which  this  paper  will  deal. 

To  correctly  understand  rhinitis  we  must  look 
at  the  anatomical  .structure  with  which  we  come  in 


contact,  and  we  find  a  membrane  lining  the  nasal 
cavities  extending  to  other  cavities,  composed  of  a 
basement  membrane  of  areolar  tissue  that  contains 
numerous  mucous  secreting  glands,  covered  exter- 
nally by  epithelium  of  the  cilitated  variety,  through 
which  the  ducts  of  the  mucous  glands  open  and 
pour  forth  their  excretions.  This  membrane  is 
abundantly  supplied  with  blood  vessels,  both  arte- 
rial and  venous,  and  its  nerve  supply  is  very  liber- 
al, coming  from  the  four  systems  of  nerves,  viz. : 
the  special  sense,  the  sympathetic,  the  motor,  and 
the  common  sensor.  That  part  of  the  membrane 
above  the  middle  turbinated  bones  is  known  as 
the  olfactory  membrane,  and  receives  the  olfactory 
nerve  filaments;  therefore  is  the  membrane  of  smell. 

The  cilia  on  this  membrane  are  longer,  and  the 
venous  supply  is  less  ;  therefore,  we  have  a  darker 
colored  surface  here  than  in  other  parts  of  the  nasal 
cavity.  The  membrane  b^low  the  middle  turbinated 
bones  is  known  as  the  pituitary  membrane.  Nothing 
in  particular  is  necessary  to  say  about  this,  except 
the  support  which  it  gives  to  the  blood  vessels  is 
very  poor ;  congestion  takes  place  easy  and  soon 
becomes  passive.  These  membranes  or  membrane, 
as  we  choose  to  consider  it,  covers  the  bony  and 
cartilaginous  walls  of  the  nasal  cavities  ;  also  covers 
the  turbinated  bones  found  in  the  cavities.  The 
structure  of  these  bones  is  peculiar,  they  being 
almost  semi-cartilaginous  of  many  surfaces  and 
very  liberally  supplied  with  vessels ;  they  are  thin- 
ly covered  with  tissue,  and  when  their  covering 
is  irritated  becomes  greatly  enlarged  by  the  en- 
gorgement of  blood,  especially  when  the  irritation 
is  lasting  or  often  repeated.  This  imperfect  ana- 
tomical sketch  will  be  sufficient  for  our  use  in  this 
paper,  and  we  will  look  at  the  physiology  for  a 
moment. 

The  most  important  function  is  for  the  prepar- 
ation of  the  air,  which  passes  over  its  surface  during 
respiration.  The  inspired  air  is  warmed,  and 
probably  a  certain  amount  of  moisture  added  to  it 
in  passing  over  the  Schneiderian  membrane.  This 
fact  is  proven  in  two  ways  :  first,  if  we  have  com- 
plete stenosis  of  nasal  cavities,  and  the  person  so 
affected  becomes  a  mouth-breather,  we  are  sure  to 
have  acute  inflammation  of  the  lower  part  of  the 
respiratory  tract ;  indeed,  so  true  is  this,  that  I  am 
quite  sure  it  could  be  proven  that  all  persons 
suffering  from  asthma  are  mouth-breathers.  Two 
cases  which  I  have  treated  for  asthma  quite  re- 
cently, and  which  are  well-known  to  all  of  the 
physicians  in  the  city,  are  both  suffering  from  nasal 
stenosis,  and  both  inspire  air  through  their  mouth. 

The  cause  of  this  inflammation  is  no  doubt  an 
improper  condition  of  the  inspired  air  when  it 
reaches  the  bronchi  and  air  cells,  being  too  cold 
and  dry,  and  not  as  nature  had  intended  it  to  be. 

Another  proof  is,  that  the  great  danger  in  trach- 
eotomy is  the  congestion  and  extension  downward 
of  the  inflammation,  and  consequent  closure  of  the 
air  cells  produced  by  cold  inspired  air  ;  in  fact,  so 
great  is  this  danger  that  intubation  of  the  larynx  is 
now  coming  into  use,  and  is  more  successfully  used 


THII  CANADA   MEDICAL   RECORD. 


3§ 


than  tracheotomy,  and  no  other  reason  can  be  given 
for  its  superiority.  The  special  function  of  smell 
we  will  not  dwell  upon,  as  it  is  generally  known 
that  its  loss  causes  no  great  inconvenience,  and, 
therefore,  to  the  human  race  is  not  very  important, 
although  in  the  brute  creation  it  is  one  of  the  most 
important  of  senses.  Another  function  is  the  act 
of  excretion,  and  just  how  for  this  affects  the  human 
system  we  are  not  prepared  to  say,  but  no  doubt 
there  is  a  great  deal  of  morbid  material  taken  out 
of  the  circulation  in  this  way,  and  when  it  is  check- 
ed a  great  many  ailments  may  be  caused,  which 
are  well  understood  when  we  work  out  the  problem 
of  re-absorption  of  worn  out  matter  and  reflex 
irritation. 

We  will  now  notice  the  pathological  conditions 
we  find  in  rhinitis,  and  then  pass  on  to  the  treat- 
ments supplemented  by  the  clinical  history  of  a  few 
cases  that  have  been  in  our  care.  We  always  find 
in  chronic  rhinitis  a  discolored  membrane,  and  if 
the  disease  has  not  passed  from  the  hypertrophied 
condition,  is  considered  the  true  state  of  this 
trouble,  we  have  a  thickened  membrane  with  en- 
largement of  a  part  or  all  of  the  turbinated  bones 
and  thickening  of  the  vomer.  The  symptoms  of 
this  condition  are  lassitude,  fever,  and  stenosis,  or, 
as  the  patient  describes  it,  a  stuffy  feeling  in  the 
head.  Auxiliary  symptoms  are  local  pain  caused 
by  pressure  upon  some  nerve  filament,  reflex  head- 
ache, deafness,  caused  by  stoppage  of  the  nasal 
orifice  of  eustachian  tube,  pharyngitis  from  exten- 
sion, and  ocular  conjunctivitis. 

The  treatment  for  catarrh  is  as  varied  as  the 
number  of  patients  you  meet ;  no  set  treatment 
will  answer  your  purpose.  First  of  all  to  remove 
the  cause  and  to  illustrate  this  I  will  cite  a  case. 

My  first  case  of  rhinitis  was  in  the  six-year-ol,d 
son  of  a  Mr.  S.  of  this  city.  The  left  nostril  was 
closed  by  the  thickening  over  the  external  end  of 
inferior  turbinated  bone  and  the  sweUing  above 
this  caused  a  bulging  of  the  left  alae  of  the  nose 
that  was  very  perceptible.  A  very  fetid  discharge 
was  oozing  from  the  nostril,  and  the  boy  was  suf- 
fering from  what  appeared  to  be  remittent  fever. 

In  this  case  fortune  favored  me ;  for  without 
scarcely  knowing  why  I  should  do  it,  I  introduced 
a  blunt  probe,  and  my  maneuvers  dislodged  a  good- 
sized  piece  of  a  chip,  which  was  blown  out  of  the 
nostril  by  an  effort  of  the  little  patient  to  get  away 
from  the  cruel  probing  he  was  undergoing.  I  then 
supplied  the  mother  with  a  Pierce  nasal  douche, 
and  gave  her  directions  for  using  it,  and  requested 
her  to  bring  the  boy  to  me  again  in  three  days. 

She  did  so  and  I  found  the  nostril  quite  open, 
the  swollen  condition  reduced  very  much,  and 
another  piece  of  a  chip  in  sight,  which  I  removed  ; 
and  in  a  few  weeks  the  nose  was  entirely  well.  I 
learned  that  this  boy  had  been  treated  by  two 
of  our  older  physicians,  for  several  months,  and 
one  of  them  had  pronounced  it  cancerous.  In  a 
bkmdering  way  I  had  relieved  the  boy  and  made 
myself  famous_  in  the  eyes  of  this  family.  From 
this  one  case  I  learned  to  always  try  and  remove 
the  cause  if  it  can  be  found.     If  scarlatina,  or  any 


of  the  other  exanthematous  fevers  be  the   cause, 

then  treat  them,  and  oftentimes  when  the  the  con- 
stitutional troubles  they  produce  are  gone  our 
catarrhal  trouble  will  cease. 

Undoubtedly  catarrh  is  more  prevalent  now  than 
in  years  past,  and  is  perhaps  caused  by  inhaling 
poisonous  gases  and  bad  air.  It  is  not  always 
easy  to  remove  the  cause,  and  must  be  treated  by 
remedies  suitable  for  its  cure.  When  we  find 
ulceration  and  sloughing  going  on  we  may  e.xpect 
to  find  pressure  from  some  source  over  the  ulcerat- 
ed surface,  and  generally  this  is  made  by  hyper- 
trophied tissue    opposite  the     excoriated  surface. 

If  the  condition  has  been  long  present,  as  we 
will  learn  by  subjective  examination,  and  we  feel 
positive  that  medical  applications  are  of  no  avail, 
then  the  best  means  to  employ  is  something  which 
will  remove  the  rebundant  tissue.  If  this  be  soft 
the  Jarvis  snare  is  most  convenient,  and  is  used 
by  first  transfixing  the  lump,  and  then  drawing  the 
wire  around  it  when  the  part  comes  away  readily. 

To  illustrate,  I  will  report  the  case  of  Mrs.  .S.,  a 
young  German  woman,  who  came  to  me  three  years 
ago  suffering  with  bronchitis,  as  she  thought,  and 
so  it  was,  but  this  was  not  the  primary  trouble  ; 
she  had  a  very  bad  pharyngitis  and  rhinitis,  the 
latter,  in  my  opinion,  being  the  cause  of  all  the  other 
conditions.  I  treated  her  by  swabbing,  and  brush- 
ing, and  internal  medication,  for  nearly  a  year, 
until  I  left  my  practice  and  went  away  to  brush  up, 
with  but  slight  success.  Upon  my  return  the 
patient  returned  and,  having  given  this  disease 
some  attention  while  away,  I  made  a  more  thorough 
examination,  and  found  a  badly  hypertrophied 
condition  of  the  posterior  ends  of  the  inferior  tur- 
binated bones  ;  these  lumps  I  cut  away,  by  using 
a  transfixing  needle  and  a  pair  of  long  scissors,  a 
rather  rude  way  but  still  it  was  successful,  and  in 
a  few  months  I  was  rewarded  with  a  perfect  cure  ; 
the  pharynx  returning  to  its  normal  condition 
under  the  use  of  astringents ;  the  bronchitis  has 
left  and  the  lady  now  reports  herself  well. 

The  medication  used  was  liq.  hydrastia,  mur. 
anion,  in  solution  and  tr.  ferri.  mur.  applied  in 
spray-form.  Sometimes  cases  present  themselves 
to  you  where  there  is  simply  congestion,  but  not 
enough  to  amount  to  hypertrophy ;  in  this  class  of 
cases  we  must  rely  on  applications,  and  one  giving 
me  the  best  result  is  argenti  nitras  in  spray-form 
used  every  third  day,  followed  by  placing  a  little 
bit  of  an  ointment  made  by  mixing  glycerine  and 
boracic  acid,  evaporating  to  a  semi-solid  consistency 
by  heat,  and  in  a  short  time  our  efforts  are  crowned 
with  success. 

Another  condition  we  often  meet  with  is  where 
there  is  an  osseous  enlargement  that  is  pressing 
some  opposing  part  and  causing  irritation  ;  this 
must  be  removed,  and  the  most  efficient  means 
for  this  removal  is  the  multiple  knife,  which  is 
made  to  revolve  by  the  motion  of  the  hand,  or  a 
foot-lathe,  and  cutting  away  the  growth,  and  bring- 
ing the  part  drawn  to  a  level.  Another  instrument 
used  is  the  pointed  scissors  and    forceps. 

Not  long  since  a  young  man  presented   himself 


36 


THE  CANADA   MEDICAL   RECORD, 


to  me  for  treatment  for  catarrh.  Upon  examination 
I  found  a  sharp  node  grown  out  from  the  vomers 
and  the  tissue  opposite    considerably    excoriated. 

In  the  act  of  respiration  you  could  see  the  part, 
rub  against  each  other,  and  it  was  easy  to  account 
for  his  catarrh. 

After  a  few  weeks  of  treatment  to  heal  the 
excoriated  surface,  and  to  relieve  the  inflammation 
asmuchpossible,  I  removed  the  node  with  the  joint- 
ed scissors,  and  the  case  is  progressing  rapidly  to- 
wards recovery.  Another  remedy  often  used  is 
caustics,  either  solid  or  acids,  to  produce  a  slough, 
but  if  the  osseous  tissue  is  enlarged  this  will  fail, 
and  if  only  the  soft  tissue  be  involved  surgical  aid 
is  much  nicer  and  more  pleasant  for   the  patient. 

There  are  other  remedies,  such  as  the  galvano 
cautery  and  pastes  to  be  applied,  but  these  should 
only  be  used  by  the  most  expert  manipulators,  and 
I  have  tried  to  keep  within  the  pale  of  the  regular 
practitioner,  only  giving  those  remedies  which  can 
be  used  by  any  careful,  observing  physician. 

I  have  only  spoken  of  true  nasal  catarrh,  not 
having  touched  cezena,  which  is  catarrh  in  an 
atrophic  form,  thinking  that  this  had  better  be  left 
to  itself,  as  it  is  a  condition  hardly  ever  cured — only 
relieved. 

In  closing  I  wish  to  speak  of  the  application 
of    remedies    and  the   best  mode    of  procedure. 

First  of  all  the  membrane  should  be  throughly 
cleansed  of  all  mucous,  and  this  is  best  done  with 
a  cotton  swab  and  some  alkaline  solution,  and 
then  thoroughly  sprayed  to  be  sure  that  all  folds 
are  clean,  then  throw  your  medicated  fluid  in  the 
form  of  spray  forced  by  condensed  air  or  hydraulic 
pressure,  and  use  enough  pressure  to  be  sure  that 
every  fold  and  sinus  receives  some  medication ; 
there  need  be  no  fear  of  injuring  the  middle  ear 
by  this  method,  or  in  doing  any  other  damage,  and 
you  leave  no  corner  for  the  disease  to  hide  in,  and 
again  light  up  the  whole  surface  of  the  nasal  cavity. 
—Prog?'ess. 


THE  DIETETICS  OF  PULMONARY 
PHTHISIS. 

BY  ALFRED  L.  LOOiMIS,  M.D.,  ETC. 

The  dietetics  of  pulmonary  phthisis  is  often  the 
most  difficult  as  well  as  the  most  important  element 
in  its  successful  management. 

In  the  limited  space  at  my  disposal  I  can  give 
only  general  rules,  and  an  outline  of  the  practice 
which  experience  has  led  me  to  adopt. 

Three  things  require  consideration  : 

ist. —  The  most  suitable  articles  of  food. 

2nd. —  The  time  and  quantity  of  its  administra- 
tion. 

3rd. —  The  use   of  artificial  digestives. 

Since  the  object  sought  is  the  maintenance  of 
the  highest  possible  nutrition,  and  as  this  must 
often  be  done  with  feeble  digestive  and  assimila- 
tive powers,  the  selection  of  food  will  not  be  deter- 
mined solely  by  their  relative  value  (chemically) 
as  food  products,  but  quite  as  much  by  the  facility 
with  which  they  are  assimilated. 


The  best  foods  are  those  from  which  the  system 
gains  the  most  heat  and  force  producing  elements, 
with  the  least  proportionate  expenditure  of  diges- 
tive and  assimilative  force. 

Milk  is  undoubtedly  the  best  food  of  all  per  se, 
but  in  many  cases  with  weak  digestive  power 
more  nutrition  is  gained  from  its  weaker  ally 
Kumyss. 

Of  the  albuminoids,  meats,  especially  beef,  and 
eggs  are  the  most  valuable. 

The  best  hydrocarbons  are  cod  hver  oil,  butter, 
cream,  and  the  animal  fats.  Sugars  and  starches 
should  be  avoided  as  far  as  possible,  since  they 
tend  to  fermentation,  and  cause  both  gastric  and 
intestinal  dyspepsia.  Only  occasionally  will  a 
patient  be  found  who  is  benefited  by  their  use. 
They  should  be  employed,  therefore,  only  for 
variety  in  diet,  and  to  avoid  that  disgust  for  all 
food  so  apt  to  be  engendered  by  a  monotonous 
diet. 

Phosphorous,  so  important  especially  in  tuber- 
cular cases,  is  secured  in  preparations  of  the  phos- 
phates, which  should  not  be  in  the  form  of  syrups. 
Vegetables  and  fruits  may  be  required  in  the  ear- 
lier stages  to  avoid  monotony,  and  later  to  satisfy 
a  capricious  appetite,  but  they  should  be  restricted 
to  the  minimum  and  to  such  as  contain  the  least 
saccharine  elements. 

Two  very  distinct  classes  of  phthisical  patients 
must  be  recognized,  those  under  thirty  and  those 
over  forty.  It  may  be  stated  as  a  general  rule 
that  for  the  first  class  the  basis  of  all  dietetic 
treatment  must  be  the  hydrocarbons  and  phos- 
phates. They  are  often  the  curative  agents  in 
young  subjects. 

On  the  other  hand  the  albuminoids  must  cons- 
titute the  principal  food  of  the  second  class.  It  is 
worthy  of  note  that  often  in  phthisis  the  demands 
of  waste  and  repair  not  only  enable  young  people, 
who  usually  object  to  all  forms  of  fat,  to  take  and 
assimilate,  but  even  cause  them  to  exhibit  a  decid- 
ed fondness  for  all  forms  of  fatty  food.  Older 
subjects,  who  in  health  use  little  albuminous  food 
and  more  fat,  are  able  to  digest  large  amounts  of 
meat,  while  fats  cause  intestinal  dyspepsia. 

In  selecting  special  articles  of  diet  for  these  two 
classes,  it  is  important  to  remember  that  there 
are  distinct  stages  which  consumptive  patients 
pass  through,  as  regards  digestive  powers.  The 
first  covers  the  period  during  which  digestion  and 
appetite  are  unaffected.  The  second  begins  with 
the  first  indications  of  septic  infection  ;  is  marked 
by  intermittent  pyrexia  and  gastric  initability.  It 
extends  to  the  time  at  which  the  stomach  refuses 
solid  food.  The  third  covers  the  remainder  of 
the  patient's  life.  It  is  in  the  first  stage  that 
the  best  results  are  obtained. 

Systematic  dieting  should  be  begun,  therefore, 
upon  the  first  suspicion  of  a  developing  phthisis. 
The  diet  can  no  longer  be  indiscriminate,  but  the 
rules  given  below  should  be  strictly  adhered  to. 
For  young  patients  meat  must  be,  and  butter  and 
cream  are  to  be  used  freely.     Milk  should  consti- 


THE   CANADA   MEDICAL   RECORD. 


37 


tute  the  principal  drink,  in  quantities  of  from  two 
to  four  (juarts  per  day.  Other  articles  are  to  be 
taken  sparingly,  simply  to  avoid  monotony.  Each 
meal  is  to  be  supplemented  by  a  generous  allow- 
ance of  cod  liver  oil  (3  ss  |  ii).  The  phosphates 
so  valuable  to  this  class  of  patients  can 
be  supplied  in  sufficient  quantity  only  by 
special  preparations.  For  patients  over  forty, 
meats  should  be  lean  rather  than  fat,  and  be  taken 
in  large  amount.  Two  to  three  pounds  of  beef, 
three  to  four  quarts  of  milk,  and  three  or  four 
eggs  may  be  given  to  such  patients  in  twenty- 
four  hours. 

In  the  second  stages,  changes  are  required  in 
the  methods  of  preparing  the  food  rather  than 
of  the  articles  employed.  All  the  food  must 
be  given  in  fine  division  and  prepared  in  the  most 
palatable  manner.  Beef  may  be  scraped  or  chopped 
with  a  dull  knife,  only  the  fine  which  adheres  to 
to  the  blade  being  used,  and  eaten  raw,  or  lightly  or 
quickly  cooked,  the  essential  points  being  the 
removal  of  all  coarse  fibre,  and  rendering  it  pala- 
table to  the  patient.  Milk  may  be  taken  raw, 
boiled,  cooked  in  custard,  curdled  or  shaken  with 
cracked  ice  and  a  little  salt.  Eggs  are  best  taken 
raw  or  soft  boiled.  Kumyss  may  in  part  take  the 
place  of  milk,  and  the  various  peptonoids  of  beef, 
milk,  etc.,  will  relieve  the  enfeebled  digestive  or- 
gans as  well  as  afford  valuable  nutrition.  Cod 
liver  oil  will  require  emulsification,  and  fresh  emul- 
sions are  to  be  preferred  to  the  stock  preparations. 
Practically  I  have  found  an  emulsion  of  oil,  pepsin 
and  quinine  available,  when  others  caused  indiges- 
tion and  offensive  eructations. 

In  the  third  stage  when  only  prolongation  of 
life  can  be  expected,  the  forced  diet  of  the  earlier 
stages  must  be  abandoned.  When  a  hearty  meal 
causes  cough  and  vomiting  with  consequent  ex- 
haustion better  results  will  be  obtained  with 
smaller  quantities  of  food.  In  such  cases  the 
food  must  be  reduced  in  quantity,  given  more 
frequently,  and  should  consist  largely  of  artificially 
digested  preparations. 

It  is  quite  customary  to  delay  the  use  of  the 
digestive  ferments  until  the  later  stages  of  the 
disease,  but  since  it  is  in  the  first  stage  almost 
solely  that  we  effect  a  cure,  it  seems  the  wiser 
course  to  concentrate  all  our  forces  upon  the  di- 
sease at  this  time. 

When  we  wish  to  crowd  the  nutrition,  twenty  to 
thirty  grains  of  pepsin,  with  fifteen  to  twenty  min- 
ims of  Acid  Hcl.  directly  after  eating,  and  ten  to 
fifteen  grains  of  pancreatine  one  hour  after  taking 
food,  will  enable  a  patient  to  digest  an  amount  of 
food,  which  otherwise  would  produce  an  acute 
dyspepsia.  When  the  digestion  of  starches  is  at 
fault  or  requires  assistance,  the  diastase  alone  may 
be  given  with  or  after  the  meal.  In  the  second 
and  third  stages  artificial  digestion  becomes  a 
necessity. 

Some  of  the  most  important  rules  which  govern 
the  dietetics  of  phthisis  may  be  formulated  as 
follows : 


1.  Every  phthisical  patient  should  take  food 
not  less  than  six  times  in  twenty-four  hours.  The 
three  full  meals  may  be  at  intervals  of  six  hours, 
with  light  lunches  between. 

2.  No  more  food  should  be  taken  at  any  one 
time  than  can  be  digested  easily  and  fully  in  the 
lime  allowed. 

3.  Food  should  never  be  taken  when  the  pa- 
tient is  suflfering  from  bodily  fatigue,  mental  worry, 
or  nervous  excitement.  For  this  reason  mid-day 
naps  should  be  taken  before,  not  after,  eating. 
Twenty  to  thirty  minutes'  rest  in  the  recumbent 
posture,  even  if  sleep  is  not  obtained,  will  often 
prove  of  more  value  as  an  adjuvant  to  digestion 
than  pharmaceutical  preparations. 

4.  So  far  as  possible  each  meal  should  consist 
of  such  articles  as  require  about  the  same  time 
for  digestion,  or,  better  still,  of  a  single  article. 

5.  Within  reasonable  limits  the  articles  of  any 
one  meal  should  be  such  as  are  digested  in  either 
the  stomach  or  intestine  alone,  i.  e.,  the  fats, 
starches  and  sugars  should  not  be  mixed  with  the 
albuminoids,  and  the  meals  should  alternate  in 
this  respect. 

6.  In  the  earlier  stages  the  amount  of  fluid 
taken  with  the  meals  should  be  small,  and  later 
the  use  of  some  solid  food  is  to  be  continued  as 
long  as  possible. 

7.  When  the  pressure  of  food  in  the  stomach 
excites  cough,  or  when  paroxysms  of  coughing 
have  induced  vomiting,  the  ingestion  of  food 
must  be  delayed  until  the  cough  ceases,  or  an 
appropriate  sedative  may  be  employed.  In  those 
extreme  eases  where  every  attempt  at  eating  ex- 
cited nausea,  vomiting  and  spasmodic  cough, 
excellent  results  are  attained  by  artificial  feeding 
through  the  soft  rubber  stomach  tube. 

S.  So  long  as  the  strength  will  permit  assimil- 
ation, and  e.xcretion  be  stimulated  by  systematic 
exercise,  and  when  this  is  no  longer  possible  the 
nutritive  processes  may  be  materially  assisted  by 
passive  exercise  at  regular  intervals. 

The  following  may  serve  as  a  sample  menu  for 
a  day  in  the  earlier  stage.  The  meat  soup  is 
made  by  digesting  finely  chopped  beef  (i  lb)  in 
water  (Oj)  and  hydrocloric  acid  (sm),  and  strain- 
ing through  cheese  cloth. 

MENU. 

On  waking. — One-half  pint  equal  parts  hot  milk 
and  vichy,  taken  at  intervals  through 
half  an  hour. 

8  a.m. — Oat  meal  with  abundance  of  cream,  little 

sugar ;  rare  steak  or  loin  chops  with  fat, 
cream  potatoes ;  soft  boiled  eggs,  cream 
toast ;  small  cup  of  coffee,  two  glasses  of 
milk. 

9  a.m. — Half  ounce  cod  liver  oil,  or  one  ounce 

peptonised  cod  liver  oil,  and  milk. 

10  a.m. — Half  pint   raw  meat   soup;   thin   slice 

stale  bread. 
11-12. — Sleep. 


38 


THE   CANADA  MEDICAL   RECORD. 


12.30  p.m. — Some  white  fish  ;  very  little  rice ;  broil- 
ed or  stewed  chicken  ;  cauliflower ;  stale 
bread  and  plenty  of  butter ;  baked 
apples  and  cream  ;  milk,  Kumyss  or 
MatEOon,  two  glasses. 

2  p.m. — Half  ounce  cod  liver  oil,  or  one  ounce 
peptonised  cod  liver  oil  and  milk. 

4  p.m. — Bottle  Kumyss  or  Matzoon ;  raw  scraped 
beef  sandwich. 

5.30-6  p.m. — Rest  or  sleep. 

6  p.m. — Some  thick  meat  or  fish  soup  ;  rare  roast 
beef  or  mutton  ;  spinach  ;  slice  stale 
bread;  custard  pudding;  ice  cream. 

8  p.m. — Half  ounce  cod  Hver  oil,  or  one  ounce 
peptonised  cod  liver  oil  and  milk. 

9-10  p.m. — Pint  iced  milk  ;  cup  meat  soup. 

1-2  a.m. — Glass  milk,  if  awake. 


CHRONIC  PROSTATITIS. 

(By  W.  H.  Danforth,  M.D.,  Boston,  Mass.,  asst.  at  the 
Disp.  Clin.,  for  Genits  Urinary  diseases.) 
Northwestern  Lancet  : — Chronic  prostatitis  is, 
in  the  majority  of  cases,  the  result  of  a  gonorrhoea, 
where  the  inflammation  has  passed  the  compressor 
urethras  or  the  prostate  itself. 

Next  in  frequency  as  causes  come  masturbation 
and  excesses  in  venery,  as  these  habits  keep  up 
a  continual  congestion  in  the  prostatic  region  ;  but 
in  this  case  the  inflammation  is  chronic  from  the 
beginning,  and  usually  the  secretion  is  mucous  and 
not  purulent. 

The  disease  may  arise  from  stricture,  unskilful 
instrumentation,  irritating  drugs,  and,  perhaps,  from 
the  passage  of  concretions  and  sand  in  the  urine. 

Probably  the  prostate  itself  is  not  always  affected 
by  the  inflammation  ;  for  it  is  often  found  normal 
in  size  and  not  tender  to  the  touch ;  this  is  most 
noticeably  the  case  in  the  chronic  cases  arising 
from  masturbation.  For  this  reason  it  seems  incor- 
rect to  apply  the  term  "  prostatitis"  to  every  inflam- 
mation in  the  prostatic  urethra.  The  inflammation 
probably  always  begins  in  the  mucous  membrane 
of  the  urethra,  and  may  or  may  not  extend  into 
the  follicles  of  the  gland  later. 

If  we  adopt  Ultzmann's  view,  we  apply  the  term 
"  catarrh  of  the  neck  of  the  bladder"  to  all  inflam- 
mations of  the  posterior  part  of  the  urethra,  whether 
involving   the  prostate  or  not. 

When  an  acute  attack  of  prostatitis  comes  on 
during  a  gonorrhcea,  it  is  announced  by  very  fre- 
quent and  painful  micturition,  weight  and  throbbing 
in  the  perineum,  pain  on  defecation,  and,  perhaps, 
an  attack  on  retention.  The  symptoms  of  the 
chronic  form,  whether  from  an  acute  case  or  other 
cause,  are  as  follows  :  (These  will  not  all  be  seen 
in  the  same  patient,  usually.) 

(i)  Increased  frequency  of  micturition,  but 
much  less  than  in  the  acute  form.  Ultzmann's  says  : 
"  Frequent  micturition  in  the  disease  of  the  pos- 
terior urethra  is  such  a  very  characteristic  symptom, 
that  from  the  presence  of  this  sign  alone  we  can 
always  conclude  with  certainty  upon  a  lesion  in 
the  neck  of  the  bladder."     (2)  "  Bearing  down" 


and  uneasiness  in  the  perineum  and  anus.  C3) 
Slight  pain  or  uneasiness  at  the  end  of  micturition. 
(4)  Tenderness  around  the  prostate  on  passage 
of  a  sound.  In  long-standing  cases  the  urethra 
becomes  anesthetic,  and  this  symptom  is  lost, 
(s)  Inability  to  urinate  on  making  the  attempt  is 
a  prominent  symptom.  (6)  Diminution  in  the  force 
of  the  stream  and  dribbling  after  micturition.  (7) 
Reflex  spasm  of  the  compressor  urethra  ;  this  is 
of  common  occurrence.  (8)  Frequent  erections 
and  erotic  desires,  as  well  as  frequent  seminal 
emissions  at  night,  are  often  complained  of;  but 
in  cases  of  long  durations  the  opposite  extreme  is 
found,  and  partial  or  complete  impotence  may  be 
present,  causing  the  utmost  depression.  (9)  There 
may  be  a  discharge  of  mucus  from  the  urethra, 
showing  the  presence  of  inflammation  anterior  to 
the  compressor  urethra;  when,  however,  the  inflam- 
mation is  confined  to  the  prostatic  urethra,  the  se- 
cretion appears  only  in  the  urine.  This,  of  course, 
is  due  to  the  strength  of  the  compressor,  keeping 
back  secretions  posterior  to  it.  (10)  Mucus  may 
be  discharged  from  the  urethra  during  straining  at 
stool,  simulating  the  discharge  in  spermatorrhoea  ; 
the  microscope  settles  this  point.  (ir)  When  the 
urine  is  passed  in  two  portions,  characteristic  ap- 
pearances are  seen.  Ultzmann  says,  "  If  only  a 
little  secretion  has  collected  in  the  posterior  urethra 
the  urine  in  the  bladder  remains  uninfluenced,  and 
if  we  have  the  patient  urinate  successfully  in  two 
glasses,  only  the  first  portion  of  the  urine  passed 
will  appear  turbid,  the  second  half  remaining  clear 
and  transparent.  If,  however,  the  secretion  in  the 
posterior  urethra  is  considerable  in  amount,  it  will 
flow  back  into  the  bladder,  make  the  urine  more 
or  less  turbid  and  even  irritate  the  bladder  itself. 

In  this  case,  both  specimens  of  urine  (passed 
into  two  glasses)  will  appear  turbid.  However,  as 
a  distinction  from  a  primary  cystitis,  the  first  half  of 
the  urine  will  appear  more  turbid  than  the  second 
and  will  contain  more  compact  flakes,  which  all 
come  from  the  urethra,  and  which  accordingly  are 
absent  from  the  second  portion  of  urine  passed.'' 
(12)  These  "flakes"  are  the  so-called  " prostatic 
shreds,"  and  consist  of  short,  thick,  clumpy  masses, 
which,  under  the  microscope,  are  seen  to  be  col- 
lections of  pus,  prostatic  epithelium  and  mucus, 
with  sometimes  a  few  spermatozoa.  They  occupy 
the  follicles  of  the  prostate,  and  are  washed  out 
by  the  urine.  (13)  Shieds  from  the  anterior  urethra 
may  also  sometimes  be  seen  in  the  first  portion 
of  the  urine  ;  these  are  longer  and  thinner,  and 
consist  of  pus  and  urethral  epithelium.  (14)  The 
urine  contains  mucus,  prostatic  epithelium,  pus, 
often  spermatozoa,  and  sometimes  blood  corpuscles. 

A  trace  of  albumin  is  often  seen,  which  disap- 
pears when  a  cure  is  effected.  (15)  On  rectal 
examination,  the  prostate  is  usually  found  somewhat 
enlarged  and  tender ;  it  may  be  normal  in  size  and 
not  tender.  In  which  case  the  inflammation  is  pro- 
bably mostly  in  the  mucous  membrane  of  the 
urethra.  (With  enlargement  of  the  gland  there 
may  be  residual  urine.)     (16)  Neuralgic  pains  in 


THE   CANADA  MJEDICAL   RECORD. 


39 


the  back  and  groin  are  frequent  subjective  symp- 
toms. Dr.  F.  S.  Watson  says  :  "  These  pains  vary 
as  to  constancy  and  duration,  and  may  be  entirely 
absent." 

The  frequency  of  micturition,  with  pain,  and 
blood  appearing  at  the  end  of  the  act,  may  simulate 
the  symptoms  of  stone  in  the  bladder.  This  hap- 
pens only  in  the  acute  cases,  and  rectal  examina- 
tion and  sounding  make  the  diagnosis  clear.  True 
hypertrophy  of  the  prostate  occurs  only  after  the 
fiftieth  year,  and  can  hardly  be  mistaken  for  an 
inflammation. 

In  cystitis  the  pain  is  felt  above  the  symphysis 
pubis  instead  of  in  the  perineum  ;  the  urine  is  gen- 
erally alkaline  and  the  second  part  of  the  urine 
is  as  turbid  as  the  first.  Cystitis  is,  however,  often 
associated  with  a  chronic  catarrh  of  the  neck  of 
the  bladder- 

The  treatment  should  be  both'general  and  local. 

The  patient  should  take  no  alcohol,  he  should 
sleep  on  a  hard  mattress  in  a  cool  room  ;  he  should 
take  moderate  exercise  daily  out  of  doors  ;  his 
bowels  should  be  kept  open,  and  he  should  be  given 
tonics  and  plenty  of  nourishing  food.  The  urine 
must  be  kept  dilute  and  unirritating  by  diuretics. 

For  this  purpose  benzoate  of  soda,  twenty  grains, 
given  four  times  a  day,  is  an  excellent  remedy. 

Locally,  counter-irritation  to  the  perineum  is 
beneficial.  One  side  of  the  raphe  is  to  be  painted 
with  cantharidal  collodion  or  tincture  of  iodine, 
and  in  a  few  days  the  other  side.  This  may  be 
kept  up  for  some  time,  and  will  usually  relieve 
the  sense  of  weight  and  uneasiness.  (Care  must 
be  taken  to  prevent  the  irritant  from  touching  the 
anus.) 

Together  with  this  the  prostatic  injection  of 
nitrate  of  silver  is  probably  the  best  remedy.  It 
is  best  to  begin  with  a  solution  of  two  grains  to  the 
ounce,  and  increase  to  five  grains.  In  making 
the  injection  it  is  well  to  pass  a  good-sized  sound 
first,  in  order  to  stretch  the  urethra  so  that  the 
fluid  may  readily  penetrate  to  all  parts.  (The 
sound  should  be  lubricated  with  glycerine,  as  oil 
will  form  a  coating  over  the  urethra  and  modify 
the  effect  of  the  application.)  Then  a  drachm  of 
the  warmed  solution  is  to  be  injected  slowly,  the 
point  of  the  syringe  having  been  located  at  the 
prostatic    urethra    by   the    finger   in    the   rectum. 

Ultzmann's  syringe  catheter,  fenestrated  on  the 
sides,  connected  by  a  rubber  tube  to  a  small 
syringe,  is  the  most  convenient  instrument  to  use. 

The  application  should  be  made  twice  a  week, 
using  no  more  than  a  five-grain  solution,  and  the 
treatment  kept  up  for  six  or  eight  weeks.  If,  in 
that  time,  no  improvement  is  noticed,  the  injections 
should  be  discontinued  for  a  time  and  other  means 
employed. 

Combined  with  the  deep  injections  and  counter- 
irritation,  large  sounds  should  be  passed  once  or 
twice  a  week.  In  the  large  majority  of  chronic 
cases  the  above  treatment  will  bring  about  good 
results.  It  is  particularly  applicable  to  the  chronic 
"  masturbation  cases." 


THE  USEFUL  ADMINISTRATION  OF 

ARSENIC  IN  DISEASES  OF  THE  SKIN. 

By  Edward  L.  Keves,  M.  D. 

The  short  article  which  appeared  in  the  first 
number  of  the  Neiv  York  Medical  Monthly^  from 
the  able  pen  of  Dr.  Fox,  upon  "  the  useless  ad- 
ministration of  arsenic  in  diseases  of  the  skin," 
seems  to  me  to  call  for  a  word  of  protest  from 
some  one  who  thinks  better  of  this  drug  than  Dr. 
Fox  appears  to  do,  and  especially  so  since  the 
editor  oi  \.\\&  Jourtial  of  Cutaneous  and  Venereal 
Diseases,  in  Medical  Record  of  June  26,  has  made 
a  general  call  for  expression  of  opinion  upon  this 
important  subject. 

The  words  of  Dr.  Fox  and  his  argument,  as  he 
puts  it,  can  hardly  be  controverted,  but  the  impli- 
cations of  his  article,  and  the  generalizations  which 
are  sure  to  be  drawn  from  it,  seem  to  me  to  be 
damaging  in  their  tendency,  and  likely  to  be 
effective  of  more  harm  than  good ;  and,  therefore, 
since  it  is  a  very  poor  question  which  has  not  two 
sides,  I  wish  to  say  a  word  on  the  other,  and  what 
seems  to  me  to  be  the  better  side. 

The  general  practitioner  who  has  his  routine 
prescription  for  all  known  symptoms,  and  who, 
upon  seeing  a  malady  of  the  skin,  takes  his  pen 
and  orders  five-minim  doses  of  Fowler's  solution 
three  times  a  day,  in  the  vague  conviction  that  by 
so  doing  he  has  performed  his  whole  duty  to  his 
patient,  is  undoubtedly  condemned  by  this  simple 
act,  and  all  that  need  be  said  of  him  or  to  him  is 
that  he  ought  not  to  treat  skin  diseases  at  all. 

The  value  of  diet,  of  hygienic  measures,  of 
topical  applications ;  the  study  of  diathesis,  and 
the  just  appreciation  of  the  cause  of  a  given  skin 
disease — all  of  these  are  doubtless  more  valuable 
factors  of  treatment  than  the  administration  of 
any  drug,  and  a  physician  is  hardly  worthy  of  the 
name  if  he  relies  upon  medicines  alone  in  the 
management  of  any  malady — cutaneous  or  general. 
In  so  far,  therefore,  it  appears  to  me  that  the 
generalizations  of  Dr.  Fox  are  accurate ;  but 
beyond  this  they  appear  faulty,  because  they  seem 
by  implication  to  attempt  to  weaken  general  con- 
fidence in  a  remedy  which,  carefully  used,  holds  a 
very  high  if  not  the  first  place  in  cutaneous  gen- 
eral therapeutics,  notably  in  the  management  of 
chronic  disease. 

The  same  rebuke  (/.  e.,  routine  administration) 
may,  with  equal  justice,  be  cast  at  cod-liver  oil 
and  the  hypophosphites  as  to  their  applicability  to 
phthisical  maladies,  at  colchicum,  at  quinine,  at 
mercury,  at  iodide  of  potassium,  or  at  any  other 
drug.  One  man  may  use  any  of  these  remedies 
without  effect  against  a  malady  over  which  they 
are  well  known  to  exercise  a  more  or  less  controlling 
influence,  and  he  may  fail ;  while  another  practi- 
tioner, continuing  the  same  remedy  and  intelU- 
gently  supplementing  it  by  other  means,  may 
conduct  his  patient  safely  to  a  cure. 

I  am  not  in  a  position  to  champion  arsenic  or 
any  other  remedy  as  a  general  ''  skin  disease,"  but 


40 


THE  CANADA  MEDICAL  RECORD. 


if  there  is  any  other  drug  more  far-reaching  in  its 
influence  for  good  upon  the  skin  in  a  general  way 
I  have  yet  to  learn  it,  and  Dr.  Fox  has  not  sug- 
gested what  it  is. 

My  observation  and  experience  in  relation  to  the 
use  of  arsenic  allow  me  to  generalize  only  upon  a  few 
points. 

Arsenic  is  distinctly  a  cutaneous  stimulant ; 
therefore,  in  the  initial  stage  of  a  malady  possess- 
ing an  inflammatory  element  (notably  eczema),  it 
is  not  only  not  useful,  but  may  be  actually  pernicious. 
Used  after  the  acute  stage  has  been  controlled  by 
appropriate  means,  it  often  speeds  the  parting 
guest  and  prevents  it  from  lingering  in  a  state  of 
prolonged  and  desperate  chronicity.  A  fitting  a- 
nology  is  the  use  of  friction  and  passage  in  joint 
disease.  This  remedy  is  very  efficient,  but  it  has 
its  time  and  place.  When  the  joint  is  acutely  in- 
flamed, message  only  adds  fuel  to  the  flame  ;  but 
when  the  fire  has  been  subdued,  then  the  stiffness 
and  loss  of  motion,  perhaps  otherwise  inevitable, 
may  be  often  overcome  by  the  skilled  application 
of  massage.  If  the  joint  would  get  well  without 
the  massage,  there  is  no  call  for  its  use,  and  no 
one  but  a  routinist  would  employ  it,  yet  that  it 
has  its  use  can  hardly  be  denied,  and  so  with 
arsenic. 

Arsenic,  in  my  opinion,  is  not  useful  unless  the 
stomach  tolerates  it  well  and  appropriates  it  in  a 
kindly  way.  When  digestion  is  interfered  with  by 
the  use  of  arsenic,  nausea  or  inappetence  produced, 
it  generally  does  no  good  often  harm.  In  such 
instances,  preparing  the  stomach  beforehand,  chang- 
ing the  diet,  disgorging  the  liver,  giving  attention 
to  the  patient's  personal  habits  will  allow  the  rem- 
edy to  exert  an  influence,  where  unaided  it  would 
be  without  value  or  even  hannful.  The  same  remarks 
ply  exactly  to  the  administration  of  cod-liver  oil, 
and  often  to  the  use  of  iron  and  other  tonics. 

The  different  preparations  of  arsenic  may  be 
called  into  play  here  in  selected  cases.  I  have 
more  than  once  taken  a  patient  with  chronic  pso- 
riasis, who  had  hopelessly  given  up  the  digestion, 
and  seemed  to  irritate  his  skin,  alid  conducted  him 
to  a  cure  by  combing  arsenious  acid  with  nux 
vomica  and  pepsin,  with  some  changes  in  diet,  or 
by  substituting  the  arsenite  of  soda  for  the  arsenite 
of  potash.  The  Bourboule  water,  a  mild  solution 
of  the  arsenite  of  soda,  is  a  very  gentle  way  of  ad- 
ministering arsenic ;  too  gentle  as  a  rule,  but  yet  I 
believe  often  effective  of  good,  particularly  in  the 
case  of  weak  digestion.  Fowler's  solution,  especially 
if  it  has  been  long  prepared,  is  very  likely  to  disa- 
gree with  digestion,  and  for  this  reason  I  seldom 
use  it. 

The  more  diffused,  generahzed  and  chronic  that 
a  given  cutaneous  malady  is,  the  greater  do  I  con- 
sider the  indication  for  the  use  of  a  suitable  pre- 
paration of  arsenic,  if  the  stomach  will  take  it 
kindly.  The  more  localized  an  affection  is,  be  it 
ever  so  chronic,  the  less  indication  is  there  for  ar- 
senic in  a  general  way,  in  my  opinion. 

Generalized  chroma  eczema,  generalized  psoria- 


sis, and  pemphigus  may,  perhaps,  be  selected  as 
the  maladies  in  which  arsenic  may  be  expected  to 
exert  what  may  be  termed  a  certain  specific  gener- 
al effect  in  controlling  the  symptoms — exceptions 
to  the  contrary  notwithstanding.  Yet  the  combi- 
nation of  mild  doses  of  arsenic  with  other  remedies 
is  not  without  value  in  some  localized  maladies, 
and  in  combating  some  forms  of  acne  and  some 
cutaneous  manifestations  of  syphilis.  Much  also 
might  be  said,  but  more  cautiously,  in  the  case  of 
neurotic  maladies  as  affecting  the  skin,  and  where 
an  element  of  nervous  debility  keeps  down  the  pa- 
tient's general  vitality,  and  prevents  other  suitable 
remedies  from  being  effective. 

In  short,  I  think  that  there  is  so  much  value  in 
the  intelligent  use  of  arsenic  that  it  seems  a  sin  to 
allow  its  association  with  that  time-honored  hum- 
bug, permiscuous  blood  letting,  as  an  appropriate 
anology  to  pass  unchallenged. — Journal  of  Cuta- 
neous and  Venereal  Diseases. 


ON  THE  VALUE  OF  BORIC  ACID  IN  VAR- 
IOUS CONDITIONS  OF  THE  MOUTH. 

BY  A.  D.  MACGREGOR,  M.B.,  KIRKALDY. 

Boric  acid  is  now  officinal,  and  justly  so.  It 
has  long  been  used  in  various  metallurgical  and 
ceramic  operations,  and  more  recently  its  preserva- 
tive power  has  been  abundantly  demonstrated.  It 
is  this  antiseptic  power  which  gives  it  its  great 
therapeutic  value.  It  is  a  very  stable  compound 
— one  of  the  most  stable  of  the  acids ;  it  is  not 
volatile,  and  only  exerts  its  action  when  in  solution; 
fortunately,  however,  it  is  soluble  in  more  than  one 
menstruum.  Up  till  now  its  chief  application  has 
been  in  connection  with  modern  surgery,  where 
the  boric  ointment,  lint,  and  lotions  all  hold  a  pro- 
minent place.  There  are  spheres  of  usefulness 
for  it,  too,  in  medicine ;  and  one  of  these  is  in 
diseases  of  the  mouth.  It  is  the  benefit  of  its 
local  action  we  usually  wish  to  gain,  for,  though 
somtimes  given  internally — as  in  irritable  condi- 
tions of  the  bladder — its  topical  antiseptic  effect 
is  more  often  desired.  In  connection  with  its 
local  application  in  various  diseased  conditions  of 
the  mouth,  its  solubility  in  water  and  glycerine,  its  1 
unirritating  character,  its  comparatively  innocuous  I 
nature,  and  its  almost  tastelessness,  are  greatly  in  ' 
its  favor.  More  particularly  is  this  the  case  in 
treating  such  conditions  in  children,  whose  oral 
cavities  cause  them  so  much  annoyance.  Speak- 
ing generally,  boric  acid  will  be  found  useful  in  all 
conditions  of  the  mouth,  fauces,  pharynx  and  nose, 
where  there  is  any  abrasion  of  the  epithelium  ; 
whether  it  be  used  as  a  powder,  gargle,  mouth-wash, 
pigment  or  confection.  More  definitely,  I  may 
say,  it  is  not  contra-indicated  in  any  of  the  forms  of 
stomatitis,  though  scarcely  severe  enough  for  the 
graver  varieties. 

In  simple  catarrhal  stomatitis,  a  mouth-wash, 
containing  from  loto  15  grains  to  the  fluid  ounce, 
speedily  cures  the  condition,  and.  exercises  the 
same  beneficial  influence  in  the  ulcerative  form, 


THE  CANADA  MEDICAL  RECOHD. 


41 


though  there,  in  addition  to  the  rinsing  of  the 
mouth,  a  local  application  in  the  form  of  the  pow- 
der or  pigment  should  be  made  to  tlie  individual 
follicular  ulcers.  The  powder  simply  consists  of 
finely  powdered  boric  acid,  mixed  in  various  pro- 
portions with  starch  ;  the  pigment  is  a  solution  of 
boric  acid  in  glycerine(i  in  4  or  5).  In  both  cases 
the  addition  of  chlorate  of  potassium  is  advanta- 
geous ;  indeed,  I  usually  combine  it,  but  it  is  not 
essential. 

Nothing  I  know  of  is  at  once  so  rapid  and  so 
efficient,  in  the  treatment  of  parasitic  stomatitis 
or  thrush,  as  this  remedy.  The  youngest  child- 
ren do  not  object  to  its  application,  and  occasion- 
ally you  have  to  caution  against  its  too  frequent 
use.  The  o'idium  albicans  quickly  succumbs  to 
its  influence,  I  am  well  aware  of  the  great  value 
of  nitrate  of  silver  in  many  of  these  conditions; 
but,  I  am  also  alive  to  its  extremely  disagreeable 
and  persistent  taste,  and  the  dislike  which  preco- 
cious children  at  once  take  to  it.  For  thrush  in 
children,  I  especially  recommend  boric  acid, 
either  as  a  mouth-pigment  or  as  a  confection. 
Honey  and  sugar  have  both  been  condemned  as 
being  inadmissible,  in  combination,  for  the  treat- 
ment of  thrush;  but  so  far  as  children  are  con- 
cerned, I  must  say  I  consider  a  confection(though 
made  with  honey),  which  has  been  impregnated 
with  boric  acid,  gains  more  by  its  palatableness 
than  it  loses  by  the  tendency  of  the  saccharine 
matter  to  further  the  growth  of  the  fungus.  The 
boric  acid  at  once  does  away  with  this  tendency,  i 
Let  the  pigment  be  frequently  painted  with  a 
brush  over  the  patches,  never  omitting  to  do  it 
after  food  has  been  taken ;  or,  a  little  of  the  con- 
fection simply  allowed  to  dissolve  in  the  mouth  ; 
and  the  days  of  the  fungus  will  soon  be  ended. 
I  have  found  boric  acid  combined  with  its  salt 
(borax)  markedly  beneficial.  Borax  alone,  how- 
ever, is  not  nearly  so  good. 

In  pharyngitis  and  relaxed  conditions  of  the 
throat  a  gargle, containing  boric  acid  and  glycerine 
with  either  tannic  acid  or  alum  in  addition, 
ought  not  to  be  forgotten. 

Let  me  allude  to  another  condition,  in  which  I 
have  found  combinations  of  this  substance  helpful 
and  grateful  to  the  patient.  I  refer  to  the  condi- 
tion in  which  we  frequentl}4  find  the  mouth, 
tongue  and  teeth  in  severe  cases  of  typhoid  fever. 
The  mouth  is  hot ;  the  lips  dry,  cracked,  and  glued 
to  the  sordes-covered  teeth  by  inspissated  mucus 
and  saliva  ;  the  tongue  dry,  or  even  glazed  and 
hard,  brown  or  black,  crusted  with  a  fcetid  fur. 
Under  such  circumstances,  a  pigment  containing 
boric  acid  (30  grains),  chlorate  of  potassium  (20 
grains),  lemon  juice  (5  fluid  drachms),  and  gly- 
cerine (3  fluid  drachms),  yields  very  comforting 
results.  When  the  teeth  are  well  rubbed  with  this, 
the  sordes  quickly  and  easily  become  detached, 
little  harm  will  follow  from  the  acid  present.  The 
boric  acid  attacks  the  masses  of  bacilli  and  bac- 
teria ;  the  chlorate  of  potassium  cools  and  soothes 
the  mucous  membrane  ;  the  glycerine  and  lemon 


juice  moisten  the  parts,  and  aid  the  salivary  secre- 
tion. I  consider  the  ajiplication  well  worth  a 
trial. 

•  So  much  for  the  soft  parts  ;  a  word  in  conclusion 
regarding  the  teeth.  Few  medical  men,  I  sui)[)ose 
have  ever  given  a  prescription  for  a  tooth-powder 
(such  a  matter  is  beneath  their  notice);  and  the 
selection  of  the  ingredients  for  the  various  pow- 
ders and  pastes  in  vogue  for  the  purpose  of  beau- 
tifying and  cleansing  the  teeth  is  left  entirely  in  the 
hands  of  those  who  certainly  should  not  know 
better  than  medical  men. "  I  have  frequently 
trespassed  on  this  debatable  ground,  and  recom- 
mend a  particular  dentifrice.  In  view  of  the 
extremely  important  part  the  teeth  play  in  the 
economy  of  life,  I  never  hesitate  occasionally  to 
inquire  as  to  the  attention  they  receive. 

A  tooth-powder  should  possess  certain  charac- 
teristics ;  it  should  be  antiseptic,  cooling,  agreeable 
to  taste  and  smell,  and  have  no  injurious  action  on 
the  teeth.  After  use,  it  should  leave  the  teeth  white, 
and  a  sensation  of  freshness  and  cleanliness  in  the 
mouth.  As  an  antiseptic  in  this  connection  noth- 
ing can  displace  boric  acid.  For  years  I  liave  used 
the  following  powder,  and  can  recommend  it : 
Boric  acid,  finely  powdered,  40  grs. ;  chlorate  of 
potassium,  3  ss  ;  powdered  guaiacum,  20  grs. ; 
prepared  chalk,  3  i ,  powdered  carbonate  of  mag- 
nesia, I  i;  attar  of  roses,  half  a  drop.  The  boric 
acid  in  solution  gets  between  the  teeth  and  the 
edges  of  the  gums,  and  there  it  discharges  its 
antiseptic  functions  ;  the  chlorate  and  guaiacum 
contribute  their  quota  to  the  benefit  of  the  gums 
and  mucous  membrane  generally ;  the  chalk  is  the 
insoluble  powder  to  detach  the  particles  of  tartar 
which  may  be  present,  and  the  magnesia  the  more 
soluble  soft  powder  which  can  not  harm  the  softest 
enamel. 

It  is  only  right  to  say  that  boroglyceride  (Barff) 
can  replace  boric  acid  in  almost  all  the  forms  of 
administration  I  have  enumerated  ;  it  is  efficacious 
slightly,  and  pleasant  to  the  taste. — British  Medi- 
cal Joiir?ial. 


SOME     APHORISMS     IN     OPHTHALMO- 
LOGY. 

By  M.  F.  Coomes,  M.D. 

1.  As  a  local  anesthetic  to  mucous  surfaces  and 
open  wounds,  the  muriate  of  cocaine  is  one  of  the 
most  certain  and  effective  agents  that  is  known. 

2.  All  surgical  operations  on  the  eye,  except 
enucleation  of  the  globe,  may  be  performed  under 
the  influence  of  cocaine  with  as  much  or  more 
safety  than  under  any  other  anesthetics. 

3.  In  all  forms  of  iritis  keep  the  pupil  dilated. 

4.  In  acute  retinitis,  unaccompanied  by  iritis, 
keep  the  pupil  contracted,  in  order  to  keep  out  as 
much  light  as  possible. 

5.  The  only  relief  for  senile  cataract  is  surgical 
interference. 

6.  The  rule  is  that  all  acute  purulent  discharges 
from  the  conjunctiva  are  contagious. 


42 


THE  CANADA  MEDICAL  RECORD. 


7.  The  only  proper  method  of  testing  the  vision 
in  persons  possessing  the  power  of  accommodation 
is  to  suspend  that  power  by  paralyzing  it,  and  then 
pursue  the  usual  method  with  the  trial  lenses. 

8.  Jequirity  is  a  dangerous  remedy  as  well  as  an 
unreliable  one,  and  should  not  be  used  by  unskill- 
ed persons. 

9.  All  kinds  of  strong  caustic  applications  are 
contra-indicated  in  the  treatmeftt  of  acute  purulent 
inflammations  of  the  conjunctiva. 

The  best  results  are  obtained  by  frequent  cleans- 
ing with  mild  saline  solutions,  and  the  use  of  weak 
solutions  of  the  vegetable  or  mineral  astrigents 
(excluding  nitrate  of  silver),  a  solution  containing 
five  grains  of  tannic  acid  and  three  grains  of  car- 
bolic acid  to  the  ounce  of  water,  or  from  one-half 
to  one  grain  of  the  sulphate  of  copper  to  the  ounce 
of  water  will  be  found  among  the  most  efficient 
agents. 

10.  It  is  always  good  surgery  to  remove  a  foreign 
body  from  the  eye,  provided  it  is  not  entirely  with- 
in the  globe  behind  the  iris.  If  the  foreign  body 
is  between  the  iris  and  the  cornea,  prompt  removal 
is  urgently  demanded. 

Great  care  must  be  taken  in  order  to  avoid 
wounding  the  lens,  as  such  an  accident  would  be 
certain  to  result  in  the  production  of  cataract.  If 
the  foreign  body  should  be  entirely  within  the 
globe  behind  the  iris,  or  if  it  should  be  large  and 
partially  within  the  globe,  the  question  to  be  set- 
tled is,  whether  it  will^be  best  to  remove  the  eye 
or  the  foreign  body. 

If  the  laceration  of  the  globe  jis  not  too  great  it 
will  probably  be  best  to  remove  the  foreign  body  ; 
and  then  if  the  globe  becomes  violently  inflamed, 
or  if  sympathetic  inflammation  of  the  other  eye 
should  occur,  remove  the  diseased  member  without 
delay. 

11.  An  eye-ball  that  is  destroyed  for  visual  pur- 
poses, and  is  painful,  should  be  removed  without 
delay,  as  it  may  induce  inflammation  in  the  good 
eye,  and  result  in  its  destruction. 

12.  Whenever  there  is  one  or  more  small  no- 
dules about  the  margin  of  the  pupil  or  in  the  iris  in 
case  of  iritis,  it  is  almost  absolute  evidence  that  the 
disease  is  syphilitic. 

13.  The  operation  of  strabotomy  should  be  per- 
formed, if  possible,  without  general  anesthesia, 
because  its  influence  so  relaxes  the  muscular 
system  that  it  is  impossible  to  determine  when  the 
operation  is  completed. 

14.  When  the  iris  is  wounded  and  is  protruding 
it  should  be  cut  off,  and  the  eye  kept  under  the 
influence  of  a  mydriatic  until  the  inflammation  has 
subsided. 

15.  An  unskilled  person  should  never  attempt 
to  replace  a  protruding  iris,  as  such  a  procedure  is 
difficult,  and  there  is  great  danger  of  injuring  the 
lens  and  inducing  cataract. 

i6.  Surgical  interference  is  the  only  means  of 
giving  permanent  relief  to  glaucoma.  Eserino  will 
give  temporary  relief,  and  cocaine  relieves  the  pain 
for  a  short  time. 


17.  One  of  the  most  efl[icient  agents  in  tenia-tarsi 
is  an  ointment  composed  of  ten  or  fifteen  grains  of 
the  yellow  oxide  of  mercury  to  one-half  ounce  of 
simple  cerate,  or  some  other  suitable  article.  This 
is  to  be  applied  to  the  lids  night  and  morning,  after 
thorough  cleansing. 

18.  Poultices  of  every  description  are  to  be 
avoided  in  diseases  of  the  eye,  unless  ordered  by 
some  one  who  is  specially  skilled  in  this  hne  of 
practice. 

19.  Whenever  there  is  great  edema  of  the  con- 
junctiva, and  particularly  when  this  is  associated 
with  excessive  purulent  discharge,  the  membrane 
should  be  snipped  in  numerous  places  so  as  to 
permit  the  pent-up  fluid  to  escape,  and  thus  pre 
vent  destruction  of  the  cornea,  which  is  always  in 
danger  in  such  cases.  Remember  that  there  can 
be  no  harm  done  by  this  cutting,  and  if  it  does  not 
give  the  desired  relief,  a  tarsarophy  should  be  done. 

20.  In  the  majority  of  cases  of  strabismus, 
glasses  are  necessary  as  well  as  tenotomy,  inasmuch 
as  the  strabismus  in  most  instances  is  dependent 
on  an  optical  defect  which,  if  uncorrected,  would 
cause  a  return  of  the  squint. 

21.  It  is  always  better  to  correct  squint  by 
means  of  properly  .adjusted  lens  than  by  tenotomy. 
—Med.  Herald. 


PROFESSOR  HUXLEY  ON  SMOKING. 

At  a  certain  debate  on  smoking  among  the 
members  of  the  British  Association,  Professor 
Huxley  told  the  story  of  his  struggles  in  a  way 
which  utterly  put  the  anti-tobacconists  to  confusion. 

"  For  forty  years  of  ray  life,"  said  he,  "  tobacco 
had  been  a  deadly  poison  to  me.  [Loud  cheers 
from  the  anti-tobacconists.]  In  my  youth,  as  a 
medical  student,  I  tried  to  smoke.  In  vain  !  At 
every  fresh  attempt  my  insidious  foe  stretched  me 
prostrate  on  the  floor.  [Repeated  cheers.]  I 
entered  the  navy.  Again  I  tried  to  smoke,  and 
again  met  with  defeat.  I  hated  tobacco.  I  could 
have  almost  lent  my  support  to  any  institution 
that  had  for  its  object  the  putting  of  tobacco 
smokers  to  death.  [Vociferous  cheering.]  A  few 
years  ago  I  was  in  Brittainy  with  some  friends  ; 
we  went  to  an  inn  ;  they  began  to  smoke  and  look- 
ed very  happy,  and  outside  it  was  very  wet  and 
dismal.     I  thought  I  would  try  a  cigar.    [Murmurs] 

I  did  so.  [Great  expectations.]  I  smoked 
that  cigar-it  was  delicous  !  [Groans.]  From  that 
moment  I  was  a  changed  man,  and  now  I  feel 
that  smoking  in  moderation  is  a  comfortable  and 
laudable   practice,   and   is    productive   of    good. 

[Dismay  and  confusion  of  the  anti-tobacconists. 
Roars  of  laughter  from  the  smokers.]  There  is 
no  more  harm  in  a  pipe  than  there  is  in  a  cup 
of  tea.  You  may  poison  yourself  by  drinking  too 
much  green  tea,  and  kill  yourself  by  eating  too 
many  beefsteaks.  For  my  own  part,  I  consider  ■ 
that  tocacco,  in  moderation,  is  a  sweetener  and 
equalizer  of  the  temper."  [Total  rout  of  the 
anti-tobacconists,  and  complete  triumph  of  the 
smokers.] — Medical  and  SurgicalReporier. 


THE   CANADA   MEDICAL   RECORD. 


43 


IODIDE  POTASSIUM  IN  SPASMODIC 
ASTHMA. 

BY  J.  A.  ORMEROD,  M.D. 

Although  iodide  potassium  is  well  known  as  a 
remedy  for  spasmodic  asthma,  it  is  a  remedy  which 
seems  to  be  held  in  very  varying  estimation.  Some 
authorities  speak  of  it  as  a  specific,  others  say  it  is 
worth  a  trial,  others  do  not  mention  it  at  all.  I 
have  36  cases  of  asthma  treated  by  me,  as  out- 
patients, with  this  drug.  All  of  them  displayed, 
though  with  varying  severity,  the  cardinal  symptoms 
of  the  disease,  viz.,  difficulty  of  breathing,  coming 
on  suddenly,  usually  in  the  early  morning  during 
sleep,  passuig  off  after  a  time  so  as  to  leave  the 
patient  comparatively  well,  but  recurring  usually 
in  a  regular  fashion,  and  at  regular  intervals. 

Whatever  be  thought  of  the  pathology  of  the 
disease,  its  existence  as  a  symptomatic  entity  is 
undoubted.  And  I  think  that  inferences  concerning 
the  effect  on  it  of  a  simple  drug  like  rod.  pot.  may 
fairly  be  drawn  from  outpatient  practice;  for  (i) 
though  the  physician  may  not  witness  the  spasm, 
the  sufferer  is  as  well  qualified  as  any  one  to  tell  of 
its  frequency  and  severity,  and  (2)  the  patient  is 
treated  without  change  of  his  every-day  surround- 
ings, a  change  which  frequently  is  of  itself  sufficient 
to  modify  this  disease. 

I  have  endeavored  to  classify  the  cases  as  follows  : 

[The  writer  gives  several  pages  in  tabular  form 
showing  result  of  treatment,  etc.]  Asthma  for  the 
most  part  uncomplicated.  Asthma  with  bronchitis 
or  emphysema  ;  the  relation  between  the  two  being 
doubtful.  Asthma  with  secondary  emphysema. 
Asthma  secondary  to   bronchitis    or   emphysema. 

But  unless  the  disease  be  watched  from  the  be- 
ginning and  over  a  length  of  time,  and  the  physician 
be  able  to  e.xamine  the  chest  both  between  and 
during  the  spasms,  it  is  difficult  to  say  into  which 
category  a  case  should  go. 

The  iodide  was  given  alone,  or  if  in  combination 
only  after  the  effect  of  the  uncombined  drug  had 
been  watched.  It  proved  a  failure  in  nine  out  of 
the  36  cases,  i.e.,  only  in  25  per  cent.  Its  good 
effects  (with  a  limitation  to  be  mentioned  presently) 
were  not  limited  to  the  uncomplicated  cases.  The 
cases  where  the  asthma  appeared  to  be  distinctly 
secondary  to  chronic  lung  disease  are  indeed  too 
few  to  say  much  about ;  but  in  some  of  them  at  least 
it  did  good.  The  symptoms  most  a'Tienable  to  the 
drug  were  certainly  the  nocturnal  attacks  of  dysp- 
noea; its  effect  on  them  was  often  remarkable  ;  thus 
in  many  cases  they  disappeared  altogether ;  in 
others  they  were  much  reduced  in  frequency  and 
severity.  But  a  troublesome  cough,  or  certain 
shortness  of  breath  on  rising  in  the  morning,  often 
persisted.  That  the  nocturnal  attacks  were  really 
controlled  by  the  iodide  was  shown  by  the  fact  that 
they  recurred  (in  many  cases)  whenever  the  drug 
was  stopped.  It  has  therefore  the  effect  of  relieving 
rather  than  curing.  Five  or  10  grains  three  times 
a  day  suited  best  in  most  cases  ;  in  some  a  lar^  er  or 
smaller  dose  did  better.  In  some  an  increase  of  the 


dose  did  good  for  a  time,  but  the  effect  semed  to 
wear  off. 

The  condition  of  the  nasal  mucous  membrane 
contributes,  it  is  said,  to  the  production  of  asthmatic 
attacks;  and  iodine  might  therefore  be  thought  to 
act  by  producing  coryza;  but  coryza  occurred  in 
very  few  of  the  patients  thus  treated.  In  one  case 
the  attacks  had  been  preceded  by  coryza,  and  they 
were  nevertheless  stopped  by  iodide. 

Syphilitic  taint  has  never,  so  far  as  I  know,  been 
alleged  as  the  cause  of  asthma.  In  one  case  the 
substituted  mercury  for  the  iodide,  and  a  relapse 
immediately  followed. 

The  gouty  diasthesis  is  an  undoubted  cause  "f 
asthma,  and  iod.  pot.  is  known  to  be  useful  in  cases 
of  gout.  But  the  promptitude  of  its  effect  on 
spasmodic  attacks  of  asthma,  and  the  promptitude 
oftl.e  relapse  when  it  is  stopped,  makes  it  unlikely. 
I  think,  that  it  acts  by  modifying  the  general 
condition  of  the  patient. 

I  believe  that  its  action  may  be  fairly  compared 
to  that  of  bromide  in  epilepsy.  The  chemical 
similarity  of  the  drugs  is  obvious.  There  are 
similarities  also  between  the  two  diseases  ;  both 
are  characterized  by  attacks  which  recur  periodical- 
ly and  often  with  considerable  regularity,  and  which 
leave  intervals  of  tolerable  health.  Epilepsy  often 
begins  in  the  night,  as  asthma  does  still  more 
frequently.  Asthmatic  attacks  may  be  preceded  by 
a  kind  of  warning.  Both  diseases  are  probably  due 
to  some  fault  in  the  central  nervous  system,  though 
in  both  extrinsic  causes  may  determine  an  attack. — 
Practitioner. 


HYDROCHLORATE  OF  COCAINE  IN  THE 
VOMITING  OF  PREGNANCY. 

Weiss  of  Prague,  has  used  this  remedy  success- 
fully in  a  case  of  vomiting  in  pregnancy  which 
had  resisted  all  previous  attempts  at  relief.  The 
patient  was  weak  and  anemic,  of  a  nervous  dispos- 
ition, and  had  suffered  in  three  different  pregnan- 
cies from  persistent  vomiting;  in  the  present  preg- 
nancy her  condition  was  serious.  Weiss  pre- 
scribed : 

B       Hydrochlorate  of  cocaine gr.  ij 

Alcohol,  enough  to  dissolve 
Water 3  V. 

S  :  One  teaspoonful  every  half  hour. 

After  the  sixth  dose  three  tablespoonfuls  of  milk 
were  well  borne  ;  after  the  eighth,  a  cup  of  broth 
with  egg,  without  vomiting.  After  the  sixteenth 
dose  the  patient  ate  with  relish  chicken  broth, 
slices  of  white  chicken  meat,  and  drank  a  glass  of 
wine  without  vomiting.  The  drug  was  then  with- 
drawn for  a  time,  owing  to  an  increased  frequency 
of  pulse  and  respiration ;  but  hourly  doses  were 
subsequently  given,  with  the  result  of  entirely 
checking  the  vomiting  and  enabling  the  patient  to 
regain  her  former  strength. — Edinburgh  Medical 
Journal. 


44 


THE  CANADA  MEDICAL   RECORD. 


THE    DIAGNOSIS    OF   ORGANIC    HEART 
TROUBLES. 

BY  EMORY  LANPHEAR,    KANSAS  CITY,  MO. 

There  are  no  problems  of  physical  diagnosis 
which  so  puzzle  the  average  practitioner  as  diffe- 
rentiating between,  and  recognizing  the  signifi- 
cance of,  the  murmurs  present  in  organic  diseases 
of  the  heart. 

It  is  quite  evident  that  proper  therapeutic  agents 
cannot  be  employed  until  an  exact  knowledge  of 
the  conditions  present  in  any  particular  case  can 
be  obtained  by  the  attending  physician.  In  most 
cardiac  affections  attended  by  organic  change 
there  are  distinct  murmurs  discoverable,  and  it  is 
only  by  a  proper  understanding  of  these  morbid 
sounds  that  an  accurate  diagnosis  can  be  made. 
Therefore,  any  guide  to  their  meaning  must  be 
acceptable  to  the  majority  of  the  medical  profession. 
To  those  who  hear,  but  fail  to  appreciate  the 
precise  meaning  of  these  sounds,  the  subjoined 
table  will  prove  invaluable. 

I  am  indebted  to  my  friend.  Prof.  A.  B.  Shaw,  of 
St.  Louis,  for  this  table,  he  having  presented  it  to 
the  class  at  the  Missouri  Medical  College  in  the 
spring  of  1879.  Many  complex  tables  have  been 
given  to  the  profession,  but  this  is  probably  the 
best,  combining,  as  it  does,  simplicity  with  easiness 
of  remembrance  ;yet  comprising  all  that  is  needed  in 
making  stethescopic  examination  of  the  heart  stating 
perfectly  the  time  and  location  of  the  murmur, 
thus  indicating  what  the  lesion  is,  and  where  it  is 
located.  I  submit  it  to  the  readers  of  this  article, 
trusting  it  may  prove  of  as  much  benefit  to  them 
as  it  has  to  me  : 

TABLE  OF    CARDIAC    MURMURS. 


V 

0 

0 

0 

u 

0 

0 

u 

0 

^^ 

f^^ 

'^ 

^ 

>-• 

W 

Q 

P 

w 

'Jl 

O/  o  i 


g'S^ 


1^ 

V  o 
P4 


Pages  might  be  written  explanatory  of  this 
table ;  in  fact,  it  covers  the  whole  subject  of  the 
diagnosis  of  organic  diseases  of  the  heart.  With 
it,  all  that  is  necessary  is  a  knowledge  of  the 
topographical  anotomy  of  the  prascordial  region  ; 
the  location  of  various  structures  mentioned  being 
known,  and  the  several  murmurs  being  heard,  all 
that  remains  is  to  distinguish  between  systolic  and 
diastolic  sounds,  and  the  diagnosis  is  accom- 
plished. Without  some  such  table  in  one's  mind, 
it  is  impossible  to  intelligently  examine  a  chest 
for  cardiac  trouble. — Kansas  City  Medical  In- 
dex. 


SHALL  PATIENT  EAT  WHAT  HE 
CRAVES  ? 

I  often  notice  in  medical  journals,  and  hear  it 
talked  by  medical  men,  that  people  should  eat 
whatever  the  appetite,  that  being  the  true  guide  to 
the  wants  of  the  system,  craves.  In  theory  this 
may  be  right,  based  upon  a  normal  appetite.  (Who 
has  one  ?)  but  in  practice  I  believe  it  decidedly 
wrong. 

Whenever  we  find  a  person  craving  some  article 
of  food  or  drink,  and  we  can  satisfy  ourselves  that 
it  is  a  demand  of  nature  tor  a  needed  supply,  give 
it  by  all  means.  But  there  are  so  many  perverted 
appetites,  cravings  and  desires,  that  one  must  dis- 
criminate very  closely,  and  think  in  straight  lines, 
or  he  will  err,  and  do  harm  to  the  body  and  life. 

Country  doctors  do  so  little  thinking  as  a  rule, 
that  advocates  and  teachers  should  be  very  careful 
what  they  teach.  Who  has  not  seen  an  old  toper 
crave  his  whiskey,  an  old  smoker  his  tobacco,  an 
opium  eater  his  drug,  or  a  dyspeptic  whose  secre- 
tions are  so  loaded  with  latic  acid  and  ttie  mucus 
membrane  of  whose  mouth,  stomach  and  bowels 
is  so  irritated  by  it,  that  functions  can  not  be  prop- 
erly performed  at  all,  and  still  craving  and  eating 
pickles,  lemons  and  other  sharp  acids,  etc.  Any 
number  of  examples  might  be  given,  and  yet  doc- 
tors will  often  tell  the  patients  to  eat  and  drink 
what  the  appetite  craves.  When  will  medical 
men  learn  to  think  and  try  to  understand  vital 
processes,  and  realise  that  disease  is  not  an  entity 
but  merely  perverted  life.  This  thought  might  be 
carried  on  into  the  realm  of  medicine,  as  well  as 
food,  its  uses  and  abuses.  There  is  a  field  here  for 
both  thought  and  experiment. 

E.  P.  Whitford,  M.D. 


DROPS  FOR  EARACHE. 
Pavesi  recommends  a  mixture  of  camphor 
chloral  2j4  parts,  glycerine  i6}4  parts,  and  oil  of 
almonds  10  parts.  This  is  to  be  well  mixed  and 
kept  in  a  well-closed  bottle.  A  pledget  of  absor- 
bent cotton  is  to  be  soaked  with  the  drops,  and 
then  introduced  as  far  as  possible  into  the  affected 
ear,  two  applications  being  made  daily.  Frictions 
may  also  be  made  each  day  with  the  preparation 
behind  the  ear.  The  pain  is  almost  immediately 
relieved. 


THE  CANADA   MEDICAL   RECORD. 


45 


URINARY    INCONTINENCE    OF    CHILD- 
REN TREATED  BY  ANODYNES  PER 

RECTUM. 
Dr.     Edward  T.  Williams    thus  writes    in  the 
Boston  and  M.  fl  S.  Jour : 

It  is  safe  to  say  that  the  modes  of  treatment  usually 
recommended  for  this  distressing  infirmity  are 
frequently  ineflective  and  disappointing.  A  failure 
of  my  own  some  years  ago,  with  a  child  nearly 
related  and  especially  dear  to  me,  led  me  to  cast 
about  for  some  improved  method.  For  the  past 
year  or  two  I  have  been  trying,  with  complete 
success  thus  far,  the  use  of  anodynes  by  the  rectum, 
in  the  form  of  injections  and  suppositories  of  mor- 
phine, belladonna  or  atropine.  I  have  now  cured 
about  six  cases  by  this  means,  besides  temporarily 
relieving  many,  more  who  have  passed  out  of  sight 
during  treatment,  so  that  I  cannot  positively  state 
the  final  results.  I  have  no  doubt,  though,  that  a 
portion  of  these  have  been  cured.  Some  of  them 
were  patients  of  the  Sea  Shore  Home,  where  the 
length  of  stay  averages  less  than  a  fortnight — too 
short  a  time  to  eflfect  a  permanent  cure  in  any  case. 
One  of  my  cases,  which  I  will  describe  presently  in 
detail,  had  been  a  constant  sufferer  for  ten  years. 
The  treatment  occupied  a  year,  off  and  on.  She 
is  now  entirely  well. 

I  find  that  morphine  alone  relieves  for  the  time 
being,  but  does  not  cure.  Belladonna  and  atropine 
are  curative,  when  continued  long  enough,  though 
I  find  them  to  be  better  borne  in  combination  with 
a  little  morphine,  which  counteracts  some  of  their 
bad  effects,  and  enables  them  to  be  given  more  con- 
tinuously. Furthermore,  the  requisite  dose  of 
belladonna  is  smaller  when  combined  with  mor- 
phine. When  these  medicines  produce  headache 
or  undue  nervous  excitability,  I  use  the  bromides 
as  a  corrective,  or  suspend  their  administration 
for  a  time.  I  have  found  no  case  where  they  could 
not  be  borne  when  properly  given. 

As  to  the  mode  of  administration,  a  fifteen  grain 
suppository  of  cocoa  butter  is  most  easily  handled, 
and  that  which  I  prefer.  They  should  contain  a 
proper^  amount  of  extract  of  belladonna  and  mor- 
phine. For  a  child  five  years  old,  say  one-eighth 
of  a  grain  of  belladonna  extract,  and  one-sixteenth 
grain  of  morphine;  but  the  doses  must  be  carefully 
adapted  to-nhe  particular  case  in  hand,  beginning 
with  a  small  dose,  with  a  smaller  relative  propor- 
tion' of  belladonna,  and  increasing  the  latter  and 
diminishing  the  morphine_'as  toleration  becomes 
established. 

If  an  enema  or  clyster  be  preferred,  it  should 
consist  of  about  a  drachm  of  lukewann  water,  with 
a  few  drops  of  atropia  and  morphine  solution  added, 
and  administered  with  the  small  hard-rubber  syringe 
(No.  2)  especially  designed  for  the  purpose.  The 
old  fashioned  clyster  of  starch-water^and  laudanum 
is  absurdly  out  of  date.  I  have  used  nothing  for 
years  but  morphine  and  warm  water,  mixed  as  for  a 
subcutaneous  injection,  only  that  the_ water  should 
be  tepid,  and  not  exceeding   a  drachm  in  amount. 


I  hardly  dare  claim  to  be  the  originator  of  this 
self-suggestive  plan,  though  I  certainly  never  heard 
of  its  being  done  by  others  before  I  adopted  it  out 
of  my  own  fancy  years  ago,  since  which  time  I  have 
freely  mentioned  it  in  conversation  and  before 
various  societies.  It  is  certainly  the  simplest  form 
of  anodyne  clyster. 

At  the  Sea  Shore  Home,  where  we  do  things  by 
wholesale,  I  have  two  solutions  of  morphine  and 
atropia  ready  made.  The  first  consists  of  one-sixth 
grain  of  morphine  and  t\venty  minims  of  water. 
The  dose  by  drops  therefrom  is  the  same  as 
that  of  laudanum,  which  makes  it  especially 
convenient  for  the  nurses.  The  other  is  one- 
sixtieth  grain  of  atropine  to  twenty  minims  of  water. 
Reckoning  one-sixtieth  of  a  grain  as  an  average 
commencing  dose  for  an  adult,  the  dose  for  a  child 
may  be  graduated  by  drops  precisely  as  with 
laudanum.  For  a  child  five  years  old,  then,  as  an 
enema,  you  might  give  for  a  commencing  dose  from 
three  to  five  drops  of  each  solution,  mixed  with  a 
teaspoonful  of  warm  water.  These  doses  may  be 
differently  combined  or  altered  in  any  way  to  suit  a 
particular  case. 

I  mention  these  points  because  it  is  convenient 
to  have  both  in  private  and  hospital  practice 
certain  methods  of  routine,  not  only  to  save  thought 
and  labor,  but  to  lessen  the  chances  of  mistake. 

I  will  conclude  by  recounting  a  single  case  as  an 
illustration  of  this  mode  of  treatment.  A  bright  and 
charmingly  pretty  girl  of  fourteen  came  under  my 
care  for  this  disease  July,  9,  1883.  Had  been  subject 
to  it  for  years,  in  fact  nearly  all  her  life.  Was  of 
a  peculiarly  sensitive,  nervous  temperament,  and 
subject  to  convulsions  in  infancy  and  early  child- 
hood, for  which  I  had  myself  attended  her.  Was 
just  beginning  to  menstruate.  The  urinary  trouble 
had  become  a  great  source  of  mortification  to  her, 
and  her  shyness  about  it  was  so  great  that  she  could 
not  be  brought  to  talk  with  me  on  the  subject,  so  that 
all  comminication  had  to  pass  through  the  mother, 
a  thing  I  should  hardly  have  put  up  with  if  it  had 
not  been  one  of  my  particular  famihes.  This  being 
my  first  case  (of  rectal  treatment)  I  began  with 
morphine  alone,  one-sixth  of  a  grain  nightly,  in 
suppository.  Failing  to  produce  full  relief  _  I 
doubled  the  strength,  making  one  third  of  a  grain, 
when  she  went  nearly  a  month  without  once  wetting 
the  bed.  On  stopping  the  suppository  the  trouble 
quickly  returned.  Recommenced  the  one-third 
grain  suppository  on  September  14th,  with  full 
relief  of  the  incontinence  as  before,  but  the  patient, 
who  was  attending  school  all  the  lime,  began  to 
get  "fidgety"  and  nervous  from  the  effects  of  the  mor- 
phine, so  that  I  was  compelled  to  give  small  doses 
of  bromide  of  potassium  daily.  This  relieved  the 
nervous  symptoms  entirely.  I  then  began  to  taper 
off  on  the  morphine,  giving  a  suppository  every 
second  or  third  night  instead  of  every  night,  or 
occasionally  halving  the  suppositor)'.  On  this 
treatment  she  began  to  wet  more  frequently,  and 
I  became  satisfied  that  morphine  alone  would  not 
cure  her.     October  29th  I  prescribed  a  suppository 


46 


THE   CANADA  MEDICAL   RECORD. 


containing  one-sixth  grain  of  morphine  and  one- 
fourth  grain  extract  of  belladonna.  On  December 
loth  I  made  it  one-eighth  grain  morphine  and 
one-half  grain  extract  of  belladonna.  Both  these 
answered  perfectly,  and  in  six  weeks  she  was 
practically  cured.  In  the  succeeding  six  months 
she  did  not  wet  more  than  six  times,  but  each  time 
was  carefully  followed  by  the  use  of  the  belladonna 
suppository  for  one  week  to  prevent  a  relapse. 
For  two  years  now,  since  the  summer  of  1884,  she 
has  been  perfectly  well,  and  improved  greatly  in 
general  health. 

I  might  report  other  cases  far  more  rapidly  cured. 
I  select  the  above  on  account  of  its  long  standing, 
and,  since  I  was  obliged  to  proceeed  someiviiat 
tentatively,  as  showing  very  well  the  comparative 
action  of  morphine  and  belladonna.  The  latter  I 
have  never  given  without  some  morphine,  believing 
they  act  better  in  combination,  as  they  do  when 
given  by  the  mouth. 

From  my  present  experience  I  regard  the  rectal 
treatment  as  superior  to  all  others  in  this  disease. 


THE  SURGICAL  TREATMENT  OF  SUBIN 
VOLUTION. 

Dr.  A.  Palmer  Dudley  thus  writes  in  the  N.  Y. 
Med.  Jour.,  September  4  : 

"  These  patients  were  at  once  put  upon  the  use 
of  hot  vaginal  injections  twice  daily.  If  there  was 
cystic  degeneration  of  the  cervix,  all  of  the  cysts 
that  could  be  reached  were  tapped.  If  the  os  and 
cervical  endometrium  were  granular,  appropriate 
treatment  for  it  was  given ;  and  applications  of 
Churchill's  tincture  of  iodine  to  the  cervix  and 
vaginal  roof,  together  with  glycerine  tampons, 
were  used  in  some  cases  as  often  as  every  other 
day.  That  this  method  of  treatment  was  beneficial 
no  one  for  a  moment  could  doubt,  but  it  did  not 
cure  my  patients.  It  did  not  reheve  the  weight 
and  dragging  pains,  or  do  away  with  the  foul 
leucorrhceal  discharges  of  which  the  patients  had 
so  long  complained. 

"  After  each  patient  had  been  kept  under  this 
form  of  treatment  for  a  certain  time,  she  was  put 
under  an  anaesthetic,  and  the  depth  of  the  womb 
carefully  noted.  If  menorrhagia  had  been  her 
habit,  the  cervix  was  rapidly  dilated  and  the  en- 
dometrium carefully  but  thoroughly  curetted  with 
Bozeman's  curette,  and  then  touched  with  a  i  to 
2,000  solution  of  bichloride  of  mercury,  wiped  dry, 
and  again  touched  with  glycerite  of  carbolic  acid. 
Many  prefer  the  use  of  Churchill's  tincture  of 
iodine  for  this  purpose,  believing  it  more  effica- 
cious in  preventing  a  return  of  the  fungosities;  but, 
in  cases  where  the  cervix  is  to  be  operated  upon, 
the  use  of  the  iodine  is  disadvantageous,  on  account 
of  its  discoloring  the  parts  and  rendering  the 
operation  more  difficult.  After  this  treatment  of 
the  endometrium,  if  the  cervix  was   lacerated,  I 


operated  for  its  closure  after  Emmet's  method, 
going  deep  into  the  angles  of  the  laceration.  If 
the  cervix  was  not  lacerated,  I  operated  after  the 
following  manner  :  I  steadied  the  cervix  with  a 
heavy^  curved  tenaculum,  and,  with  a  pair  of  sharp 
narrow-bladed  scissors,  I  made  a  deep,  narrow 
V-shaped  incision  in  each  side  of  the  cervix,  ex- 
tending the  incision,  if  possible,  deep  enough  into 
the  uterine  tissue  to  sever  what  we  ordinarily  style 
the  circular  artery.  Then,  after  letting  the  in- 
cisions bleed  quite  thoroughly,  I  closed  the  wound 
by  passing  sutures  from  without  inward  across  the 
incision,  taking  care  that  the  first  sutures  ligated 
the  several  vessels.  After  the  operation,  warm 
water  vaginal  injections  were  used  for  cleanliness 
only.  If  the  uterus  was  retroverted,  a  pessary  was 
fitted  and  allowed  to  remain  in  position  while  the 
wound  was  healing." 

The  results  were  satisfactory. 


THE  MILK  TREATMENT. 

T.  A.  McBride,  M.D.,  New  York. 

The  patient  is  to  use  skimmed  milk,  and  skimmed 
milk  alone  ;  no  other  kind  of  nourishment. 

The  patient  is  to  take,  three  or  four  times  daily, 
and  at  regularly  observed  intervals,  from  two  to  six 
ounces  of  skimmed  milk. 

This  must  be  taken  slowly,  and  in  small  quanti- 
ties, so  that  the  saliva  may  be  will  mixed  with  it. 
The  reaction  of  the  -milk  to  test  paper  must  be 
neutral  or  alkaline. 

The  first  week  is  the  most  difficult  to  get  over, 
unless  the  patient  has  a  strong  will. 

During  the  second  week  two  ordinary  quarts  may 
be  consumed  during  the  day.  The  milk  must  be 
drunk  four  times  daily ;  at  8  a.m.,  at  noon,  at  4 
and  8  p.m.  The  hours  may  be  changed,  but  regu- 
lar intervals  must  be  maintained. 

If  the  patient  comply  with  these  directions  he 
will  complain  neither  of  hunger  or  thirst,  although 
the  first  doses  appear  so  very  small. 

The  daily  quantity  may  be  increased  to  eighty  or 
more  ounces. 

If  after  having  attained  this  quantity  or  more, 
and  the  patient  gets  worse,  diminish  the  amount  to 
the  quantity  used  the  first  week,  and  increase  more 
slowly. 

Constipation  at  the  beginning  is  a  good  sign. 
This  may  be  remedied  by  warm  water  injections, 
or  by  the  use  of  castor  oil,  rhubarb,  addition  of 
sugar  of  milk  to  the  milk,  or  by  taking  some  bicar- 
bonate of  soda  at  bed-time.  If  the  constipation  be 
obstinate,  a  little  coffee  may  be  added  to  the 
morning  dose  of  milk,  or  towards. 4  p.m.,  stewed 
prunes  or  a  roasted  apple. 

If,  on  the  other  hand,  diarrhoea  result,  and  rum 
bling  of  the  bowels  is  frequent,  the  milk  is  too  rich 
or  is  being  taken  in  too  large  doses. 


THE   CANADA    MEDICAL   RECORD, 


47 


Feverishness  is  no  contra.-indication  to  its  use. 
If  the  patient  is  very  thirsty  he  may  drink  Clismic, 
Bethesda,  Poland  or  Vichy  Water.  If  he  have  a 
strong  desire  for  solid  food  at  the  end  of  the  second 
or  third  week,  he  may  have  a  little  stale  white  bread 
or  toasted  bread  with  salt,  in  the  morning  and 
again  at  4  p.m.  Once  a  d;iy  he  may  have  some 
soup  made  of  milk  and  oatmeal. 

After  continuing  this  treatment  for  five  or  six 
weeks  it  may  be  modified,  by  allowing  the  milk 
only  thrice  daily,  and  once  a  day  steal-  or  a  chop. 
Raw  meat  digests  most  easily,  and  should  be  used 
in  preference  to  the  cooked,  when  possible. 

It  may  be  necessary  to  add  a  little  salt  to  the 
milk  in  some  cases,  and  in  others  to  have  the  milk 
drank  when  very  hot.  If  the  patient  became  i\nt- 
ulent,  buttermilk  is  often  beneficial  in  small  quan- 
tities. 


THE  TREATMENT  OF  SCALP  WOUNDS  AT 
THE  CHAMBERS  STREET  HOSPITAL. 

Dr.  C.  R.  Parke,  in  an  article  published  recent- 
ly in  the  JVeui  York  Medical  journal,  makes  the 
following  statements  : 

Our  present  method  of  treating  a  scalp  wound 
is  as  follows  :  Upon  admission  of  the  patient,  the 
wound  and  bloody  hair  are  tnoroughly  cleanscrd 
with  a  douche  of  the  hydronaphthol  solution, 
next  the  hair  is  carefully  cut  with  scissors  for  about 
one  inch  around  the  margins  of  the  wound,  after 
which  it  is  cleanly  shaved  ;  the  wound  is  now 
again  cleansed  with  the  hydronaphthol,  all  tlots 
and  foreign  bodies  being  removed,  and  careful 
examination  for  fracture  made.  This  not  being 
found,  we  proceed  to  the  dressing,  which  consists 
in  inserting  ten  or  twelve  horse  hairs  through 
the  bottom  of  the  wound,  the  opposing  edges 
of  the  wound  being  carefully  approximated  and 
sewn  together  with  catgut  sutures,  the  horse 
hair  projecting  about  three-fourths  of  an  inch 
beyond  the  ends  of  the  Wound  and  thus  acting  as 
an  excellent  drain.  The  wound  is  now  again 
washed  with  the  hydronaphthol,  and  powdered 
touofom  lig.ht!7  dusted  over  the  line  of  the  su- 
tures, upon  which  are  applied  a  few  layers  of  iodo- 
ferm  gauze ;  over  this  is  placed  a  large  compress 
bf  absorbent  gauze,  extending  several  inches 
.beyond  the  wound  on  every  side,  the  whole  being 
held  in  place  by  a  bandage,  the  style  of  which 
depends  upon  the  location  of  the  injury.  The 
batient  is  told  to  return  in  two  days,  provided  no 
ipain  or  unlooked-for  symptoms  arise,  under  which 
'circumstances  he  is  requested  to  return  at  once. 
Upon  returning  two  days  later,  as  a  rule,  we  find 
'primary  union  throughout  the  entire  length  of  the 
ivound,  excepting  at  the  ends  where  the  drain 
protrudes.  We  have  now  converted  the  open 
;scalp  wound  into  a  perfectly  drained  sinus.  All 
'but  three  or  four  of  the  horse  hairs  are  removed, 
'the  sinus  is  irrigated  with  the  hydronaphthol  solu- 
'tion,  and  the    same  style   of  dressing   re-applied. 


In  two  or  three  days  more  the  sinus  has  so  nar- 
rowed down  that  the  remaining  horse  hairs  can 
with  safety  be  withdrawn,  and  complete  healing 
can  occur  under  the  dressing  then  applied;  the 
catgut  sutures  are  absorbed  and  give  rise  to  no 
trouble.  The  wound  thus  heals  with  little  or  no 
scar,  as  compared  with  the  plan  which  allows  the 
wound  to  granulate  from  the  bottom,  and  further- 
more offers  the  advantage  of  healing  in  a  much 
shorter  time.  The  virtues  which  I  maintain  for 
the  hydronaphthol  solution  over  those  possessed 
by  the  carbolic  acid  and  bichloride  solutions  are 
that  it  is  without  odor,  and  does  not  burn  or  dis- 
color the  hands  as  carbolic  acid  does,  neither  does 
it  ruin  one's  instruments  nor  cause  any  danger 
from  absorption,  as  if  the  case  with  the  bichloride, 
while  at  the  same  time  it  is  a  perfect  deodorizer, 
non-irritant,  and,  as  I  think,  a  desinfectant. 

In  order  to  give  a  little  idea  of  the  results  we 
obtain  under  this  method  of  treatment,  I  took  at 
random  30  out  of  the  1 23  cases  treated  here  in 
thirty  days  and  carefully  looked  the  patients  up  ; 
five  of  them  never  returned  after  the  first  dressing 
was  applied.  Of  twenty-five  there  was  a  full 
■record  until  they  were  discharged  cured.  The 
longest  period  that  any  patient  was  under  treat- 
ment was  ten  days,  and  the  shortest  three  days, 
the  average  being  six  plus.  The  greatest  number 
of  dressings  employed  in  any  case  was  six,  and  the 
smallest  two,  the  average  being  three  plus. 

The  Canada  Medical  Record. 

k  Monthly  Journal  of  Medicine  and  bnrgery- 

EDITORS  : 

FRANCIS  Ty.  CAMPBELL,   MA.,  M.D.,  L.K.C.P.  LOND. 

Editor  and  Proprietor. 

E.  A.  KENNEDY,  M.A.,  M.D.,  Managing  Editor. 

ASSISTANT  EDITORS: 
CASEY  A.  WOOD,  CM.,  lil.D. 
GEORGE  E,  AEMSTKONG,  CM.,  M.D. 

8PB8CBIPTION   TWO   DOLLARS    PER    ANXO.M. 

AU  CO  ii/iiu:Uculi07is  and  Exchanges  must  be  aJdressed  to 
tk^.lUors,fJfHwer^o(i,  Post  Office,  Montreal . 

MONTREAL,  NOVEMBER,  1886. 

TO  OUR  SUBSCRIBERS. 
We  beg  that  our  subscribers  will  look  at  the 
date  on  their  address  label.  That  date  is  the  time 
to  which  their  subscription  is  paid.  Ever)'  now 
and  then  we  get  a  note,  asking  for  a  statement  of 
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tion. Such  a  request  is  unnecessary.  Every  month 
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48 


THE   CANADA   MEDICAL   RECORD. 


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by  looking  at  the  label  on  his  Record.  We  regret 
to  say  that  a  great  many  are  very  far  in  arrear. 
Will  all  our  subscribers  look  at  their  label,  and 
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PERSONAL. 

Dr,  Longeway,  (M.D.,  Bishop's  College,  1886,) 
has  removed  from  Highgate,  Vermont,  to  Mont- 
real, where  he  has  commenced  practice.  He  has 
also  been  appointed  an  Assistant  Demonstrator  of 
Anatomy,  in  the  Medical  Faculty  of  his  Alma 
Mater. 

Dr.  Freleigh,  M.D.,  Bishops' College,  1886,  has 
commenced  practice  in  Montreal. 

Dr.  McCow,  M.D.,  McGill,  1886,  has  commen- 
ced practice  in  Montreal. 

Dr.  Schmidt,  M.D.,  McGill  College,  1886,  has 
settled  in  Montreal. 

Dr.  Wood,  M.D.,  McGill,  1876,  has  returned 
from  Florida  and  commenced  practice  in  St. 
Johns,  Que. 


REVIEWS. 
Jhe  healing  of  arteries  after  ligature  in  man  arid 
animals.  By  J.  Collins  Warren,  M.D., 
Assistant  Professor  of  Surgery,  Harvard  Univer- 
sity ;  Surgeon  to  the  Massachusetts  General 
Hospital ;  Member  American  Surgical  Associa- 
tion; Honorary  Fellow  Philadelphia  Academy  of 
Surgery.  One  Volume.  184  Pages.  Superbly 
illustrated  with  Twelve  Full-page  Plates  in 
Black  and  Colors.  Parchment  Muslin  Binding. 
Price  $3.25.  William  Wood  and  Company, 
New  York. 

The  great  facilities  afforded  the  author  have  en- 
abled him  to  present  to  the  profession  a  mono- 
graph at  once  comprehensive  and  original.  The 
importance  of  the  subject  to  the  surgeon  is  evident 
and  though  much  has  been  written  elsewhere  the 
author,  while  not  discarding  the  labors  of  others, 
arrives  at  conclusion  based  upon  his  own  observa- 
^  tions  and,  therefore,  valuable.  The  work  is  rendered 
more  valuable  by  the  excellent  plates  which  illus- 
trate the  different  phases  through  which  the  vessel 
passes  after  ligation  and  until  no  further  change 
occurs. 

Separate  chapters  are  devoted  to  the  history  of 
the  ligature,  experiments  on  animals,  the  ligature  of 
arteries  in  man,  as  shown  by  specimens  from  the 
different  museum,  closure  of  fcetal  vessels.  The 
summary  on  chapter  fifth  includes  his  conclusions 


and  an  appendix  describing  the  methods  employed 
in  these  investigations.  A  Bibliography  con- 
taining 235  references  arid  an  index  complete  the 
volume.  ^ 

The  Physician's  Pocket  Day-Book.  By  C.  Henri 
Leonard,  M.A.,  M.D.,  Detroit,  Mich.  Price 
$1.00. 

This  is  a  vpry  convenient  form  of  visiting  list, 
and  accomiTiodates  daily  charges  for  25  or  50 
families  weekly,  an  obstetrical  record  and  Dr. 
and  Cr,  cash  account.  For  the  young  phy- 
sicians c^ommencing  practice  it  will  be  found 
one  of  the  best  diaries  extant,  as  it  serves  the  pur- 
pose of  day  book  and  ledger  combined.  It  is 
arranged  for  13  months,  and  the  record  may  begin 
at  ar-y  month  of  the  year. 


A  Laboratory  Guide,  in  Urmalysis  and  Toxico 
lo^.  By  R.  A.  WiTHAM,  A.M.,  M.D.,  pro- 
fpssor  of  Chemistry  and  Physics,  University 
jf  the  city  of  New  York,  etc.  Wm.  Wood  & 
Co.,  New  York. 

A  concise  and  practical  guide,  very  suitable  for 
laboratory  work,  is  every  alternate  page  left 
blaiik  for  the  purpose  of  entering  additional  notes. 
We  commend  this  little  work  to  the  student  or 
busy  practitioner  as  a  very  useful  aid  for  the  pur- 
poses indicated.  

Ouilines^lrf--ihe  Pathology   and   Treatment   of 
Syphilid  and  allied  venereal  disease.     By  H. 
VoN  Zeissl,  M.D.J  late  professor  at  the  Imperial 
Royal  University  of  Vienna,    translated  by  H. 
Raphael,  M.  D.,  Bellevue  hospital,  one  volume, 
402  pages.  D.  Appletcn  &  Company,  New  York. 
This  is  a  second  edition  of  this  work,  the  success 
of  the  first  inducing  a  revision  of  the  text,   so  as 
to  make  the  description  of  venereardiseilSOS"^s'per- 
fectas  possible.     The  value  of  the  work  is  attested 
by  the  fact  that  the  author  devoted  a  lifetime  spe- 
cially to  the  study  and  treatment  of  these  affections. 
The  descriptions  are  concise  and  graphic,  promi- 
nence being  given   to   the  pathology  of  the  struct 
lures  concerned,  and  the  remedies  and  formulas  are 
such  as  have  been  found, by  long  clinical  experience,' 
to  be  best  adapted  for  the  treatment  of   the  differ' 
ent  phases  of  these  diseases.     Although  the  work) 
offers  but  little  that  is  new,  still  the  practical  physi- 
cian, whose  time  does  not  permit  the  study  of  more 
extensive  works,  will  find  this  a  valuable  aid  in  his' 
practice. 


THE  CANADA  MEDICAL  RECORD, 


Vol.  XV. 


MONTREAL,  DECEMBER,  1886. 


No.  3. 


O  OIsTTEJlSTTS. 


ORIGINAL  COMMUNICATiaNS. 

Ilock  ami  Rv  in  Acutn  ami   Subacute 
Bioiiclii'iis  40 

University  Bislioi)'s  College 4H 

SOCIETY  PROCEEDINGS. 

MetUeo-Cliirurgical    Society    of    Mon- 
treal        5- 

PROGRESS  OF  SCIENCE. 

ASimple  Alelhodfor  tlie  Diagiiosiy  of 
Orjjanic    Valvular   Diseases  of  tho 

Heart 55 

Irritable  Brain  in  Children 57 

Tho  Value  ofJExterual  Applications  in 


tlu'  'I'lv.'^ii  iiiont  ofjCUiMren.— Effects 

ol  TuM  Witter     59 

Bistiiuili  Sul'nitrate  iu  Burns 62 

Weaning  63 

Insomnia  in  the  Agud 63 

Winter  Indigestion 64 

Biliousness ....*■........  64 

The  Dietetics  of  Pulmonary  Phthisis...  6r. 

The  Dietary  in  Indigestion, 66 

Sore  Nipples 68 

Camphor, Cliloral  and  Cocaine  in  Tooth- 
ache  .' 68 

'J'he  u^e  atid  nhuse  of    Tea 68 

Phylnlaoca  Decandrain   Treatmeut  of 

Bronchocele  — 70 


The  Treatment  of  Bronchitis  ..  "^ 

EDITORIAL 

College  of  Physicians  and  Surgeons,  Pro- 

vince  of  Quebec J 

Credit  Wliere  Due JJ 

Small-Pox  at  Kingston,  .laniaica 7J 

Forty    thousand    new    doctors  in  ten 

ypars II 

A  Curious  Wager ■-     *^ 

On  a  Means  of  Recognizing  that  the  Um- 
bilical Cord  is  round  the    neck    of 

theChlld J2 

Treatment  of  Ingrowing  Toe-nail '-i 


(t)n6inal  BammiiiikaUQid. 

ROCK  AND    RYE    IN   ACUTE    AND    SUB- 
ACUTE BRONCHITIS. 
Bv  Heber  Bishop,  B.A.,  CM.,  M.D.,  Boston,  Mass. 
I  have  had  excellent  results  in  the  administration 
of  rock  and  rye  in  acute  and  sub-acute  forms  of 
bronchitis,  and  have  found  it  of  particular  value  in 
children.    The  ease  with  which  the  ordinary  patient 
will  take  the  drug  renders  it  worthy  of  a  trial. 

As  a  proof  of  its  efficacy  I  will  cite  one  instance 
(that  of  a  child  two  years  old).  I  was  called  to  the 
patient  at  5  o'clock  in  the  evening,  found  that  the 
child  had  commenced  with  an  ordinary  coriza, 
running  from  the  nose,  which  had  been  observed 
for  two  or  three  days  ;  the  night  before  had  com- 
menced to  cough,  which  during  the  day  had  be- 
come so  severe  that  I  was  summoned  in  the  after" 
noon. 

The  general"  appearance  of  the  child  was  indica- 
tive of  capillary  bronchitis  respirations  72  per 
minute,  pulse  150,  temperature  102°  the  ate  nasi 
dilated  and  the  face  turgid  and  purple  with  that 
frightfully  distressed  appearance.  Urine  scanty 
(had  not  micturated  for  18  hours)  ;  with  each  cough 
the  child  would  cry  out. 

Upon  listening  with  the  stethoscope  coarse, harsh, 
rales  were  heard  over  both  lungs,  with  some  fine 
mucous  crepitation  over  a  portion  of  the  left  lung 
behind.  I  immediately  ordered  linseed  meal  poul- 
tices to  be  applied,  enveloping  the  chest  and  back 
completely,  and  prescribed  a  mixture  of  syr.  ipecac, 
(niin.  5)  syr.  Acacia  (min.  15)  and  Morphia  (gr. 
i-5oth.)    to  be   administered  every   four  or   five 


hours ;  and  directed  that  a  teaspoonful  of  rock  & 
rye  and  glycerine  be  given  in  as  much  water  every 
two  hours.  At  my  visit  next  morning  found  the 
child  better  and  sleeping  quietly,  did  not  disturb 
her.  Discontinued  the  syr.  ipecac.  Acacia  and 
morphia  but  continued  the  rock  &  rye  and  glycerine 
at  regular  intervals  of  two  hours. 

At  my  evening  visit  found  the  child  sitting  up 
and  playful,  all  acute  symptoms  subsided,  pulse 
118,  temperature  99.  Respirations  33.  This  re- 
markable change  had  occurred  in  24  hours. 

In  nearly  every  case  of  bronchitis  that  I  have 
given  it,  rock  &  rye  controlled  the  cough  besides 
acting  as  a  stimulant,  and  in  young  children  it  does 
not  bind  up  the  bowels  the  same  as  Brandy  will 
often  do.  In  winter  cough  (so  called)  it  exerts  a 
very  soothing  effect. 


UNIVERSITY  BISHOP'S  COLLEGE. 
The  Annual  Dinner  of  the  Medical  Undek- 
graduate's  Society. 
The  annual  dinner  of  the  Undergraduates  of  the 
Medical  Faculty  of  the  University  of  Bishop's  Col- 
lege came  off  on  December  9,  1886,  in  the  Ladies' or- 
dinary of  the  Windsor  Hotel,  and  was  marked  by 
much  cordiality.  Some  seventy-five  gentlemen, 
some  representing  the  other  universities,  sat  down 
to  an  excellent  dinner,  to  which  full  justice  was 
done.  Dr.  F.  W.  Campbell,  M.  A.,  M.  D.,  L.  R. 
C.  P.,  London,  Dean  of  the  Faculty,  occupied  the 
chair.  On  his  right  were  seated  Mr.  Heneker, 
Chancellor  of  the  University,  Dr.  Anderson,  Uni- 
ted States  Consul  General ;  Dr.  McEachran,  Mr.  J. 
S.  Hall,  M.P.P.,  Dr.  George  Ross,  representing 
McGill,  and  Dr.  Proudfoot.     On  the  left  of  the 


50 


THE   CANADA  MEDICAL   RECORD. 


chairman  were  Dr.  Adams,  Principal  of  the  Bis- 
hop's College  School,  Lennoxville;  Alderman  White 
Acting  Mayor,  Dr.  Kingston,  Messrs.  Alex.  Mur- 
ray, David  Burke,  I.  H.  Slearns  and  Dr.  Lapthorne 
Smith.  After  dinner  Messrs.  Rholler  (sole),  Tait, 
Jubb,  Clarke  and  Fairfield  sang  in  a  very  acceptable 
manner  "  Thy  face  I  never  see."  The  secretary  of 
the  committee,  Mr,  Albert  E.  Phelan,  then  read  let- 
ters of  regret  at  inability  to  be  present  from  the  fol- 
lowing— Sir  John  A.  Macdonald,  the  Lieut-Gover- 
nor of  Quebec,  General  Sir  Frederick  Middleton, 
the  Tjord  Bishop  of  Quebec,  the  Lord  Bishop  of 
Montreal,  the  Mayor,  Rev.  Cannon  Norman,  D. 
C.  L.,  R.  N.  Hall,  Q.  C,  M.  P.,  L.  H.  Davidson, 
Q.  C,  the  Faculty  of  Trinity  College,  Rev.  James 
Hepburn,  Dr.  Roddick,  Dr.  R.  P.  Howard,  Dr. 
James  Bell,  Dr.  Sirois,  Three  Rivers  ;  Dr.  Freligh 
Dr.  Spendlove,  Magog;  Dr.  Thomas,  Green  Bay, 
Wis  ;  Dr.  McEachran,  Dr.  Chas.  McEachran,  Dr. 
Stevens,  Durham ;  J.  M.  Kirk,  Aid.  H.  R.  Gray, 
Hon.  S.  P.  Stearns,  former  U.  S.  Consul,  Major 
Vidal,  St.  John's  Infantry  School,  Dr.  Lafontaine, 
Chambly,  and  Dr.  J.  B.  Saunders. 

THE  QUEEN. 

''  When  I  forget  my  Sovereign 
May  my  God  forget  me." 

—  7/iarlow. 
In  proposing  this  toast,  which  was  drunk  with 
enthusiasm,  the  chairman  paid  a  high  tribute  to 
Our  Gracious  Sovereign,  and  expressed  the  hope 
that  Montreal  would  honor  her  jubilee  in  a  becom- 
ing manner.  The  company  sang  the  national  an- 
them. 

THE    GOVERNOR-GENERAL. 

"  Not  P.  hero  but  a  man  and  a  brother." 

—  Thackcry, 
This  toast  was  also  given  by  the  chairman,  who 
remarked  that  he  remembered  all  the  Governor- 
Generals  of  Canada  since  Lord  Elgin,  and  he  was 
glad  to  say  that  none  were  more  accomplished  and 
scholarly  than  Lord  Lansdowne.  The  toast  was 
duly  honored,  the  guests  singing  "  For  he's  a  jolly 
good  fellow." 

"  PRESIDENT  OF   THE    UNITED   STATES." 
"  The  government   of  the  people,   by  the  people  and  for 
the  people  shall  not  perish  from  the  earth." — A.  Linceln. 

The  chairman,  in  giving  this  toast,  stated  that 
the  relations  existing  between  the  peoples  of  Cana- 
da and  the  United  State«  were  of  the  most  cordial 
nature,  notwithstanding  the  fact  that  the  Canadians 
wanted  to  catch  all  the  fish  within  the  three  miles 
limit.  [Laughter.]  The  line  which  separated 
them  was  but  an  imaginary  one.  Canadians  had 
the  highest  respect  for  their  great  neighbors,  who 


had  been  especially  fortunate  in  selecting  good 
men  to  represent  her  here.  In  appointing  Dr.  An- 
derson President  Cleveland  had  selected  a  worthy 
and  accomplished  gentleman,  while  at  the  same 
time  honoring  the  medical  profession  to  which 
they  were  all  glad  to  belong.  The  toast  was 
heartily  honored,  the  orchestra  striking  up  "  Yanke<i 
Doodle." 

Dr.  Anderson  was  given  a  very  cordial  reception 
on  rising  to  respond.  He  remarked  that  he  had 
just  finished  reading  the  Fisheries  correspondence 
and  felt  in  a  warlike  mood  (laughter)  when  he  had 
been  called  upon  by  a  delegation  and  invited  to 
be  present  at  the  dinner  to  answer  to  the  toast  to  the 
United  States.  He  was  glad  to  observe  that  hardly 
'In  event  of  this  kind  was  allowed  to  pass  without  a 
oast  being  given  to  the  United  States.  This  indi- 
cated that  an  amicable  feeling  prevailed  here  for 
his  country.  As  a  citizen  of  the  United  States  he 
thanked  them  most  heartily  for  the  honor  done 
him.  Dr.  Anderson  closed  with  some  humoristic 
allusions  at  the  expense  of  the  profession  to  which 
he  and  the  guests  belonged. 

MAYOR  AND  CORPORATION. 
"The   best   laid   schemes   of  mice  and   men    g.ing   aft 
agley" — Burns. 

The  chairman  in  proposing  this  toast  observed 
that  if  Montreal  did  not  receive  her  fair  share  of 
representation  in  the  Legislature  she  certainly  was 
well  represented  in  the  City  Council.  Each  ward 
had  three  aldermen.  At  the  present  rate  of  annex- 
ation this  body  would  become  as  numerous  as  the 
Dominion  Parliament.  [Laughter.]  After  paying 
a  compliment  to  the  Mayor  for  his  conduct  in 
trying  circumstances,  he  called  upon  Aid.  AVhite 
to  respond. 

The  acting  Mayor  thanked  the  company  on 
behalf  of  the  Mayor  and  his  colleagues  of  the  City 
Council  for  the  toast  drunk  in  their  honor.  As 
the  corporation  was  growing  rapidly  be  hoped  too 
many  of  its  schemes  would  not  "  gang  aft  agley.', 
He  hoped  that  that  body  would  always  do  all  in 
its  power  to  further  the  interests  of  the  great  edu- 
cational interests  of  the  city  with  which  his  hosts 
were  so  intimately  connected.  He  concluded  by 
again  thanking  them  for  their  kindness  and  wishing 
all  success  to  Bishops'  University. 

AL.MA    MATER. 
"  May  youtli  and  honor 
court  thy  hallowed  shades." 

Dr.  R.  A.  Kennedy  proposed  a  toast  to  "  Alma 
Mater "  in  appropriate  terms.  In  the  course  of 
his  remarks  he  stated  that  it  had  often  been  asked 


I 


THE   CANADA   MEDICAL   RECORD. 


51 


why  the  Medical  Faculty  of  Bishops'  had  been 
established  in  this  city.  Those  who  had  questioned 
the  usefulness  of  this  undertaking  found  an  answer 
in  the  good  work  which  it  was  now  doing,  and  in 
the  success  which  had  crowned  its  efforts.  The 
Faculty  had  done  a  great  deal  to  elevate  the 
standard  of  medical  education,  which  was  every 
day  becoming  more  eitense.  There  were  now 
over  1,000  medical  students  in  the  Dominion  of 
Canada  in  1885  and  231  graduates.  The  men  who 
had  been  trained  in  Bishops'  were  a  credit  to  the 
profession.  He  closed  by  referring  to  the  state- 
ment which  had  been  circulated,  that  it  was  con- 
templated to  remove  the  University  from  Lennox- 
ville  to  Montreal.  He  hoped  this  was  true,  and 
would  be  accomplished.  He  called  upon  the  Chan- 
cellor to  respond. 

The  Chancellor  was  very  heartily  received  on 
rising.  To  answer  to  such  a  toast,  he  said,  was  an 
easy  task  as  it  had  the  full  sympathy  of  all.  The 
subject,  however,  was  so  large  and  included  so 
many  ideas,  that  he  did  not  know  exactly  which 
one  to  touch  upon.  Two  points,  however,  had 
come  prominently  before  him,  and  to  these  he  would 
refer.  As  to  the  idea  of  removing  the  Univer- 
sity into  Montreal,  he  would  say  that  nothing 
was  known  of  the  project  at  Lennoxville.  If 
the  scheme  could  be  carried  out,  however,  it 
would  open  for  the  University  a  larger  sphere  of 
usefulness  than  that  to  which  it  was  now  limited 
by  being  situated  in  the  country.  It  was  a  matter 
which  was  well  worthy  of  consideration.  They 
could  rest  assured,  however,  that  as  long  as  the 
University  remained  at  Lennoxville  it  would  do  all 
jn  its  power  to  turn  out  men  second  to  none. 
(Applause.)  They  would  look  more  to  quality  than 
quantity.  With  regard  to  the  Divinity  Faculty,  an 
important  scheme  had  been  discussed  in  the  last 
Synod,  and  this  consisted  in  bringing  all  divinity 
degree  conferring  powers  under  one  organization. 
While  Bishops'  was  determined  to  maintain  its 
full  rights,  as  granted  by  its  Royal  charter,  it  would 
like  to  see  the  formation  of  an  Examining  Board 
made  up  from  the  different  universities,  which 
would  stamp  upon  divinity  degrees  that  character 
which  would  make  them  respected  the  world  over. 
Some  years  ago  an  appeal  had  been  made  by 
Bishops'  University  to  the  sister  universities,  to 
join  in  the  formation  of  an  Examining  Board  in  the 
arts ;  but,  unfortunately,  had  met  with  no  response. 
If  the  standard  of  Bishops'  was  not  sufficiently 
good  they  were  willing  to  raise,  but  if,  on  the  other, 


that  ofthe  other  universities  was  not  what  it  should 
be,  it  was  for  them  to  elevate  theirs,  and  the  con- 
sequence would  be  that  Canada  would  turn  out  in 
divinity  men  who  would  be  respected  everywhere. 
The  same  was  the  case  in  the  medical  profession. 
Bishops',  which  possessed  the  same  rights  as 
Oxford,  Cambridge,  London  and  Durham  Univer- 
sities, would  be  inconsistent  if  it  gave  up  an  iota 
of  its  rights.  He  felt  that  the  best  interests  of 
Canada  required  that  its  higher  education  should 
be  respected  the  world  over.  -  A  general  Examining 
Board  would  achieve  this  desirable  result.  If  a 
man  went  out  of  the  universities  in  Canada  after 
having  undergone  an  examination  before  the  Gen- 
eral Board,  that  man  would  at  once  be  favored 
with  the  confidence  ofthe  public.  (Applause.)  The 
second  point  to  which  he  desired  to  refer  to  was 
the  want  of  re[)resentation  in  the  governing  bodies 
of  the  country  of  interests  of  higher  education. 
At  Quebec  there  were  lawyers  and  physicians  but 
tlie  learned  bodies  were  unrepresented.  The 
suffrage  had  been  so  lowered  here  as  well  as  in  the 
old  country,  that  the  ignorant  classes  were  fully 
represented,  while  nothing  had  been  done  to  secure 
representation  for  the  learned  classes.  In  England 
the  universities  were  represented  in  Parliament 
and  why  should  not  the  same  thing  exist  in  Cana- 
da ?  (Hear,  hear.)  The  subject  was  such  an 
important  one  that  pressure  should  be  brought  to 
bear  on  the  Government  to  consider  it.  Whether 
the  universities  should  be  represented  in  the  local 
or  federal  parliaments  was,  of  course,  a  matter  for 
thought.  Under  the  present  system  the  general 
interests  of  education  were  in  the  hands  of  a 
Council  of  Education  at  Quebec  and  a  Minister 
of  Education  at  Toronto.  Both,  however, 
gave  up  all  their  attention  to  the  common  schools 
and  had  nothing  to  do  with  universities.  If  the 
universities  of  the  country  were  braught  more 
closely  together  the  alliance  would  partake  of  a 
more  general  character  and  this  would,  perhaps, 
be  a  reason  why  these  learned  bodies  should  be 
represented  in  the  Dominion  Parliament.  Without 
hurting  any  one's  feelings  he  could  well  say  that 
there  was  less  intelHgence,  as  a  rule,  in  the  Legis- 
latures than  in  the  Dominion  House.  There  was 
a  more  pressing  need  of  elevating  the  intellectual 
standard  ofthe  Legislatures,  and  there  was  no  rea- 
son why  the  highest  class  of  intelligence  which  was 
to  be  found  in  the  universities  should  not  be  repre- 
sented. (Applause.)  The  chancellor  closed  by  sta- 
ing  that  the  Univesity  took  the  greatest  interest  in 


1 


52 


THE   CANADA   MEDICAL   RECORD. 


the  medical  school  and  hoped  that  it  would  continue 
to  prosper.  It  always  had  sent  men  all  over  the  coun- 
try, to  the  United  States,  the  West  Indies,  and  even 
China  and  Japan,  and  everywhere  the  name  of 
Bishops  had  been  honored  and  respected.  He 
wished  them  all  the  success  which  they  deserved. 

Principal  Adams  also  replied  to  the  toast,  and 
thanked  the  Chancellor  for  the  very  valuable 
suggestions  which  he  had  made.  The  present 
year  was  a  very  encouraging  one  for  Bishops',  and 
and  there  was  a  larger  entry  at  both  the  Lennox- 
ville  school  and  the  medical  school.  He  was 
glad  to  see  that  many  of  the  art  students  of  the 
school  had  joined  the  Montreal  school,  and  con- 
cluded by  wishing  every  success  to  their  Alma 
Mater. 

Dr.  Proudfoot  then  sang  "  Me  Ain  Bonnie 
Mary." 

DEAN    .'VND   PROFESSOR. 

"  Men  who  their  duties  know,  but  know  their  lights,  and 
knowing  dare  maintain." 

This  toast  was  proposed  in  suitable  terms  by 
Mr.  W.  E.  Fairfield,  the  vice-chairman,  and  was 
duly  acknowledged  by  Dr.  Wood  in  a  very  amu- 
sing speech. 

SISTER  UNIVERSITIES. 

"  Their  cause  I  plead,  plead  it  in  heart  and  mind, 
A  fellow  feeling  makes  us  wondrous  kind  " 

— David  Garrick, 

This  toast  was  proposed  by  the  vice-chairman, 
and  heartily  honored. 

Dr.  George  Ross,  representing  McGill,  respond- 
ed in  an  appropriate  speech.  He  said  the  kindest 
feeling  existed  between  universities.  They  worked 
together  in  the  greatest  harmony,  and  McGill 
took  great  interest  in  Bishops',  to  which  many  of 
its  graduates  were  now  attached  as  professors. 
He  congratulated  then  upon  their  success,  and 
hoped  that  their  friendly  rivalry  would  always  be 
stamped  with  good  fellowship. 

Responses  were  also  made  by  Mr.  Ferguson,  of 
Kingston  University,  Mr.  Edgar,  of  McGill,  Mr. 
C.  T.  Moral,  of  Victoria,  and  Mr.  J.  Mount,  of 
Laval. 

HOSPITALS. 
"  I  was  sick  and  ye  visited  me." 
This  toast  was  proposed  by  Dr.  Trenholme, 
and  responded  to  by  Dr.  Kingston,  who  expressed 
the  kindliest  feeling  for  Bishops'  and  paid  a  high 
compliment  to  the  general  excellence  and  earnest- 
ness of  its  undergraduates. 

Dr.  Perrigo  also  acknowledged  the  toast  on 
behalf  of  the  Western  Hospital. 


SISTER    FACULTIES. 
'■■  Who  shall  decide  when  Dodcrs  disagiee." 
' '  Possession  is  nine  points  of  the  law" 
"  O  I  star  eyed  science  hast   thou  wandered  here." 
"  Healthy  religion,  a  sound  mind  in  a  sound  body." 

This  toast  was  proposed  by  Dr.  Trenholme, 
and  after  being  duly  honored,  was  responded  to 
in  suitable  terms  by  Mr.  Hamilton  of  the  arts 
faculty. 

OUR    GUESTS. 

"  Happy  to  meet  sorry  to  part." 

Mr.  Heneker,  in  responding,  expressed  the  hope 

that  all  would",atlend  the   annual  dinner  of  the 

Alma    Mater,    which   would   be   held   shortly    in 

Quebec. 

OUK  GRADUATES. 
*'  To-morrow,  to  fresh  woodsand  pastures  new." — Milton. 

The  toast,  which  was  enthusiastically  honored) 
was  proposed  by  Mr.  James  M.  Jack  and  suitably 
acknowledged  by  Dr.  R.  Wilson. 

Other  toasts  followed  to  the  "  Class  of  '87," 
'' Be  ready  for  all  changes  in  the  future."  "Our 
Freshmen" — "  With  smiles  that  were  childlike  and 
bland." 

THE  LADIES. 
"  A  perfect  woman  nobly   planned  ;" 
"  To  warn,  to  comfort  and  command." 

"The  Press'' — "The  pen  is  mightier  than'the 
sword." 

The  proceedings  were  concluded  by  the  singing 
of  the  National  Anthem. 

The  following  gentlemen  forming  the  committee 
are  entitled  to  great  credit  for  the  success 
attained  :  Dr.  F.  W.  Campbell, ^chairman,  W.  E. 
Fairfield,  '87,  vice  chairman.  Dr.  R.  A.  Kennedy, 
Dr.  J.  B.  McConnell,  Dr.  H.  L.  Reddy,  Dr.  A.  L. 
Reddy,  Dr.  A.  Smith,  Rollo  Campbell,  '87,  F.  H. 
Pickel,  '88,  Jas.  .^M.  Jack,  '89,  C.  E._Elliott,  '90, 
and  Albert  E.  Phelan,   '87,  secretary. 

Gruendwald's  orchestra  was  in  attendance  and 
contributed  a  select  programme, 

MEDICO-CHIRURGICAL  SOCIETY  OF 

MONTREAL. 

Stated  Meeting  Oct.  22nd,  1886. 

President,  in  the  Chair. 

Aortic  Aneurism. 

The  president  called  on  Dr.  M.  C.  McGannon, 

of  Brockville,  who  was  present,  to  give  the  history 

of  an  interesting  specimen  of  double  aneurism  of 

the  arch  of  the  arota  shown  by  him  to  the  society. 


THE   CANADA   MEDICAL   RECORD. 


53 


Dr.  McGannon  said  that  the  patient  was  well  six 
months  ago.  First  symptoms  were  those  of  a 
severe  bronchitis.  Resonance  was  complete  on 
both  sides  but  absence  of  breathing  on  the  right 
side,  patient  at  that  time  had  no  pain,  temperature 
and  pulse  were  normal,  and  iiearl  sounds  slightly  ac- 
centuated. Later  a  pulsation  could  be  discerned  to 
the  right  of  the  sternum.  Temperature  went  up  and 
the  lungs  became  consolidated,  patient  lost  appetite, 
cough  with  expectoration  increased.  But  at  no  time 
was  there  any  peculiarity  of  the  voice  or  any  signs 
of  pressure,  except  on  the  bronchi. 

In  reply  to  Dr.  Smith,  Dr.  McGannon  stated 
that  the  patient  died  from  exhaustion.  Dr.  Ross 
asked  if  there  was  any  tugging  at  the  trachea  per. 
ceptable.     Dr.  McGannon  replied  in  the  negative. 

Dr.  Johnston  said  that  the  specimen  showed 
that  both  aneurisms  were  of  very  rapid  growth, 
and  in  neither  was  there  any  signs  of  lamination 
in  the  clot. 

Dr.  Gardner  exhibited  the  following  pathologi- 
cal specimens  obtained  during  the  previous  ten 
days. 

I.  A  submucus  hyoma  was  removed  by  enuclea- 
tion. The  patient  was  the  mother  of  several 
children,  the  last  born  5  years  ago,  and  had  suff- 
ered from  uterine  hemorrhage  ever  since.  After 
dilating  the  uterus  the  capsule  was  slit  up,  the 
tumor  grasped  with  a  vulsillum,  separated  by  the 
finger  and^dragged  from  its  bed.  The  shreds  of 
capsule  trimmed  off,  the  cavity  well  douched  with 
hot  water,  and'  Churchill's  iodine  freely  applied. 
No  drainage  or  irrigation  was  practiced.  The  pa- 
tient made  an  easy  and  rapid  recovery. 

Cystic  tumor  of  the  labium. 

II.  A  cyst  of  the  left  labium  magus  of  five  years 
growth  and  the  size  of  a  hen's  egg.  It  was  easily 
enucleated  entire.  This  was  probably  a  degener- 
ated glan^  of  Bartholine  extirpation  of  a  cancer- 
ous uterus. 

III.  A"  cancerous  uterus  from  a  patient  of  49 
years.  Patient  had  interior  pelvic  pain  and  the 
other  usual  symptoms  of  malignant  disease  of 
uterus.  "Examination  before  the  operation  proved 
that  within  the'  broad  ligament  near  the  pelvic 
glands  were  seriously  involved.  The  removal  was 
performed  by  the  vaginal  method. 

The  patient  being  placed  in  the  lithotomy 
position,  and  so  retained  by  Clover's  crutch,  the 
uterus  was  drawn  downwards  and  forwards  to  the 
pubes  and  the  vaginal  mucous  membrane  incised 
all  round  the   cervix.     Then    the   base   of  each 


broad  ligament  was  ligatured  by  transfixion  with 
a  curved  needle  carrying  strong  silk.  Next  the 
posterior  cul-de-sac  was  opened  into  the  Douglas 
pouch  and  the  bladder  separated  completely.  The 
uterus  was  then ^retroverted  through  the  posterior 
cul-de-sac.  After  this  the  broad  ligaments  in 
their  ujjper  parts  were  clamped  on  each  side  with 
Terrier's  clamps  for  the  purpose,  and  the  ampu- 
tation of  the  uterus  completed.  Some  bleeding 
I)oints  were  secured  and  the  operation  completed 
by  a  T  dranage  tube  laid  in  the  Douglas  pouch. 
The  clamp  forceps  were  removed  at  the  end  of 
three  days  and  the  drainage  tube  a  day  later. 
The  patient  recovered  without  a  bad  symptom. 
Ovarian   Cystoma. 

IV.  A  muUelocular  ovarian  cystoma  removed 
from  a  lady  of  68  years.  In  this  case,  48  hours  after 
the  operation,  the  patient  developed  a  pleuresy  of 
the  right  side,  which  extended  to  the  left  two  days 
later.  The  pulse  reached  175  per  minute,  and 
was  irregular  and  intermittant.  This  was  prompt- 
ly checked  by  ten  minute  doses  of  tincture  of  digi- 
talis every  4  hours.  No  symptoms  referable  to 
the  operation  appeared,  the  alarming  chest  com- 
plication soon  amended  and  rapid  and  complete 
convalescence  took  place. 

Ovarian  Cystoma. 

V.  A  muUelocular  ovarian  cystoma  from  a  young 
lady  of  22.  There  were  some  adhesions,  and 
troublesome  bleeding  from  a  rent  in  the  broad 
ligament  as  oozing  continued  after  applicature  of 
a  continuous  suture  ;  a  drainage  tube  was  used  for 
48  hours.  The  second  ovary  was  found  cystic 
and  removed.  Dr.  Gardner  remarked  that  Schroid- 
er  formerly  saved  any  portion  of  the  second  ovary 
not  seriously  involved,  but  of  late  had  discontinued 
the  practice.  Dr.  Schroider  cites  a  case  where 
pregnancy  took  place  after  removal  of  one  ovary 
and  part  of  the  second. 

Discussion. 

Dr.  Trenholme  referring  to  Dr.  Gardner's 
method  of  extirpation  of  the  uterus,  stated  that 
his  method  of  procedure  usually  consisted  in  re- 
trovertion  of  the  uterus,  and,  after  ligation,  removal 
of  it  piece  by  piece,  separating  the  anterior  wall 
from  the  bladder  with  the  finger.  As  the  disease 
returned  in  two  cases  this  year,  in  his  practice, 
after  removal  of  the  uterus  he  has  lost  faith  in  the 
operation  of  extirpation  of  the  uterus  for  maglig- 
nant  disease. 

Dr.  Kennedy  thought  that  cutting  through  the 


5i 


THE  CANADA  MEDICAL   RECORD. 


posterior  cul-de-sac  shortened  the  operation,  and 
that  the  Terrier's  clamp  would  greatly  simplify  it. 

He  asked  Dr.  Gardner  for  statistics  of  the 
o])eration. 

Dr.  Gardner  in  reply  stated  that  the  mortality 
after  total  extirpation  of  the  uterus,  was  not  more 
than  10  to  12  per  cent,  on  the  continent,  but  it  was 
to  be  remembered  that  in  France,  especially,  the 
uterus  was  frequently  removed  for  other  causes, 
e.g.,  incurable  prolapsus,  etc. 


Stated  Meeting,  Nov.  e^t/i,  1886. 
J.  C.  Cameron,  II.D.,  President,  in  the  Ch.\ir. 

Abscess  of  tli,e  brain. — Dr.  Proudfoot  ■exhibited 
specimens  from  a  case  of  abscess  of  the  brain,  and 
gave  the  following  account  of  the  case  : — 

This  patient,  female,  aged  20,  was  admitted  to 
the  Western  Hospital,  under  Dr.  Perrigo,  July  4th. 
At  the  time  of  admission  she  was  suffering  from  in- 
tense pain  in  the  head  and  distressingly  loud  tinni- 
tus aurium,  with  discharge  of  pus  from  the  meatus. 
There  was  also  constant  retching  and  vomiting,  the 
patient  b^ing  unable  to  retain  any  food  upon  the 
stomach.  Dr.  Perrigo  examined  the  patient,  and 
finding  a  large  polypus  blocking  the  meatus  trans- 
ferred her  to  my  care.  The  polypus  was  removed 
under  ether,  and  the  tympanic  cavity  thoroughly 
cleansed  by  a  stream  of  warm  water,  there  being  a 
large  perforation  of  the  membrane  through  which 
the  polypus  passed.  The  polypus  was  the  ordinary 
mucous  variety.  The  after-treatment  consisted  in 
syringing  the  ear  with  warm  water  every  two  or 
three  hours  and  a  4-gr.  solution  of  zinc  sulph. 
dropped  into  the  ear ;  and  as  there  appeared  a  slight 
redness  of  the  skin  over  the  mastoid  process,  a 
small  bag  of  ice  was  kept  over  that  part.  There 
was  no  vomiting  after  the  removal  of  the  polypus, 
and  on  the  following  day  the  patient  seemed  much 
better  and  was  able  to  take  some  food,  although 
the  appetite  was  not  good.  All  redness  and  ten- 
derness over  the  mastoid  process  had  entirely  dis- 
appeared, but  the  pain  in  the  head  was  still  com- 
plained of,  though  not  so  severe  as  at  first ;  the  pain 
was  always  referred  to  the  base  of  the  skull  on  the 
affected  side.  There  was  no  irregularity  of  the 
pupils,  and  their  mobility  was  fairly  good.  The 
pulse  remainded  about  60  and  the  temperature 
never  above  100  °  .  The  discharge  from  the  mea- 
tus was  profuse.  On  the  9th  the  patient  complained 
of  increasing  pain  in  the  head,  and  there  was  con- 
siderable uneasiness.     She  ^was  put  upon  potass. 


bromid.  grs.  x  every  four  hours,  but  the  patient 
appeared  to  be  getting  gradually  worse,  and  on  the 
13th  I  determined  to  remove  the  whole  ofthemas- 
toid,  if  necessary,  in  hopes  of  giving  some  relief, 
although  I  was  convinced  from  the  first  time  I 
saw  the  patient  that  the  brain  had  already  become 
affected.  She  died  suddenly  at  6  o'clock  the  fol- 
lowing morning.  The  nurse  had  syringed  her  ear 
and  gone  from  the  ward ;  when  she  returned  in  a 
short  time  she  found  the  patient  had  drawn  the 
bedclothes  over  her  head  and  died  without  making 
the  slightest  sound.  Previous  to  her  admission 
into  the  hospital  she  had  been  treated  by  a  physi- 
cian for  syphilis,  and  her  breath  had  the  mercurial 
fcetor.  I  also  found  that  she  had  complained  of 
pain  in  the  head  and  had  been  unable  to  retain 
anything  upon  her  stomach  for  about  two  weeks 
before  I  saw  her.  It  was  therefore  more  than 
probable  that  the  abscess  of  the  brain  had  started 
before  her  admission  to  the  hospital.  The  abscess 
was  a  large  one,  containing  a  large  amount  of 
foetid  pus,  and  extending  from  a  perforation  in  the 
posterior  part  of  the  petrous  bone,  close  to  the 
semi-circular  canals,  right  across  the  lobe  of  the 
brain,  until  it  finally  pressed  upon  tlie  medulla, 
accounting  for  the  sudden  death  of  the  patient.  I 
am  convinced  Jiat  no  operation  would  have  saved 
the  life  of  the  patient. 

Dr.  Johnston  exhibited  a  specimen  of  colloid 
cancer  of  the  rectum,  which  involved  the  whole 
circumference  of  the  gut  for  five  inches  above  the 
anus.  Infiltration  most  extensive  in  anterior  wall 
and  involved  the  prostate  gland.  Inguinal  gland, 
on  both  sides,  infiltrated  by  colloid  cancer.  Recto- 
peritoneal  glands  uninvolved.  One  small  can- 
cerous nodule  in  lung,  and  an  extensive  acute 
softening  tuberculosis. 

Dr.  Shepherd  exhibited  a  kidney  with  tuber- 
cular pyelitis;  also  a  large  calculus,  'extracted 
with  great  difficulty  from  the  pelvis  of  kidney. 
Weigh  of  calculus  4  ozs.  7  drs.  Patient  doing 
well  at  date,  one  week  after  operation. 

Dr.  Kennedy  exhibited  the  tubes  and  ovaries 
which  he  had  removed  from  a  patient  in  the 
Western  Hospital.  The  woman  was  27  years  old, 
and  gave  the  following  history  :  She  was  married 
at  18,  and  shortly  afterwards  became  pregnant; 
at  the  same  time  had  an  attack  of  gonorrhoea.  So 
far  as  could  be  ascertained,  both  conditions  were 
coincident.  She  miscarried  at  the  fifth  month, 
was  very  ill  and  confined  to  bed  for  weeks  after- 
wards,  and   has    never    been    well   since.     Her 


fllE    CAN- DA    MEDICAL    RECORD- 


55 


htisband's  death  obliged  her  to  follow  the  occu 
pation  of  saleswoman,  which  aggravated  the  con- 
dition. Menstruation  became  frequent  and  pain- 
ful, so  that  ultimately,  at  these  periods,  she  was 
compelled  to  keep  her  bed  and  use  narcotics. 
During  the  interval  the  pelvic  pain  was  continuous^ 
After  some  years  she  again  married,  but  found 
sexual  intercourse  painful.  She  had  for  years 
sought  relief,  and  being  advised  to  try  change  of 
climate,  had  gone  to  Australia,  -and  lately  had 
come  to  Canada.  About  a  year  ago  she  applied 
to  Dr.  Kennedy,  and  various  remedies  were  tried 
in  vain.  Local  examination  did^  not  reveal  any- 
thing positive  beyond  apparent  enlargement  of 
both  tubes  and  extreme  sensitiveness  of  the  pelvic 
organs.  As  the  patient  was  becoming  a  confirmed 
invalid,  and  the  history  and  symptoms  indicated 
diseased  tubes,  an  operation  was  ^suggested  and 
acceded  to.  On  October  9th  she  was  operated 
on,  and  the  tubes  and  ovaries  removed.  The 
tubes  are  enlarged,  with  thickened  Avails,  and 
perfectly  occluded  at  the  free  ^extremity  from 
agglutination  of  the  fimbriaj  ;  cystic  degeneration 
had  also  commenced  in  both  ovaries.  This 
patient  could  not  possibly  have  again  conceived. 
No  pelvic  adhesions  were  found,  the  uterus  being 
freely  moveable  and  smaller  than  normal.  The 
patient  progressed  favorably,  and  is  now  fully 
convalescent. 

Dr. .  Wm.  Gardner  read  a  paper  entitled 
"  Glimpses  of  Abdominal  Surgery  in  Europe  dur- 
ing the  past  Summer." 

Dr.  R.  P.  Howard  thought  the  account  of  the 
two  cases  of  laparotomy  in  puerperal  peritonitis  of 
extreme  interest.  He  thought  that  physicians 
ought  to  be  far  less  reluctant  that  at  present  in 
adopting  this  means  of  treatment.  He  also  asked 
for  Tail's  treatment  of  peritonitis  after  operations. 
Dr.  Kingston  had  witnessed  recently  Keith  of 
Edinburgh  operate.  His  operation  contrasted 
with  those  mentioned  by  being  a  slow  one.  He 
divides  pedicle  by  actual  cautery,  and  waits  for  all 
oozing  to  cease.     His  incision  is  a  free  one. 

Dr.  Cameron  wished  to  know  if  anyone  would, 
in  his  opinion,  be  justified  in  neglecting  antiseptic 
precautions'in  operating. 

Dr.  Gardner,  in  reply,  said  that  Mr.  Tait  attri- 
butes^  much  of  his  success  to  the  avoidance  of 
opium,  as  it  tends  to  bring  about  adhesions  by 
keeping'^bowels  quiet,  and  also  makes  constipation 
more  difficult  to  overcome.  For  symptoms  we  are 
accustomed  to  recognize  as  those  of  commencing 


peritonitis,  viz.,  abdominal  pain,  tympanites  and 
vomiting,  he  gives  a  saline  cathartic  and  tur)5en- 
tine  enemata  of  strength  of  one  teaspoonful  to  4 
ozs.  soap  and  water.  Tait  insists  on  absence  of 
all  fluids  from  the  diet  for  24  to  36  hours.  Muller 
washes  out  abdomen  in  peritonitis  with  }i.  per 
cent,  solution  of  common  salt.  One  secret  of 
Tait's  success  was  doubtless  the  wonderful  rapidity 
of  operating  and  the  consequent  short  anesthesia, 
the  use  of  drainage-tube  to  avoid  delay  in  case  of 
hemorrhage,  frequent  washing  out  during  opera- 
tion in  case  of  hemorrhage  and  to  remove  the  con- 
tents of  burst  cysts,  and  also  to  his  after-treatment. 
He  did  not  agree  with  Tait  as  regards  this  avoid- 
ing the  use  of  the  nail-brush  and  the  use  of  un- 
boiled water. 

Dr.  HiNGSTON  mentioned  that  recently,  in  the 
case  of  a  burst  cyst,  he  had,  from  urgency,  been 
compelled  to  wash  out  the  abdomen  freely  with 
common  water  from  the  tap.  The  patient  had 
recovered  without  a  bad  symptom. 

J^/iQ^Ji^eS-^  0/  Science. 

A  SIMPLE  METHOD  FOR  THE    DIAGNO- 
SIS OF  ORGANIC  VALVULAR  DISEASES 
OF    THE  HEART. 
By  F.  Peyre  Porciier,  M.  D. 
We   will    make   no    allusions    in    this   paper  to 
hypertrophy,  dilatation,  pericarditis,  or  other  disea- 
ses of  the  organ. 

It  is  almost  needless  to  say  that  the  first  effort 
of  one  who  is  desirous  of   knowing  whether  the 
valves  and  orifices  of  the    heart   are  diseased  is, 
obviously,  to  notice  if  there  be  any   derangement, 
abbcrratiou,  or  change  from   the  normal  sounds  ! 
He  takes  care  to  listen  at  the  base  and  at  the 
apex,    paying   separate  attention    to    each    point 
respectively  ;  and  also  to  the  condition  of  the  right 
and  left  cavities — in  order  if  he  does  discover  any 
morbid  sounds    (a   modification    of  the    natural 
being  always  a  morbid  sound)  that  he  may  isolate 
I  and  designate  the  derangement   or  lesion    which 
such  morbid  sound  surely  indicates.     It  simplifies 
the  process  very  much  to  know  that  for  the  great- 
er number  of  endocardial  lesions  or  injuries  (^it  is 
needless  to  give  the  figures)  are  found  in  the  left 
cavities.     He  should  keep  in  mind  also  that  the 
structure  of  the  valves  or  curtains  at  the  base  of  the 
heart  (the   semilunar  or   sigmoid   valves  of  aorta 
and  pulmonary  artery)  are  analogous  in  shape,  and 
act  similarly  and  simultaneously.     They  are  placed 
at  their  respective  gateways  with  similar   intent ; 
they  close  and  open,  give  ingress  and  egress  to  the 
coluirin  of  blood  synchronously.     The  same  is  true 
of  those    at  the  point  or   apex    (the  bicuspid  or 
mitral,  and  tricuspid).     These,  placed  between  the 
left  and  right  auricles  and  ventr.cles  respectively, 


56 


THE   CANADA   MEDICAL    RECORD. 


differ  essentially  in  form  and  structure  from  those 
at  the  base  of  the  organ — but  they  resemble  each 
other  in  their  general  shape  ;  they  also  open  and 
close  simultaneously,  and  perform  analogous  func- 
tions with  each  otjier  in  the  economy  of  the  organ. 

So,  in  making  a  diagnosis  in  the  case  of  a  heart 
supposed  to  be  diseased,  we  address  our  examina- 
ation  to,  and  fix  our  mind  upon  these  t'wo  sets 
of  valves  separately,  to  see  if  any  of  them  are 
diseased,  and  if  so,  to  note  both  what  is  the 
nature  of  the  change -which  exists  in  their  own 
structure,  and  what  modifications  have  been  pro- 
duced by  their  alteration  form  upon  the  orifice 
which  they  close  and  open.  This  essential  method 
of  procedure  (covered  with  the  statement  made 
above  regarding  the  very  marked  infreqiiency  of 
diseases  of  the  right  cavities)  already  greatly 
simplifies  the  study  of  the  diseased  valves.  It  is 
practiced  even  by  the  novice  in  such  inquiries ; 
and  when  one  is  seen  examining  the  heart  at  ran- 
dom— regardless  of  the  above  rule — it  is  clear  to 
the  looker-on  that  he  has  not  mastered  the  first 
horn-book  lesson  upon  the  subject,  and  that  it  is 
impossible  for  him  to  form  any  accurate  conclu- 
sions. He  may  know  that  the  organ  is  diseased, 
but  he  cannot  tell  where  the  injury  is. 

Besides  this,  whoever  is  desirous  of  investigating 
a  case  of  heart  disease,  must  have,  in  addition  to 
his  anatomical  knowledge,  fully  and  clearly  in  his 
mind,  the  whole  action  and  reaction  in  the  cavities 
of  the  organ  during  its  systole  and  diastole  ;  he 
must  know  when  and  where  the  current  is  flowing 
out,  and  when  and  where  its  passage  is  estopped 
— whether  at  the  back-gates,  or  at  the  front-gates, 
and  conversely.  For  it  is  when  those  muscular 
and  tendinous  strings  and  cords  at  the  apex,  or 
those  semilunar  curtains  at  the  base,  which  open 
and  shut  these  orifices,  are  defective,  i.  e.,  when 
they  close  imperfectly,  are  deficient — (  "  /«- 
sufficiency  ") — and  permit  regurgitation  when  they 
should  not ;  or  when  by  fibrinous  or  other  deposits 
upon  the  valves  the  orifices  are  fiarro^oed  or 
roughened  (''stenosis"),  and  thus  obstruct  the 
forward  flow,  and  give  rise  to  abnormal,  morbid 
sounds ;  it  is  the  consideration  and  explanation  of 
this  problem  which  is  his  object  in  every  case 
which  becomes  the  subject  of  critical  inquiry. 

It  is  essential  then  that  besides  a  full  apprecia- 
tion of  the  currents  and  checks  in  the  incessant 
working  of  the  organ — the  onward  flow  and  the 
movements  of  the  fleshy  barriers  which  suddenly 
and  rythmically  arrest  the  flow — he  should  first 
kno7i.'  the  normal  healthy  sounds  in  order  to  detect 
the  slightest  dn'iation  from  ihem ;  and  he  should 
localize  these  deviations,  for  they  are  necessarily 
viorbid iOMXi^i,  and  indicate  diseased  vali-es. 

It  being  necessary,  then,  for  the  observer  to 
know  the  cause  and  rationale  of  the  normal  sounds, 
we  will  state  them.  It  is  pretty  well  agreed  that  the 
first  sound  (represented  by  the  word  '■lubb")is 
synchronous  with  the  systole  of  the  organ,  and  is 
owing  to  one  or  all  of  three  causes,  viz.-  the 
contraction  of  the  muscular  ventricals,  the  sudden 


closure  of  the  auriculo-ventricular  valves  which 
prevents  the  blood  from  regurgitating  into  either 
auricle,  and  the  impulsion  of  the  heart  against  the 
walls  of  the  chest.  At  this  moment  a  column  of 
blood  is  driven  forcibly  through  the  aorta  and 
pulmonary  artery,  and  the  auricles  are  silently 
filling  with  blood  from  the  valveless  venre  cava; 
and  from  the  pulmonary  veins. 

That  the  second  sound  (represented  by  the 
word  "  dup  ")  is  synchronous  with  the  diastole  of 
the  organ,  and  is  due  to  the  shutting  up  of  the 
aortic   and   pulmonary   artery   semilunar   valves. 

Tl.e  closure  of  these  valves  at  this  moment  pre- 
vents the  regurgitation  of  the  blood  from  the  aorta 
and  pulmonary  artery  into  the  ventricles,  when  dur- 
ing the  diastole  of  the  ventricles  these  valves  are 
being  filled  from  the  auricles. 

Duiing  the  prolonged  interval  of  rest  following 
(which  is  equal  in  duration  to  the  first  and  twice 
the  length  of  the  second  sound),  we  may  suppose 
that  the  auricles  are  still  silently  pouring  their  con- 
tents into  the  ventricles,  the  portals  of  which  are 
now  wide  open.  During  this  period  of  apparent 
calm  the  heart  endowed  with  a  high  degree  of  nervj 
ous  energy  derived  from  the  cardiac  ganglia  of  the 
sympathetic  and  the  pneumogastric,  wound  round 
and  enwrapped  with  bundles  of  concentrically 
interlaced  muscular  fibres,  layer  upon  layer,  as  if 
encased  with  triple  steel,  and  indeed  the  very 
"  cunningest  pattern  of  excelling  nature "  as 
respects  endurance,  strength  and  force,  is  prepar- 
ing, like  a  wild  animal  gathering  for  its  spring,  for 
the  next  systolic  paroxysm,  when  its  contents 
will  be  forced  into  the  delicate  meshes  of  the  lungs 
and  be  driven  through  the  finest  capillary  tubes 
in  the  remotest  tissues  of  the  organism. 

We  will  confine  our  attention  at  present,  whilst 
attempting  to  describe  the  morbid  sounds  and  the 
lesions  they  indicate,  to  what  takes  place  in  the 
left  cavities,  for  whatever  is  true  of  the  left  is  true 
of  the  right,  so  far  as  the  circulation  of  the  blood  is 
concerned,  and  we  will  simplify  matters  much  by 
so  doing. 

Now  with  the  first  sound  (systolic)  the  blood 
is  being  driven  through  the  opened  aortic  orifice 
at  which  moment  the  back-gate  (the  mitral  or 
bicuspid)  is  shut.  So,  if  we  have  a  deranged  or 
abnormal  first  sound  heard  with  the  greatest 
intensity  at  the  base  of  tiie  heart  (and  it  is  not 
a  soft,  inorganic,  ana;mic  murmur,  which  is  owing 
to  the  thinness  of  the  blood,  and  which  is  out 
of  the  present  question),  there  is  necessarily  a 
narrowing  (stenosis)  or  roughness  of  the  aortic 
orifice — an  obstruction  there  by  vegetations, 
atheroma,  or  other  morbid  condition  preventing 
the  natural  flow  of  blood  through  the  aortic  orifice, 
and  deranging  or  modifying  the  natural  sound. 

Hence  a  deranged  first  sound  at  the  base  of  the 
heart  indicates  "narrowing  or  obstruction  stenosis 
in  other  words  of  the  aortic  valves. 

But  suppose  this  abnormal,  morbid  first  sound 
ha>  its  greatest  intensity  at  the  apex  of  the  heart. 

It  must  be  owing  to  this  fact  that  the  back-gate 


THE    CANADA    iMEDICAL    KECORD. 


57 


has  a  chink  in  it — it  is  more  or  less  open,  in  place 
of  being  tightly  closed  as  it  should  be  ;  the  column 
of  blood,  instead  of  meeting  witli  the  normal  resis- 
tance of  the  closed  and  perfect  mitral  valve  (bicus- 
pid), in  order  tliat  it  maybe  propelled  through  the 
aorta  and  reacli  the  utmost  boundaries  of  the  tree  of 
life— it  is  leakin,;^  b'ack  tiirough  the  defective  por- 
tals of  the  mitral — is  regurgitating  into  the  left 
auricle  ;  and  it  gives  out  to  the  ear  placed  over  the 
apex  a  morbid  murmur,  or  noise,  more  or  less 
proloiii^cd,  in  place  of  the  ordinary  normal  first 
sound  (represented  by  the  word  "  lub").  The 
valve  is  necessarily  defective  as  a  flood-gate  ;  it  is 
incapable  of  close  shutting  up;  that  its  mechanism 
has  become  defective  is  indisputable,  and  we  pro- 
nounced positively  upon  the  subject. 

So  a  deranged  first  sound  at  the  apex  indicates 
insufficiency  of  the  mitral  valve,  caused  by  vegeta- 
tions, or  other  result  of  endocarditis. 

We  have  now  disposed  of  derangements  of 
abnormalities  (which  are  always  morbid)  of  the 
first  sound  of  the  heart  both  at  the  base  and 
ape.x.  They  indicate  nothing  else  but  what  we 
have  said  they  do. 

Let  us  now  proceed  to  pronounce  upon  de- 
rangements of  the  second  sound  (diastolic),  should 
they  be  noticed  either  at  base  or  apex :  If  the 
second  sound  is  deranged,  its  greatest  intensity  or 
disturbance  being  at  the  base  of  the  heart,  it  must 
necessarily  indicate  the  exact  opposite  condition  to 
that  which  we  stated  that  derangements  of  the  first 
sound  indicated,  for  exactly  the  reversed  condition 
of  affairs  is  taking  place;  the  semilunar  valves  are 
shutting  now,  they  were  open  then.  The  valves 
at  the  base  are  acting  directly  contrary  to  those  at 
the  point  also  ;  when  one  set  are  shut  the  other 
set  are  open.*  During  the  second  sound  we  know 
the  aortic  valves  are  closing,  in  order  to  keep  the 
blood  temporarily  from  flowing  backward  into  the 
left  ventricle  (which  is  a  reservoir  of  supply).  So  if 
there  is  a  morbid  second  sound  (diastolic)  at  the 
base,  the  valves  of  the  aorta  are  insufficient.  The 
front  gate  has  not  closed  tightly,  there  are  vegeta- 
tions, hardened  plaques  of  fibrine,  or  bone,  or 
cartilage,  which  interfere  with  integrity  or  pliancy 
of  the  delicate  curtains  which  form  this  front 
floodgate ;  and  the  column  of  blood  in  the  aorta, 
instead  of  remaining  quiescent  for  a  moment,  as  it 
should  and  does  do  in  a  state  of  health,  regurgi- 
tates into  the  dilating  ventricle  and  gives  a  de- 
ranged, morbid  second  sound.  Therefore  a  mor- 
bid second  sound  at  the  base  indicates  insufficiency 
of  the  aortic  valves. 

Now  suppose  the  deranged,  morbid  second  sound 
its  seat  of  greatest  intensity  at  the  apex,  instead  has 
of  being  at  the  base,  it  is  very  plain  then  that  the 
back  gate,  the  mitral  bicuspid  orifice,  is  narrowed, 

* — third  well-known  relation  may  very  properly  be  stat- 
ed here  to  complete  the  sketch  of  these  antagonisms  and 
contrasts.  This  regards  the  cavities  of  the  organ.  The 
ventricles  and  auricles  are  synergetic  only  with  themselves, 
when  the  former  are  contracting  the  latter  are  dilating,  and 


obstructed  (stenosis),  and  the  blood  in  passing 
through  makes  a  noise.  Because  during  the  second 
sound  (diastolic,)  the  mitral  orifice  should  be  wide 
open  to  allow  the  blood  from  the  auricle  to  enter 
noiselessly  and  fill  up  the  ventricle,  otherwise 
there  would  be  no  supply  for  the  next  systolic 
effort  of  the  heart.  If  the  orifice  is  obstructed  or 
narrowed  the  blood  does  not  pass  through  noise- 
lessly as  in  a  state  of  health  ;  the  second  sound  is 
abnormal ;  there  is  a  murmur.  A  disturbed  second 
sound  at  the  apex  indicates  then  stenosis  of  the 
mitral  orifice. 

Our  table  nOw  is  very  easily  constructed,  and 
being  based  upon  eminently  natural  and  scientific 
foundations,  namely,  the  physical  laws  of  the 
heart's  structure,  functions  and  actions,  it  must 
serve  as  a  ready  method,  enabling  us,  or  anyone 
else — even  the  most  uninstructed — to  make'  a 
diagnosis  of  all  the  uncomplicated  organic  diseases 
of  the  valves  at  the  orifices  of  all  the  chambers  of 
the  heart.  As  it  is  necessarily  true  and  correct, 
and  though  it  may  not  seem  very  simple,  it  requires 
no  thought  to  apply  it  to  any  case  before  us  ;  nor 
is  it  necessary  that  we  should  at  the  time  of  apply- 
ing it  understand  w/iy  it  is  correct : 

The  formula  and  the  order  of  the  words  to  be 
recalled  are: 

Stenosis.  Insufficiency. 

Insufficiency.  Stenosis. 

For  example  : 

A  deranged  ist.  sound  indicates 
Stenosis  of  the  aortic  or  pul- 
monary artery  valves. 
At  the  base —     A  deranged  2nd  sound  indicates 
Insufficiency    of  the   aortic   or 
pulmonary  artery   valves. 
A  deranged  ist    sound  indicates 
Insufficiency  of  the  bicuspid  or 
of  the  tricuspid  valves. 
Ai  the  apex —     A  deranged  2nd  sound  indicates 
Stenosis  of  the  bicuspid  or  of 
the  tricuspid  valves. 
All  we  have  to  do  is  to  memorize  these  words 
in  their  order,  as  a  formula,  to  elucidate  at  the 
bedside  the  valvular  diseases  of  the  heart.    Observe 
what  sounds  are  derariged  at  the  base,  then  at  the 
apex,  and  pronounce  accordingly.     Of  course  the 
known  relative  positions  of  the  four  valves  must 
guide  us  in  deciding  which  of  the  two  valves  at 
the  base,  or  at  the  apex,  the  abnormal  murmur 
proceeds  from,  so  as  to  di?tingush  between  the 
valvular  derangements  of  the  right  and  left  heart. 


IRRITABLE  BRAIN  IN  CHILDREN. 

In  the  London  Medical  Press,  August  11, 
1886,  Dr.  William  H.  Day  reports  five  cases  of 
this  affection,  from  the  study  of  which  he  draws 
the  following  conclusions  : 

These  cases  are  common  enough  in  young 
children,  though  frequently  overlooked  at  an  early 
stage,  when  the  symptoins  might  be  subdued. 
The  disease  is  sometimes  seen  in  children  who  are 


58 


THE   CANADA   MEDICAL   RECORD. 


rickety,  and  in  whom  dentition  is  delayed.     Ex- 
citable and  nervous  children  are  prone  to  the  dis- 
order.    This  irritable  state  of  brain  may  follow 
moderate  exposure  to  the  sun  and  also  to  cold,  the 
head  never  becoming  hot  nor  the  face  flushed.    A 
long  exposure  to  the  sun's  rays,  or  a  greater  degree 
of  cold,  invite  an  active  form  of  cerebral  conges- 
tion.    If  the  congestion  be  moderate  and  promptly 
attended  to,  and  the  child  is  of  good  constitution, 
the  attack  passes  off  gradually  and  the  usual  health 
soon  returns.     It  is  in  the  initial  stage  that  threat- 
ening mischief  may  be   averted.     This    irritable 
state  of  the  brain  is,  in  many  cases,  primarily  one 
of  anemia  of  the  brain,  as  already  stated,  for  the 
vital  powers  are  first  depressed  and  lowered.  The 
brain  is  imperfectly  nourished.     It  ceases  to  res- 
pond.    It  has  lost  its  tone.     The  little  patient  has 
pains  in  the  head ;  his  pupils  are  contracted,  and 
he  shuns  the  light;  he  is   disturbed  by  dreams, 
and  sleep  is  unrefreshing.     The  irritability  persists 
until  the    congestive    stage  is    reached,  when  it 
vanishes  altogether,  or  is  supplanted  by  lethargy 
and  indifference.  The  distribution  of  blood  througli 
the  brain  in  Tfe  is  not  uniform  ;    some  parts  are 
more  abundantly  supplied  than  others  ;  hence  we 
come  to  understand  why  cerebral  hemorrhage  is 
common  to  certain  situations,  and  softening  of  the 
brain  in  the  adult  from  partial   anemia  in  other 
parts,  when  the  proper  blood-supply  is  obstructed 
and  the  circulation  is  disturbed.     In  young  child- 
ren the  peculiarities  of  the  cerebral  circulation  are 
more  noticeable,  and  by   reason  of  the  fact  that 
ossification  of  the  skull  is  incomplete  and  the  fon- 
tannelles  are  open  and  elastic,  the  amount  of  blood 
within  the  cranium  is  subject  to  great  variation. 
Partial  anemia  of  certain  parts  of  the  brain,  fol- 
lowed by  local  congestion  of  other   parts,    may 
possibly  explain   some  of  the  symptoms  I   have 
described,  and  the  influence  which  the  circulation 
must  have  upon  the  functions  of  the  brain. 

Congestion  of  the  brain  in  early  life  very  fre- 
quently succeeds  the  stage  of  irritation,  if  it 
does  not  usually  accompany  it  in  a  greater  or  lesser 
degree.  This  arises  from  the  readiness  with  which 
the  brain  circulation  is  disturbed.  Young  children 
in  good  health,  who  go  too  long  without  food,  or 
do  not  obtain  sufficient  sleep,  get  wayward,  fretful, 
and  exhausted.  \Vhen  food  and  rest  are  obtained, 
the  symptoms  subside,  and,  the  circulation  being 
strengthened,  they  pass  away.  This  is  a  state  of 
irritation,  and  exhaustion  is  its  chief  cause. 

The  diagnosis  in  cases  of  irritable  brain  is  rarely 
difficult.  Failing  health,  caprice  of  manner,  fits 
of  ill  temper,  lassitude,  pallor,  loss  of  appetite, 
and  unrefreshing  sleep  are  among  the  earliest  and 
characteristic  signs.  But  even  these  symptoms  may 
mean  little  in  a  young  child,  as  they  are  common 
to  many  slight  ailments,  and  quickly  pass  away. 
At  the  same  time  we  cannot  be  too  watchful,  as 
there  is  an  ever-threatening  danger  while  the  brain 
is  in  active  growth  and  development.  As  the  dis- 
order stea.ls  on,  sleep  becomes  disturbed,  and  the 
cheeks  occasionally  flush.     With  these  symptoms 


there  may  be  no  elevation  of  temperature,  and  no 
acceleration  of  the  pulse,  for  the  nervous  system 
has  not  yet  transmitted  any  disquieting  influence 
to  the  circulation.  A  considerable  time  may  elapse 
before  we  know  there  is  any  headache,  for  the 
child  may  be  too  young  to  express  its  sensations  ; 
but  if  the  hand  is  frequently  raised  to  the  head 
while  it  rolls  from  side  to  side  on  the  pillow,  we 
may  be  tolerably  certain  that  it  is  uneasv  and  pain- 
ful. 

In  typical  cases  of  congestion  of  the  brain  in 
children  there  are,  in  addition  to  the  symptoms  I 
have  enumerated,  severe  headache  and  often  vom- 
iting. Sometimes  there  is  much  oppression,  livi- 
dity  of  the  face,  and  a  tendency  to  heavy  sleep, 
hence  the  similarity  to  meningitis  in  its  later  stages. 
Usually,  however,  the  two  affections  run  a  different 
course.  In  simple  congestion,  if  the  constitution 
is  good  and  no  convulsions  occur,  the  fever  is 
slight  and  the  attack  passes  off  in  a  few  days. 
This  is  not  the  rule  in  meningitis. 

If  we  turn  to  the  temperature  as  a  means  of 
diagnosis,  it  is  worthless  if  not  taken  in  connection 
with  other  signs.  The  temperature  in  fatal  cases 
of  meningitis  may  not  reach  the  height  it  does  in 
simple  irritation,  but  it  generally  does,  and  at  the 
time  of  death  is  much  higher.  In  the  fifth  case 
the  temperature  ran  up  to  104°,  and  yet  the  con- 
stitutional symptoms  were  nothing  like  so  severe 
as  in  the  first,  second,  and  fourth  cases.  The 
temperature  is  exceedingly  mobile  in  children  of 
nervous  temperature,  rising  and  falling  with  extra- 
ordinary rapidity  on  very  slight  provocation. 

In  long  standing  examples  of  cerebral  conges- 
tion and  disturbance,  vascular  changes  may  be. 
expected  to  occur  in  the  optic  disks.  Active  con- 
gestion is  such  a  near  approach  to  inflammation 
that  the  line  of  demarkation  can  hardly  be  drawn. 
The  two  conditions  are  generally  blended,  a  minor 
degree  of  inflammation  being  mixed  up  with,  or 
superadded  to,  the  cases  of  irritable  brain  and 
congestion.  It  is  in  cases  of  purely  irritable  brain 
that  ophthalmoscopic  changes  are  generally  absent, 
and  accordi  ng  in  nearly  all  the  cases  I  have  re- 
lated none  were  found.  Too  great  importance 
should  not  be  attached  to  any  ophthalmoscopic 
appearances  that  may  be  present  in  the  cases  I 
have  been  describing.  We  have  seen  that  no  optic 
changes  were  noticed  in  the  cases  that  were  irrit- 
able, rather  than  congestive.  As  these  are  often 
absent  in  simple  meningitis,  and  sometimes  in  the 
tubercular  variety,  even  when  it  occurs,  as  it  gen- 
erally does,  at  the  base  of  the  brain,  I  think  caution 
is  needed  before  coming  to  a  hasty  conclusion. 

Treatment.  A  favorable  result  depends  in  a  great 
measure  on  meeting  the  symptoms  with  prompti- 
tude at  the  outbreak,  when  there  are  only  slight 
headache,  alteration  of  manner,  and  disturbed 
sleep  to  guide  us  in  that  early  stage,  when  it  is 
impossible  to  say  what  is  the  essential  cause  of  the 
trouble,  what  is  its  exact  nature,  and  what  is  its 
probable  termination. 

Rest,  in  these  cases  of  irritable   brain,  is  to  be 


THE   CANADA    MEDICAL    RECORD. 


50 


strictly  observed,  since  it  checks  tlie  overcxpcndi- 
turc  of  nerve  force  by  conducing  to  repose  and 
slec]i.  Tine  brain  being  sensitive,  exhausted,  and 
easily  fatigued,  absolute  rest  is  as  much  needed 
for  its  recovery  as  it  is  for  a  broken  limb  or  a  dis- 
located joint.  This  simple  precaution  is  seldom 
sufficiently  insisted  upon  until  it  is  too  late.  Strong 
light,  noises  in  the  room,  and  the  presence  of 
anxious  friends  tend  to  excite  these  young  patients. 
Through  tlie  medium  of  the  nervous  system  the 
circulation  becomes  disturbed.  Physiological  rest 
t,ran(]uillizes  the  circulation,  allays  excitement,  and 
favors  recovery. 

If  the  head  is  hot  (and  this  belongs  to  the  con- 
gestive rather  than  to  the  irritative  class)  a  cold 
lotion  or  ice-water  rags  may  be  applied  to  it.  Cold 
continually  applied  to  the  head  will  often  induce 
tranquillity  and  sleep,  when  bromide  and  chloral 
fail.  Cold  soothes  the  patient.  If  we  dread  the 
approach  of  meningitis,  henbane,  and  even  small 
doses  of  morphia  in  combination  with  hydrate  of 
chloral,  will  prove  of  the  utmost  benefit  in  the  early 
stages. 

An  aperient  will  generally  be  demanded.  A 
grain  of  calomel,  followed  by  a  little  syrup  of 
senna,  or  by  a  few  grains  of  sulphate  of  magnesia 
and  nitrate  of  potash,  will  answer  well  if  the 
strength  _is  good  and  there  is  any  heat  of  head. 
After  this  some  bromide  of  potassium,  with  small 
doses  of  the  iodide  or  hydrate  of  chloral,  accord- 
ing to  circumstances,  should  be  given  regularly. 
When  the  symptoms  of  cerebral  congestion  pre- 
dominate the  bowels  can  scarcely  be  kept  too  open, 
and  if  there  be  arterial  tension  aconite  in  combin- 
ation with  the  bromide  will  tend  to  reduce  it  and 
calm  the  excited  brain  at  the  same  time. 

The  feeding  of  these  cases  is  important.  It 
should  be  nourishing  from  the  first,  and  in  the 
absence  of  vomiting  (which  we  have  noticed  in 
all  the  cases)  milk  and  beef-tea  are  to  be  freely 
given.  Food  from  the  first,  in  a  nourishing  and 
readily  assimilable  form,  should  be  given. 


THE  VALUE  OF  EXTERNAL  APPLICA- 
TIONS IN  THE  TREATMENT  OF  CHIL- 
DREN—EFFECTS  OF  COLO  WATER. 

When  one  hand  is  immersed  in  cold  water  the 
temperature  of  the  other  hand  also  falls.  Cold  not 
only  cools  the  surface  of  the  body  but  affects  mar- 
kedly the  condition  of  internal  organs  through  the 
nervous  system,  especially  in  children. 

Brown.-Sequardjias  shown,  by  experiment,  that 
cold  applied  to  the  lumbar  region  contracts  the 
arterioles  of  the  kidney,  and  consequently  dimi- 
nishes the  blood  supply  to  those  organs.  When  cold 
water  is  applied  to  the  surface  of  the  body  the  cutis 
anseriiia  immediately  becomes  manifest,  the  skin 
paler,  the  respiration  is  sobbing,  and  the  pulse  is  be- 
comes quickened.  If  the  temperature  be  not  too 
the  low  condition  of  reaction  soon  supervenes.  The 
coldness  is  succeeded  by  a  feeling  of  warmth,  and 


the  dcpicssion  by  a  feeling  of  exhilaration.  The 
bath  should  not  be  continued  too  long  for  this  tonic 
effect. 

If  the  tonic  effect  is  well  shown  the  circulation 
is  equalized  and  invigorated,  tissue  metamor- 
[ihoses  take  place  more  rapidly;  and  with  the 
increased  tissue  changes  and  activity  of  assimila- 
tion the  appetite  is  increased  and  the  body  gains 
weight  and  strength. 

The  cold  bath  should  have  a  temperature  of  from 
40  °  to  70  °   F. 

Wet-Pack.  This  is  occasionally  an  efficient  way 
of  applying  cold  water.  A  large  towel  may  be 
wrung  out  of  cold  water  and  wraiJjjed  about  the 
little  patient,  and  covered  with  a  blanket.  The 
sense  ofchilliness  at  first  experienced  is  soon  fol- 
lowed by  an  exhilarating  glow. 

When  reaction  is  well  established,  the  pack 
should  be  removed  and  the  body  vigorously  rubbed 
with  dry  towels.  Unless  active  diaphoresis  be  the 
object,  the  application  of  the  wet  pack  should  not 
continue  more  than  fifteen  minutes.  If  the  little 
patient  be  enveloped  with  tlie  wet  sheet,  standirig 
and  rubbed  vigorously  with  the  sheet,  reaction  will 
be  more  quickly  induced. 

When  the  pack  is  removed  the  patient  should 
be  vigorously  rubbed  with  coarse  towels. 

The  doiiclie  is  where  the  water  is  poured  from  a 
height  upon  the  patient.  This  means  is  rarely 
available  in  die  treatment  of  children. 

The  external  applications  of  cold  water  in  the 
treatment  of  the  diseases  of  children  are  many,  and 
some  of  them  vei-y  important. 

In  tonsillitis,  diphtheria,  and  croup,  the  cold- 
pack  applied  to  the  neck  will  oftentimes  give  great 
relief.  In  laryngismus  stridulus,  the  application  of 
cold  water  in  this  way  will  sometimes  quickly 
relieve  the  distress  in  breathing. 

For  spasm  of  the  glottis,  Morell  Mackenzie 
recommends  that  while  the  child's  body  is  placed 
in  a  warm  bath,  that  cold  water  be  dashed  in  the 
face. 

In  the  first  stage  of  laryngo-tracheal  diphtheria, 
among  other  means,  the  same  authority    recom- 
mends that  an  ice-bag  be  applied  to    the    throat. 
One  of  the  most  important  uses  of  cold  water  is 
in  fevers,  for  its  antipyretic  effects. 

Zeimssen's  method,  by  placing  the  patient  in  a 
tepid  bath,  and  gradually  cooling  the  water,  by  the 
addition  of  ice,  to  the  required  temperature,  which 
may  be  60  °  F.,  or  even  40  °  F.,  according  tothe 
height  of  the  pyrexia  and  the  rapidity  of  its  descent, 
may  be  sometimes  available  in  treating  children. 
The  bath  may  be  used  from  one  to  six  times  a  day, 
and  continue  each  time  until  the  temperature  is 
brought  down  to  the  required  limit. 

In  the  treatment  of  children's  diseases  the  wet- 
pack  is,  however,  generally  preferable,  on  account 
of  the  ease  with  which  it  is  applied.  The  litde 
patient  may  be  put  in  the  pack  several  times  a  day, 
and  remain  from  five  minutes  to  an  hour.  Hyper- 
pyrexia often  kills.  The  deplorable  determination 
inay  sometimes  be  averted  by  the  cold  bath;  and  it 


60 


THE  CANADA  MEDICAL  RECORD. 


is  in  these  cases  that  its  remarkable  effects  are  most 
conspicuously  shown.  In  scarlatina,  for  instance, 
when  the  temperature  rises  to  105  °  or  106  °  and 
there  are  alarming  symptoms,  the  cold  wet-pack 
will  prove  of  very  efficient  service.  Most  families 
have  a  prejudice  against  the  application  of  cold 
water,  especially  in  the  eruptive  diseases.  It  will, 
therefore,  be  necessary,  usually  to  use  that  means 
least  likely  to  frighten  the  patient  and  meet  with 
opposition  on  the  part  of  the  family. 

Trousseau,  in  the  treatment  of  these  cases  with 
a  high  temperature,  was  in  the  habit  of  placing  the 
patient  in  bath-tub,  and  directing  that  three  or  four 
pailfuls  of  water  be  dashed  over  him  every  one- 
fourth  minute  to  one  minute,  after  which  he  was  put 
in  bed,  and  covered  with  the  bed-clothes,  without 
being  dried.  The  physician  in  private  practice 
who  should  try  this  "  dashing  "  process,  would  in 
most  cases  find  himself  unceremoniously  dashed 
out  of  the  house. 

Zeimsscn's  method  might  be  used  in  some  cases ; 
but  the  cold-pack  or  cool  sponging  will  usually 
meet  with  less  opposition  and  will  be  foimd  very 
effectual. 

J.  Lewis  Smith  says  that  in  most  cases  he 
prefers  to  reduce  the  temperature  h^y  the  constant 
application  to  the  head  of  a  rubber  bag  containing 
ice.  The  bag  should  be  one-third  full,  so  that  it 
may  fit  over  the  head  like  a  cap. 

If  the  temperature  is  above  104°,  he  makes  a 
similar  application  over  the  neck  at  the  same  time, 
which  not  only  abstracts  heat,  but  diminishes  the 
pharyngitis,  adenitis  and  cellulitis. 

A  Jacobi,  in  an  article  on  "  Typhoid  Fever  in 
the  Young,  "  says  :  "  To  reduce  high  temperatures 
quinia  has  been  frequently-  recommended,  though 
it  has  not  served  me  well  in  infectious  diseases.  " 
I  will  add  that  I  have  found  quinine  not  only  use- 
less in  these  cases,  but  under  certain  conditions, 
even  with  a  high  temperature,  exceedingly  danger- 
ous. A  rational  empiricism  is  safer  in  the  treat- 
ment of  children  than  a  blind  adherence  to  scien- 
tific theories." 

"  The  best  antipyretic  is  cold." 

"  No  cold  bath  for  cold  extremities ;  no  more 
cold  bath,  when  once  after  it  the  extremities  re- 
main cold  or  cool.  In  these  cases  the  surface 
becomes  colder  than  before,  it  is  true;  the  interior, 
however,  is  warmer  than  it  was." 

"  Warming-pans  ought  always  to  be  used  to  the 
feet  and  legs  when  cold  is  to  be  applied." 

In  a  very  full  and  interesting  article,  William 
Perry  Watson,  after  speaking  of  the  various  ways 
already  mentioned  of  applying  cold  water,  directly 
or  indirectly,  speaks  of  a  rubber  cot  which  he  uses, 
made  of  rubber  tubing  and  sheet-lead,  which  may 
be  folded  about  the  little  patient. 

In  acute  cerebral  congestion,  cold  water  may  be 
applied  to  the  head  while  the  feet  and  legs  are 
immersed  in  warm  water,  or  covered  with  mustard 
and  flaxseed  poultices. 

Cold  to  the  spine  is  one  of  the  most  effective 
Remedies  in  some   <pases  of  chorea.     It  is   most 


conveniently  applied,  perhaps  in  the  form  of  an 

ether  spray. 

In  infantile  convulsions  cold  may  be  applied  to 
the  head,  while  the  body  is  immersed  in  warm 
water. 

In  my  experience,  weekly  cachectic  children  are 
best  treated  by  the  application  of  the  morning 
cold  bath  followed  by  vigourous  rubbing  ;  and  I 
believe  it  to  possess  more  beneficial  results,  in  most 
cases,  than  any  system  of  medication  without  the 
external  application.  I  have  used  it  for  several 
years  in  these  cases  with  the  happiest  results.  I 
am  in  the  habit  of  prescribing  at  the  same  time 
small  doses  of  Fowler's  solution,  as  an  aid  to  di- 
gestion and  assimilation  in  these  cases.  This 
treatment  should  be  continued  for  some  length 
of  time,  if  there  are  no  contraindications  ;  the 
effect  of  two  or  three  applications  will  be  hardly 
noticeable.  It  is  well  to  begin  by  using  tepid  wa- 
ter,  and  have  it  a  little  cooler  at  each  succeeding 
application  until  a  temperature  of  about  60  °F., 
is  reached.     It  is  well  to  put  a  little  salt  in  the  bath 

Under  the  treatment  indicated  these  cases  will 
sometimes  improve  with  astonishing  rapidity  ;  the 
weight  will  increase,  the  appetite  become  better, 
the  color  return  to  lips  and  cheeks,  and  the  irrita- 
tive cough,  so  common  in  such  cases,  cease. 

Dr.  Forchheimer,  in  speaking  of  the  treatment 
of  rachitis,  says  :  "  I  rely  upon  ihese  baths  (salt 
and  cold  water)  and  upon  fresh  air  as  the  main 
agents  for  curing  this  disease." 

JVarM  and  hot  water.  What  is  the  effect  when 
the  body  is  immersed  in  warm  water?  It  causes 
at  first  a  pleasant  sensation  ;  the  skin  becomes  red, 
the  pulse  increases  in  rapidity,  but  the  tension  is 
less,  and  a  sense  of  giddiness  and  depression  is 
soon  experienced.  Extreme  muscular  weakness 
supervenes  if  the  bath  be  prolonged.  Transpira- 
tion from  the  skin  is  increased.  The  temperature 
of  the  body  rises.  There  is  rapid  disintegration  of 
tissue.  The  warm  bath  should  have  a  temperature 
of  from  90  ®  to  100  °  F.,  and  the  bath  from  100  ° 
to  106°  F. 

It  is  not  necessary  to  speak  of  the  various  ways 
of  applying  warm  and  hot  water,  the  Turkish  or 
Russian  bath,  the  hot-pack,  etc. 

Extremely  hot  water  is  similar  in  its  immediate 
effects  to  cold.  The  same  remarks  that  were  made 
in  regard  to  the  application  of  cold  water  to  the 
neck  in  laryngismus  stridulus,  etc.,  may  be  applied 
to  hot  water. 

In  acute  desquamative  nephritis,  warm  fomen- 
tations may  be  applied  to  the  back  widi  good 
effects. 

Wakefulness  or  restlessness  of  children  may  of- 
ten be  overcome  by  a  warm  bath  taken  just  before 
bed-time. 

In  various  diseases,  asmeningtis,  cerebro  spinal 
meningitis  or  threatened  convulsions,  the  body  may 
be  immersed  in  warm  water,  or  flannels  wrung  in 
mustard-water  may  be  applied  to  the  feet  and  legs 
with  the  happiest  results. 

I  have  again  and  again  seen  this  simple  means 


THE  CANADA   MEDICAL   RECORD. 


CI 


followed  by  quiet  and  sleep,  after  bromide  of  po- 
tash— the  child's  opium — in  large  doses  has  been 
without  effect. 

Where  there  is  congestion  of  the  brain  from  any 
cause  and  a  warm  bath  is  required,  the  physician 
should  see  to  the  temperature  of  the  water  himself; 
for  if  it  be  too  hot,  it  may  defeat  the  end  in  view, 
and  instead  of  relieving  the  engorged  vessels  the 
shock  of  the  too  warm  water  on  the  cutaneous 
nerves  may  cause  a  rupture  of  blood-vessels,  a 
gush  of  blood  may  be  from  the  nose,  or  sudden 
dilatation  of  one  pupil,  and  sudden  death;  a  very 
inipleasant  result,  one  which  I  have  known  to 
happen,  and  which  is  likely  to  bring  a  valuable 
means  of  relief  and  cure  into  disrepute. 

Flannels  wrung  from  warm  water  and  covered  with 
dry  flannels  or  oiled  silk,  make  one  of  the  neatest 
and  best  applications  that  can  be  made  to  the  cliest 
in  pneumonitis  or  catarrhal  bronchitis. 

In  treating  pneumonia  in  children,  L.  Emmet 
Holt  says  he  has  little  faith  in  drugs,  and  sum- 
marizes the  treatment  which  he  would  recommend 
in  these  words  :  "  Nourishment,  opium,  alcohol, 
local  applications." 

After  tonsillitis  has  continued  until  abscess  is 
almost  certain,  Morell  Mackenzie  advises  the  per- 
sistent application  of  warm  poultices  to  the  neck 
to  encourage  suppuration.  I  am  satisfied  that  the 
persistent  application  ofhot  fomentations — prefera- 
bly flannels  wrung  from  simple  hot  water — from 
the  start  may  hasten  resolution  and  prevent  abscess. 
In  entro-colitis,  gastro  enteritis  and  the  various 
inflammatory  affections  of  the  abdominal  organs, 
heat  is  always  indicated  ;  and  there  is  no  doubt 
that  in  these  applications,  properly  applied,  the 
physician  has  a  more  potent,  reliable,  and  easily 
controllable  agent  than  in  any  remedy  or  class  of 
remedies  which  may  be  administered  per  os. 

Winckel  says  that  permanent  baths  are  indicated 
for  those  children  who  are  extremely  feeble  between 
twenty-three  and  thirty-six  7aeeks  of  age,  and  with 
those  who  are  in  a  state  of  profound  asphyxia  in 
consequence  of  hemorrhage  from  the  cord  after 
accouchement. 

He  had  a  bath  especially  constructed,  in  which 
a  child  could  be  comfortably  kept  constantly  for 
several  days  in  succession  in  water  at  a  tempera- 
ture of  97  ^  to  100  °    F. 

Henry  N.  Read,  Assistant  Physician,  Long 
Island  College  Hospital,  in  speaking  of  ephemeral 
high  temperature  in  young  children,  after  quoting 
Bouchut — who  says  in  his  work  on  Diseases  of 
Children,  "  in  the  first  stage  of  childhood  there 
is  no  relation  between  the  intensity  of  the  symp- 
toms and  the  extent  of  the  material  lesions  " — 
writes  "  that  the  most  intense  fever,  restlessness, 
and  spasmodic  movements,  etc.,  may  disappear  in 
twenty-four  hours,  leaving  no  traces.  The  pulse 
and  respiration  may  become  extremely  rapid, 
and  the  temperature  run  up  to  105  °  or 
more."  In  these  cases  we  can  only  explain  the 
phenomena,  as  Dr.  Read  does,  by  the  insufficient 
regulating  power   of  the    nervous  system.      The 


nervous  system  no  doubt  plays  an  important  part 
in  the  regulation  of  the  body  heat,  although  its 
action  and  exact  influence  is  ill  understood.  In 
these  cases  1  should  put  great  faith  in  the  sedative 
action  of  the  tepid  or  warm  bath.  Dr.  Read 
recommends  the  administration  of  chloral  hydrate  ; 
Da  Costa  and  Wilson,  of  Philadelphia,  speak  well 
of  the  same  treatment. 

Poultices.  Some  of  the  applications  already  spok- 
en of  might  come  under  this  head  ;  in  fact  there  is 
no  better  ajjplication,  where  simple  heat  and  moist- 
ure are  desired,  the  flannels  wrung  from  hot  water 
and  covered  with  dry  flannel  or  oiled  silk.  Spongio- 
pilline  may  be  used  in  place  of  the  flannel,  or  a 
layer  of  cotton  batting  covered  with  oiled  silk 
makes  a  light  and  neat  poultice,  which  may  be 
left  in  place  for  several  days.  If  it  be  desirable  to 
produce  a  little  cutaneous  irritation  in  the  case  of 
children,  a  spice-poultice  makes  a  light  and  con- 
venient poultice.  It  is  well  to  mix  the  white  of  an 
egg  and  a  little  glycerine  with  the  spices  to  prevent 
them  from  becoming  dry  too  soon.  I  prefer  in 
most  cases  an  ordinary  flax-seedmeal  poultice  to 
which  a  litde  mustard  has  been  added.  If  it  be 
desirable  to  keep  the  poultice  moist  as  long  as 
possible,  a  litde  glycerine  may  be  mixed  with  it. 
The  physician  should  always  either  give  minute 
instructions  in  regard  to  making  and  applying  any 
poultice  ordered,  or,  better,  see  to  it  himself — as 
a  poultice,  unless  properly  made  and  applied,  miy 
do  more  harm  than  good. 

A  hop  poultice  is  popular,  but  probably  owes 
its  good  effects  simply  to  the  heat  and  moisture. 
If  the  chest  be  covered  with  flannel  and  oiled 
silk   in  every  case  of  measels,  many  lung  compli- 
cations might  be  avoided,  says  J-  Lewis  Smith. 

Poultices  should  not  be  continued  too  long ; 
for  if  kept  too  long  in  conact  with  a  large  surface 
they  depress  the  vigour  of  the  system,  and  lower 
the  tone,  so  that  recovery  may  be  prolonged. 
They,  also,  if  kept  in  place  too  long,  cause  lit- 
de abscesses  which  are  very  irritating. 

Inunctions.  Inunctions  of  fat  are  useful  in 
most  fevers,  especially  in  scarlet  fever,  to  relieve 
the  dry  condition  of  the  skin.  Cocoa  butter  is  the 
best,  perhaps,  but  lard  or  olive  oil  may  be  used. 
Colbat  advocates  the  use  of  inunctions  of  lard 
or  vaseline,  not  only  in  scarlatina,  but  in  variola, 
pneumonia,  etc.  His  experience  has  been  that  the 
inunction  is  always  followed  by  a  period  of 
calm  and  repose,  and  with  a  reduction  of  the  body 
temperature  from  one  half  to  two  degrees. 

I  shall  not  speak  of  the  various  medicinal  agents 
that  may  be  put  into  the  circulation  by  means  of 
inunction,  such  as  mercurials,  cod-liver  oil,  etc. 
Neither  have  I  spoken  of  the  medicinal  agents 
that  may  be  absorbed  from  baths  or  vapors. 

I  will  mention  one  means,  however,  which  is 
very  little  used,  and  which  is  of  great  benefit  in 
treating  weakly  children,  who  are  sallow.and  have 
pasty,  whitish  stools  ;  and  that  is  by  'general  baths 
with  a  solution  of  nitro-muriatic  acid  one  ounce  to 
gallon. 


62 


THE   CANADA   MEDICAL   KECORD. 


Cot/iiter-in-itants.  In  speaking  of  mustard,  etc., 
in  poultices,  I  have  already  mentioned  some  forms 
of  counter- irritation.  There  are  a  few  others  that 
the  physician  who  is  called  upoii  to  treat  children 
should  bear  in  mind. 

H.  C.  Wood  strongly  recommends  the  oil  of 
amber  as  being  especially  valuable  as  a  counter- 
iriitanl  in  the  treatment  o(  the  b/'onchitis  of  young 
children,  associated,  as  it  often  is,  with  marked 
nervous  disturbance  and  tendency  to  collapse. 
The  oil,  diluted  with  from  one  to  three  parts  of 
sweet  oil,  and  applied  to  the  chest  as  a  sort  of 
stupe,  sometimes  acts  very  happily  ,in  allaying 
nervousness  as  well  as  internal  congestion. 

For  pertussis,  among  the  thousand  and  one  re- 
medies, John  M.  Keating  speaks  well  of  coun- 
ter-irrtation  as  an  important  measure,  and  mentions 
croton  oil,  oil  of  amber,  and  oil  of  cloves,  which 
may  be  mixed  with  olive  oil,  and  rubbed  on  the 
chest  three  times  a  day,  and  the  surface  afterward 
covered  with  oiled  silk.  J.  Lewis  Smith  also  ad- 
vises mild  counter-irritation  in  pertussis.  The 
same  authority  advises  counter-irritation  along  the 
spine  and  nucha,  after  discontinuance  of  ice-bags 
in  cerebrospinal  meningitis. 

Dr.  Faulkner,  of  Pittsburgh,  advises  as  an  effici- 
ent means  of  treatment  in  many  cases  of  asthma, 
counter-irritation  over  both  pneumogastrics  with 
Churchill's  tincture  of  iodine. 

In  tetanus  infantum,  Dr.  Merriwether,  of  Ala- 
bama, says,  if  there  is  ho  improvement  from  the 
medicine  which  he  orders,  he  applies  a  blister 
larger  than  a  dollar,  to  the  umbilicus,  and  with 
this  treatment  the  child  generally  improves.  Warm 
foot-baths  and  stimulating  embrocations  along 
the  spine  are  proper  adjuvants  to  the  treatment. 
Trousseau  sometimes  used  blisters  to  the  legs  in 
scarlatina  dropsy  with  good  effect  in  conjunction 
with  hydragogue  cathartics.  Blisters  are  very  sel- 
dom required  in  treating  children,  especially  in  the 
case  of  young  or  weakly  children  they  should  be 
used  with  extreme  caution.— Z>r.  F.  H.  Knicker- 
bocker, in  Archives  of  Pediatrics. 


BISMUTH  SUBNITRATE  IN  BURNS. 
By  a.  M.  Cartledge,  M.  D. 
Professor   of  the  Principles  and  Practice  of  Surgery,  and 
Clinical  Surgery,  in  tlie  Hospital  College  of  Medicine, 
Louisville. 

Burns  are  among  the  most  troublesome  injuries 
the  surgeon  is  called  to  attend.  He  has  to  ex- 
ercise a  degree  of  patience  only  equalled  by  the 
victim's  pain.  Nearly  all  the  usual  methods  of 
treating  burns  locally  are  decidedly  inefficient. 
About  the  only  true  principle  advanced  for  centu- 
ries was,  that  air  should  be  excluded  from  the  burnt 
surface,  and -this  no  doubt  was  the  suggestion  of 
some  suffering  patient. 

It  is  the  usual  custom  in  burns  of  the  second, 
third,  and  fourth  degree  (and  these  constitute  the 
largest  class,  and  the  varieties  especially  alluded 
to  in  this  paper)  to  immediately  smear  the  parts 


with  some  substance,  a,s  flour,  starch,  or  white  lead. 
These  dressings,  by  excluding  air  from  the  exposed 
nerve  terminals,  fulfill  one  indication  of  treatment, 
but  in  others  utterly  fail,  and  later  do  much  harm. 
Suppuration  occurs  often  as  a  result  of  the  decom- 
position of  the  vegetable  substances,  and  this  to- 
gether with  the  impediment  to  drainage  favors 
very  materially  septic  absorption. 

In  burns  of  much  extent  it  becomes  necessary 
to  remove  such  dressings  as  early  as  the  third  day 
to  prevent  serious  systemis  symptoms ;  and  now 
the  real  trouble  comes.  The  pain  inflicted  in  re- 
moving such  a  dressing,  provided  the  burn  is 
extensive,  is  simply  appalling.  I  have  observed 
it  attended  by  not  inconsiderable  shock,  even  where 
the  most  careful  precautions  by  way  of  soaking 
was  practiced.  It  is  generally  customary  after 
removing  such  a  dressing  as  has  been  described  to 
apply  some  oleaginous  dressing  either  the  old 
carron  oil — linseed  oil  and  lime  water  equal  parts, 
or  the  more  modern  carbolized  oil.  Some  have  dis- 
carded the  various  powders  and  pastes  and  resort 
primarly  to  the  carbolized  oil. 

This  last  has  been  my  practice  until  recently. 
But  the  carbolized  oil  does  not  meet  all  the  indi- 
cations of  treatment,  and  is  I  think  much  inferior 
either  as  a  primary  or  secondary  dressing  to  the 
subnitrate  of  bismuth.  The  principles  involved  in 
the  treatment  of  burns  does  not  materially  differ 
from  that  in  other  open  wounds.  The  application 
of  principals  in  practice  are  somewhat  modified  by 
the  peculiarities  of  the  injury.  The  application  of 
antiseptic  methods  to  burns  of  great  superficial 
extent  is  attended  with  considerable  difficulty. 
However,  patience  and  care  with  an  anesthetic, 
ifnecessary,  will  accomplish  much  in  this  way. 

The  ideal  dressing  for  a  burn  is  the  one  that  is 
thoroughly  protective,  hence  comfortable,  and  one 
that  can  remain  longest,  viz.,  antiseptic.  I  think 
in  the  present  state  of  our  knowledge  bismuth  and 
absorbent  cotton  is  the  nearest  approach  to  such 
a  dressing. 

Mode  of  application. — The  parts  should  be  as 
perfectly  cleansed  as  possible  with  warm  carbolized 
water  on  listerine.  I  usually  puncture  any  large 
vesications  in  second  degree  burns.  Then  if  the 
burn  be  small  superficial  extent  piwder  it  over  with 
bismuth,  over  this  a  good  thick  layer  of  absorbent 
cotton,  and  over  all  a  bandage.  If  the  injury  cov- 
ers considerable  extent,  so  as  to  render  the  too  free 
use  of  bismuth  dangerous,  make  a  solution  in  water 
of  the  bismuth  and  paint  it  over  the  part.  This 
last  permits  of  a  uniform  distribution  of  a  minimum 
quantity.  I  have  used  this  dressing  in  several  cases 
of  burn,  and  in  one  extensive  scald  of  the  leg, 
second  and  third  degree,  and  so  far  have  not  wit- 
nessed any  evidence  of  bismuth  poisoning. 

The  results  have  been  very  satisfactory,  in  two 
or  three  cases  scarcely  any  suppuration  occurring. 
I  have  not  used  it  in  burns  involving  as  much  as 
one-founh  of  the  surface  of  the  body,  but  think 
with  care  it  may  be  used  safely.  A  dressing  of  this 
kind  promotes  to  the   greatest  degree  healing  by 


THE   CANADA   MEDICAL   RECOED. 


63 


scabbing,  wliicli  is  the  method  tO  be  desired  in 
burns.  After  removing  the  cotton,  because  of 
sni)puralion  it  may  be,  it  is  not  necessary  to  remove 
the  bismuth  scab  entirely,  but  cleanse  any  point  of 
supijuraiion  and  powder  a  little  bismuth  on,  then 
reai)[)ly  fresh  cotton.  Tliis  method  saves  the  sur- 
geon much  labor,  the  patient  much  pain,  and  does 
much  to  save  life  from  septic  absorption  and  sup- 
l>urativc  exhaustion.  P'inally  by  promoting  healing 
by  scabbing  instead  of  by  granulation,  it  will  do 
much  to  lessen  subsequent  conlractinu  in  burn 
cicatrices. — Progress,  Louisville,  Ky. 


WEANING. 
This  important  process  has  called  forth 
the  most  careful  thought  on  the  part  of  such  emi- 
nent men  as  Trousseau,  Archambault,  and  Julius 
Simon,  and  others.  If  it  is  done  prematurely, 
suddenly  or  at  an  unseasonable  period  of  the  year, 
one  may  expect  as  a  result  diarrhoea,  gastro-enter- 
itis,  or  cholera  infantum,  this  result  being  due  to 
the  irritation  which  is  causd  to  the  organs  which 
are  accustomed  to  and  adapted  to  the  digestion  of 
human  milk.  If  an  acute  affectionis  produced,  the 
symptoms  arc  indigestion,  diarrhoea,  and  vomiting, 
which  may  come  on  in  repeated  attacks  and  may 
quickly  prove  fatal.  Acutegastro-enteritis  sometimes 
takes  the  form  of  cholera  infantum.  Instead  of  the 
acute  form  there  may  be  a  sub-acute  or  a  chronic 
one,  the  belly  becomes  enlarged  and  the  stomach 
dilated  and  rachitis  with  its  well  known  phenomena 
may  intervene.  In  other  cases  '  the  skin,  the 
mucous  membranes,  and  the  lymphatic  glands  may 
be  involved,  and  scrofula  appear  as  the  result  of 
improjjer  weaning.  Two  questions  are  to  be  con- 
sidered in  connection  with  this  subject:  (i)  When 
(that  is,  at  what  age)  should  weaning  take  place  ; 
(2)  how  should  it  be  done?  Of  decided  import- 
ance, also,  is  a  consideration  as  to  the  time  of  the 
year  when  this  may  best  be  accomplished.  The 
summer  is  the  least  desirable  season  for  it, 
for  reasons  which  will  at  once  occur.  The  most 
favorable  is  the  winter,  and  then,  in  turn,  the 
spring  and  the  autumn.  As  to  the  proper  age  for 
weaning  Trousseau  made  the  mistake  of  laying 
down  the  general  rule  that  it  should  be  accom- 
plished when  the  child  had  cut  his  sixteen  teeth, 
whatever  might  be  his  age.  But  if  a  child  has 
been  nursed  at  the  breast  he  will  have  his  teeth 
when  he  is  twelve  or  fifteen  months  of  age ;  while, 
if  he  has  been  nourished  in  part  at  the  breast  and 
in  part  by  the  bottle,  the  first  dentition  will  not  be 
finished  until  he  is  two  years  or  two  and  a  quarter 
years  of  age.  As  to  the  disturbances  which  Trous- 
seau attributed  to  dentition,  or  to  weaning  in  the 
interval  between  the  eruption  of  two  groups  of 
teeth,  it  is  believed  that  they  have  been  exaggerat- 
ed. The  age  of  eighteen  months  is  considered  as 
a  good  average  for  the  period  of  weaning,  modifying 
circumstances  occasionally  requiring  an  earlier 
time,  but  more  frequently  a  later  one.  Should  ' 
weaning  be    attempted   earlier   than  tlie  twelfth  j 


month,  it  will  be  attended  with  danger  to  the 
child's  life,  and  this  attempt  is  in  reality  resjjonsi- 
ble  for  the  great  mortality  among  infants.  When 
artificial  nourishment  must  be  adopted,  milk  alone 
should  be  used,,  and  the  author  protests  against 
the  soups,  panadas,  and  other  more  or  less  indi- 
gestible substances  which  are  given  to  infants 
from  four  to  six  months  of  age  under  the  jiretext 
of  preparing  them  for  weaning.  He  considers 
that  the  advice  of  Trousseau  and  others  upon  this 
point  has  done  great  harm. 

Ilo'd)  are  children  to  be  weaned?  If  the  child 
has  reached  the  age  of  twenty  months  the  question 
is  easily  answered.  If  he  persists  in  wanting  the 
breast,  having  already  been  fed,  in  part,  upon  milk, 
eggs,  and  other  easily  digested  food,  the  nipjjle 
and  the  surrounding  surface  may  be  smeared  with 
some  saline  or  bitter  substance,  and  this  will 
speedily  produce  the  desired  result.  Should  wean- 
ing occur  between  the  ages  of  twelve  and  fifteen 
months  the  diflicullics  will  be  greater,  for  diarrhoea, 
athrep.sia,  and  rachitis  are  among  the  possible 
results.  Milk  should  still  form  the  basis  of  the 
child's  diet,  and  this  should  continue  lor  several 
montlis,  soft-boiled  eggs  and  light  gruels  being 
added.  When  the  child  must  be  weaned  under  the 
age  of  twelve  months,  the  greatest  care  must  be 
taken,  mother's  milk  should  be  very  gradually 
replaced  by  cow's  milk  or  better  by  asses's  milk. 
Should  cow's  milk  be  given,  it  must  be  heated  over 
a  water  bath  and  fed  from  a  cup — not  from  a 
spoon  or  a  bottle.  Any  food  excepting  milk  must 
be  considered  positively  dangerous  for  children 
under  the  age  of  twelve  months.  Meat,  vegeta- 
bles, and  other  substances,  has  been  which  are  fit 
only  for  strong  stomachs,  must  be  withheld  for 
months  after  the  breast  has  been  entirely  abandon- 
ed. \Vine,  coffee,  beer,  and  cider  must  also  be 
entirely  withheld  from  young  children. — Archives 
of  Pediatrics. 


INSOMNIA  IN  THE  AGED. 

D.  C.  L.  Dana  (New  York  Bulletin  of  Clin. 
Soc.)  has  found  the  information  contained  in  the 
text-books  upon  insomnia  in  the  aged  to  be  but 
very  slight  in  amount.  Insomnia  was  not  frequent 
in  the  aged,  but  when  it  was  present  it  was 
sometimes  very  intractable.  In  his  exper- 
ience iron  did  not  relieve  the  anemia  of  the  aged 
so  as  to  produce  sleep.  Alcohol  with  food  is 
another  remedy,  and  many  recommended  hot 
gruel  with  alcohol  before  going  to  bed.  While 
alcohol  will  relieve  some  cases,  there  are  others  in 
which  the  insomnia  was  increased.  The  bromides 
and  chloral,  even  when  given  in  enormous  doses, 
often  failed  to  give  relief.  Opium  was  another 
remedy.  Good  results  have  been  obtained  with  a 
combination  of  cannabis  indica  and  codeia  ;  from 
five  to  six  minims  of  the  fluid  extract  of  cannabis 
indica  with  one-sixth  to  one-eight  of  a  grain  of 
codeia  might  be  used.  One-forth  of  a  grain  of  the 
extract  of  cannabis   taken  aloae  sometimes  might 


64 


THE   CANADA   MEDICAL   RECORD. 


be  effective.  As  a  rule,  however,  the  combination 
with  codeia  was  preferable.  Hyoscyamiiie  was 
sometimes  useful,  but  in  nervous  fidgety  persons  it 
would  sometimes  produce  an  actual  delirium. 
Under  ordinary  circumstances  the  dose  should 
not  be  increased  above  one-fourteenth  of  a  grain 
to  obtain  the  desired  effect.  The  effect  of  these 
remedies,  he  thought,  had  been  increased  by  addi- 
tion of  from  two  to  three  drops  of  tincture  of 
aconite  two  or  three  times  a  day  to  relieve  the 
tension  of  the  blood  vessels.  Tincture  of  valerain 
and  compound  spirits  of  lavender  sometimes  acted 
like  a  charm  in  relieving  insomnia.  Large  doses 
(3i-3i)  lupulin  were  also  often  effective. — New 
England  ^Icdical  Monthly. 


WINTER  INDIGE.STION. 

In  an  opening  address,  delivered  before  the  Sec- 
tion of  Medicine  at  the  Brighton  meeting  of  the 
British  Medical  Association,  Dr.  VV.  H.  Broad- 
hent  spoke  as  follows  on  the  topic  above  indicated  : 

As  cold  and  damp  weather  sets  in,  there  are 
many  persons  who  begin  to  suffer  from  pain  after 
eating,  "and  flatulence ;  or  these  symptoms  may 
not  set  in  until  later  in  the  winter,  when  the  cold 
and  short  days  have  reduced  the  vital  powers. 
Very  frequently  the  connection  between  the  indi- 
gestion and  the  seasbn  of  the  year  is  not  recogniz- 
ed, and  the  subjects  of  it  simply  look  upon  them- 
selves as  liable  to  dyspepsia,  which  they  associate 
with  certain  articles  of  diet  instead  of  with  the 
winter,  or  attribute  it  to  want  of  exercise  and  fresh 
air.  As  is  wgll  known,  however,  cold,  and  especi- 
ally cold  with  damp,  will  inhibit  digestion,  some- 
times so  completely  that  a  hearty  meal,  eaten  with 
avidity  after  a  cold  drive,  will  be  vomited  almost 
unchanged  hours  afterward ;  but  this  takes  place 
more  frequently  in  a  minor  degree,  sufficiently 
to  give  rise  to  discomfort,  and  a  sense  of  distention, 
or  the  cold  will  inhibit  the  hepatic  functions,  and 
cause  constipation. 

Now  in  all  such  cases  it  is  not  the  food  which 
disagrees  with  the  stomach,  but  the  stomach  which 
disagrees  with  the  food;  and  the  appropriate  treat- 
ment is  not  levelling  down  the  nourishment  to  the 
digestive  capacity  of  the  stomach,  but  the  bringing 
up  of  the  functional  energy  of  the  stomach  to  the 
requirements  -of  digestion,  by  extra  food  of  a 
stimulating  character,  such  as  beef  tea,  or  an  egg- 
flip,  between  meals,  by  stimulants  at  meals,  and 
by  tonics.  So  with  regard  to  winter  indigestion, 
winter  is  not  the  time  for  cutting  off  food,  when  it 
is  required  in  larger  amount  to  neutralize  the 
influence  of  external  cold.  What  is  wanted  is 
protection  from  the  de|)ressing  influence  of  cold, 
or  the  means  of  neutralizing  it. 

It  is  quite  true  that  most  people  eat  far  too 
much,  and,  again,  that  with  regard  to  the  stomach, 
as  well  as  to  all  other  organs  and  parts  of  the 
body,  the  principle  of  functional  rest  is  of  primary 
importance  in  dealing  with  disease  ;  and  restriction 


of  food,  and  even  temporary  starvation,  is  often 
necessary  ;  but  we  must  distinguish,  and  not  starve 
those  who  are  suffering  from  inadequate  nourish- 
ment, or  employ  treatment  for  catarrh,  or  ulcer, 
or  organic  disease,  when  nothing  of  the  kind  is 
present. 


BILIOUSNESS. 

What  is  commonly  known  as  an  acute  bilious 
attack  is  more  properly  an  acute  indigestion. 

The  treatment  of  biliousness  is  prophylactic, 
alimentary  and  medicinal.  Prophylaxia  is  con- 
cerned with  avoidance  of  all  the  known  causes, 
whether  of  a  toxic,  malarial,  or  alimentary  charac- 
ter. A  plain  diet  of  bread,  milk,  oatmeal, 
vegetables  and  fruit,  with  lean  meat  or  fresh  fish 
in  moderation,  and  abstinence  from  alcoholic 
stimulants  seems  to  be  the  ideal  fare  for  the 
biliously  predisposed.  This  kind  of  diet  is  especi- 
ally applicable  for  hot  weather  when  albuminoids 
are  apt  to  clog  the  portal  system,  and  pastries  are 
an  abomination,  and  when  a  broiled  schrode,  a 
little  chicken  or  mutton  broth  with  bread  and 
stewed  fruit  will  make  a  more  healthful  meal  than 
the  more  sumptuous  fare  of  a  modern  fashionable 
dining  saloon. 

Exercise  in  the  open  air  is  of  recognized  utility 
in  promoting  oxidation  and  elimination,  enhancing 
the  digestive  and  assimilative  processes,  and  light- 
ening the  burdens  of  the  liver.  Moreover,  exercise 
(whether  by  rowing,  horseback  riding,  gardening, 
walking,)  hinders  absorption  of  bile  by  the  hepatic 
venous  radicals,  and  promotes  the  passage  of  that 
fluid  into  the  duodenum,  through  the  increased 
compression  exerted  on  the  liver  by  the  diaphragm 
and  abdominal  muscles ;  this  is  in  accordance 
with  a  recognized  physiological  law. 

The  victim  of  an  acute  bilious  attack  will  gener- 
ally get  righted  in  a  few  days  by,  first  abstinence 
from  all  food,  then  a  diet  of  porridge  and  milk,  or 
skimmed  milk  alone,  and  a  very  gradual  return  to 
solid  food,  which  for  several  days  should  be  re- 
stricted to  toast,  a  little  lean  meat  or  broiled  fish, 
with  some  succulent  vegetables,  or  ripe  fruit.  As 
for  medicines,  saline  aperients,  such  as  sulphate 
of  soda,  Epsom  or  Rochelle  salts  in  full  doses  in 
the  morning,  or  the  now  fashionable  tumblerful 
of  Hunyadi  Janos  will  generally  suffice  to  clear 
the  prima:  nice  ;  the  latter  has  especially  a  repu- 
tation for  evacuating  bile.  The  striking  relief 
obtained  by  free  bilious  evacuation  has  often  been 
remarked,  and  the  veteran  transgressor  resorts  to 
his  blue  pill  or  podophyllin  with  every  recurrence 
of  his  malady.  Of  late  euonymin  has  come  much 
into  use  as  a  cholagogue. 

Harley  recommends  to  persons  who  seem  to 
have  a  more  than  usual  tendency  to  biliousness 
traceable  to  sluggish  biliary  secretion,  and  where 
there  seems  also  to  be  defective  nerve  action, 
small  doses  of  nux  vomica  or  strychnia  after  their 
meals.  This  may  be  combined  with  belladonna 
and  aloes  as  in  the  aloin,  strychnia,  and  belladonna 


tHE  CANADA   MEDICAL  RECORb. 


65 


pill.  The  bilious  person  is  generally  constipated, 
hence  such  a  i)iil  has  a  s[)ccial  utility.  Fothergill's 
pill  of  ipecac,  capiscum,  and  i)il.  aloes  et  myrrh, 
has  done  good  service  in  such  cases.  Nitro- 
inuriaiic  acid  and  taraxacum  have  a  reputation 
which  is  i)robably  not  altogether  built  on  imaginary 
results.  Jiut  bilious  dyspeptics,  while  they  should 
be  attentive  to  the  functions'  of  eliminations  (and 
doubtless  the  ancient  predilection  for  purgatives 
has  been  justified  by  modern  scientific  research 
which  finds  in  intestinal  septicemias  and  alkaloids 
of  putrefaction  many  of  the  evils  fonnerly 
attributed  to  peccant  humors  and  atrabilitary 
disorders)  should  aim  especially  to  be  good 
hygienists  and  learn  to  live  right ;  but  this  is  coun- 
sel which  everybody  gives  and  nobody  takes. — 
Boston  Med.  and  Surg.  Jour. 


THE 


DIETETICS    OF     PULMONARY 
PHTHISIS. 


By  Alfred  L.  Loomis,  M.D.,  etc 

The  dietetics  of  pulmonary  phthisis  is  often  the 
most  difficult  as  well  as  the  most  important  element 
in  its  successful  management. 

In  the  limited  space  at  my  disposal  I  can  give 
only  general  rules  and  an  outline  of  the  practice 
which  experience  has  led  me  to  adopt. 

Three  things  require  consideration  : 

1st. — The  most  sutiable  articles  of  food. 

2d. —  The  time  and  quantity  of  its  adminis- 
tration. 

3d. —  The  use  of  artificial  digestion. 

Since  the  object  sought  is  the  maintenance  of 
the  highest  possible  nutrition,  and  as  this  must 
often  be  done  with  feeble  digestive  and  assimilative 
powers,  the  selection  of  food  will  not  be  determined 
solely  by  their  relative  value  (chemically)  as  food 
products,  but  quite  as  much  by  the  facility  with 
which  they  are  assimilated. 

The  best  foods  are  those  from  which  the  system 
gains  the  most  heat  and  force  producing  elements 
with  the  least  proportionate  expenditure  of  digestive 
and  assimilative  force. 

Milk  is  undoubtedly  the  best  food  of  all  per  se. 
but  in  many  cases  with  weak  digestive  power 
more  nutrition  is  gained  from  its  weaker  ally 
Kumyss. 

Of  the  albuminoids,  meats,  especially  beef,  and 
eggs  are  the  most  valuable. 

The  best  hydrocarbons  are  cod  liver  oil,  butter, 
cream,  and  the  animal  fats.  Sugars  and  starches 
should  be  avoided  as  far  as  possible,  since  they 
tend  to  fermentation,  and  cause  both  gastric  and 
intestinal  dyspepsia.  Only  occasionally  will  a 
patient  be  found  who  is  benefited  by  their  use. 
They  should  be  employed  therefore  only  for  variety 
in  diet  and  to  avoid  that  disgust  for  all  food  so  apt 
to  be  engendered  by  a  monotonous  diet. 

Phosphorous,  so  important  especially  in  tuber- 
cular cases,  is  secured  in  preparations  of  the 
phosphates,  which  should  not  be  in  the  form  of 


syrups.  Vegetables  and  fruits  may  be  required  in 
the  earlier  stages  to  avoid  monotony,  and  later  to 
satisfy  a  capricious  ajjpetite,  but  they  should  be 
restricted  to  the  minimum  and  to  such  as  contain 
the  least  saccharine  elements. 

Two  very  distinct  classes  of  phthisical  patients 
must  be  recognized,  those  under  thirty  and  those 
over  forty.  It  may  be  stated  as  a  general  rule 
that  for  the  first  class  the  basis  of  all  dietetic  treat- 
ment must  be  the  hydrocarbons  and  phosphates. 
They  are  often  the  curative  agents  in  young  sub- 
jects. 

On  the  other  liand  the  albuminoids  must  con- 
stitute the  principal  food  of  the  second  class.  It 
is  worthy  of  note  that  often  in  phthisis  the  de- 
mands of  waste  and  repair  not  only  enable  young 
people,  who  usually  object  to  all  forms  of  fat,  to 
take  and  assimilate,  but  even  cause  them  to  exhib- 
it a  decided  fondness  for  all  forms  of  fatty  food. 
Older  subjects  who  in  health  use  little  albuminous 
food  and  more  fat  are  able  to  digest  large  amounts 
of  meat,  while  fats  cause  intestinal  dyspepsia. 

In  selecting  special  articles  of  diet  for  these 
two  classes  it  is  important  to  remember  that  there 
are  distinct  stages  which  consumptive  patients  pass 
through  as  regards  their  digestive  powers.  The 
first  covers  the  per'od  during  which  digestion  and 
appetite  are  unaffected.  The  second  begins  with 
the  first  indications  of  septic  infection  ;  is  marked 
by  intermittent  pyrexia  and  gastric  irritability.  It 
extends  to  the  time  at  which  the  stomach  refuses 
solid  food.  The  third  covers  the  remainder  of 
the  patient's  life.  It  is  in  the  first  stage  that  the 
best  results  are  obtained. 

Systematic  dieting  should  be  begun,  therefore, 
upon  the  first  suspicion  of  a  developing  phthisis. 
The  diet  can  no  longer  be  indiscriminate,  but  the 
rules  given  below  should  be  strictly  adhered  to. 
For  young  patients  meat  must  be  and  butter  and 
cream  are  to  be  used  freely.  Milk  should  consti- 
tute the  principal  drink,  in  quantities  of  from  two 
to  four  quarts  per  day.  Other  articles  are  to  be 
taken  sparingly  simply  to  avoid  monotony.  Each 
meal  is  to  be  supplemented  by  a  generous  allow- 
ance of  cod  liver  oil  (5  ss  S  ii) .  The  phosphates, 
so  valuable  to  this  class  of  patients,  can  be  sup- 
plied in  sufficient  quantity  only  by  special 
preparations.  For  patients  over  forty,  meats 
should  be  lean  rather  than  fat,  and  be  taken  in 
large  amount.  Two  or  three  pounds  of  beef, 
three  to  four  quarts  of  milk,  and  three  or  four 
eggs  may  be  given  to  such  patients  in  twenty-four 
hours. 

In  the  second  stages,  changes  are  required  in 
the  method  of  preparing  the  food  rather  than  of 
the  article's  employed.  All  the  food  must  be 
given  in  fine  division  and  prepared  in  the  most 
palatable  manner.  Beef  may  be  scraped  or  chop- 
ped with  a  dull  knife,  only  the  fine  which  adheres 
to  the  blade  being  used,  and  eaten  raw  or  lightly 
or  quickly  cooked,  the  essential  points  being  the 
removal  of  all  coarse  fibre  and  rendering  it  palatable 
to  the  patient.     Milk  may  be  taken  raw,  boiled, 


06 


THE   CANADA    MEDICAL   RECORD. 


cooked  in  custard,  curdled  or  shaken  with  cracked 
ice  and  a  little  salt.  Eggs  are  best  taken  raw  or 
soft  boiled.  Kumyss  may  in  part  take  the  place 
of  milk,  and  the  various  peptonoids  of  beef,  milk, 
etc.,  will  relieve  the  enfeebled  digestive  organs  as 
well  as  afford  valuable  nutrition.  Cod  liver  oil 
will  require  emulsification  and  fresh  emulsions  are 
to  be  preferred  to  the  stock  preparations.  Practi- 
cally I  have  found  an  emulsion  of  oil,  pepsin  and 
quinine  available  when  others  caused  indigestion 
and  offensive  eructations. 

In  the  third  stage  when  only  prolongation  of 
life  can  be  expected,  the  forced  diet  of  the  earlier 
stages  must  be  abandoned.  When  a  hearty  meal 
causes  cough  and  vomiting  with  consequent  ex- 
haustion better  results  will  be  obtained  with 
smaller  quantities  of  food.  In  such  cases  the  food 
must  be  reduced  in  quantity,  given  more  frequent- 
ly, and  should  consist  largely  of  artificially  digested 
preparations. 

It  is  quite  customary  to  delay  llie  use  of  the 
digestive  ferments  until  the  later  stages  of  the 
disease,  but  since  it  is  in  the  first  stage  almost 
solely  that  we  effect  a  cure,  it  seems  the  wiser 
course  to  concentrate  all  our  forces  upon  the 
disease  at  this  time. 

When  we  wish  to  crowd  the  nutrition  twenty  to 
thirty  grains  of  pepsin  with  fifteen  to  twenty 
minims  of  Acid  Hal.  directly  after  eating,  and  ten 
to  fifteen  grains  of  pancreatine  one  hour  after 
taking  food  will  enable  a  patient  to  digest  an 
amount  of  food,  which  otherwise  would  jsroduce 
an  acute  dyspepsia.  When  the  digestion  of 
starches  is  at  fault  or  requires  assistance,  the 
diastase  alone  may  be  given  with  or  after  the 
meal.  In  the  second  and  third  stages  artificial 
digestion  becomes  a  necessity. 

Some  of  the  most  important  rules  which  govern  the 
dietetics  of  phthisis  may  be  formulated  as  follows  : 

1.  Every  phthisical  patient  should  take  food 
not  less  than  six  times  in  the  twenty-four  hours. 
The  three  full  meals  may  be  at  intervals  of  six 
hours  with  light  lunches  between. 

2.  No  more  food  should  be  taken  at  any  one 
time  then  can  be  digested  easily  and  fully  in  the 
time  allowed. 

3.  Food  should  never  be  taken  when  the 
patient  is  suffering  from  bodily  fatigue,  mental 
worry  or  nervous  excitement.  For  this  reason 
midday  naps  should  be  taken  before,  not  after, 
eadng.  Twenty  to  thirty  minutes'  rest  in  the 
recumbent  posture,  even  if  sleep  is  not  obtained, 
will  often  prove  of  more  value  as  an  adjuvant  to 
digestion  than  pharmaceutical  preparations. 

4.  So  far  as  possible  each  meal  should  consist 
of  such  articles  as  require  about  the  same  time  for 
digestion,  or  better  still,  of  a  single  article. 

5.  Within  reasonable  limits  the  articles  of  any 
one  meal  should  be  such  as  are  digested  in  either 
the  stomach  or  intestine  alone,  i.e.,  the  fats, 
starches  and  sugars  should  not  be  mixed  with  the 
albuminoids,  and  the  meals  should  alternate  in 
this  respect. 


6.  In  the  earlier  stages  the  amount  of  fluid 
taken  with  the  meals  should  be  small,  and  later 
the  use  of  some  solid  food  is  to  be  continued  as 
long  as  possible. 

7.  When  the  pressure  of  food  in  the  stoinach 
e-xcites  cough,  or  when  paroxysms  of  coughing 
have  induced  vomiting,  the  indigestion  of  food 
must  be  delayed  until  the  cough  ceases,  or  an 
appropriate  sedative  may  be  employed.  In  those 
extreme  cases  where  every  attempt  at  eating  ex- 
cites nausea,  vomiting  and  spasmodic  cough, 
excellent  results  are  attained  by  artificial  feeding 
through  the  soft  rubber  stomach  tube. 

8.  So  long  as  the  strength  will  permit  assiini- 
lation  and  excretion  must  be  stimulated  by  system- 
atic exercise,  and  when  this  is  no  longer  possible 
the  nutritive  processes  may  be  materially  assisted 
by  passive  exercise  at  regular  intervals. 

The  following  may  serve  as  a  sample  menu  for 
a  day  in  the  earlier  stage.  The  meat  soup  is  made 
by  digesting  finely  chopped  beef  (ilb)  in  water 
(Oj)  and  hydrochloric  acid  (5M)  and  straining 
through  cheese  cloth. 

MENU. 

On  waking. — One-half  pint  equal  parts  hot  milk 
and  vichy,  taken  at  intervals  through 
half  an  hour. 

5  a.m. — Oatmeal  with  abundance  of  cream,    little 

sugar  :  rare  steak  or  loin  chops  with 
fat,  cream  potatoes  ;  soft  boiled  eggs, 
cream  toast ;  small  cup  of  coffee,  two 
glasses  of  milk. 

9  a.m. — Half  ounce  cod  liver  oil,  or  one  ounce 

peptonized  cod  liver  oil  and  milk. 

10  a.m. — Half  pint   raw   meat    soup  ;   thin    slice 

stale  bread. 

1 1- 1 2. — Sleep. 

12.30p.m. — Some  white  fish;  very  little  rice; 
broiled  or  stewed  chicken ;  cauli- 
flower; stale  bread  and  plenty  of 
butter ;  baked  apples  and  cream  ; 
milk,  Kumyss  or  Matzoon,  two 
glasses. 

2  p.m. — Half  ounce  cod  liver  oil,  or  one  ounce 
peptonized  cod  liver  oil  and  milk. 

4  p.m. — Bottle  Kumyss  or  Matzoon  ;  raw  scraped 
beef  sandwich. 

5.30-6  p.m. — Rest  or  sleep. 

6  p.m — Some  thick  meat  or  fish  soup  ;  rare  roast 

beef  or  mutton  ;  spinach  ;  slice  stale 
bread  ;  custard  pudding  ;  ice  cream. 

8  p.m. — Half  ounce  cod  liver  oil,  or  one  ounce 
peptonized  cod  liver  oil,  and  milk. 

9-10  p.m Pint  iced  milk;  cup  meat  soup. 

1-2  a.m. — Glass  milk,  if  awake. 


THE  DIETARY  IN  INDIGESTION. 

By  J.  MiLNER  FoTHERGiLL,  M.D.,  Edin. 

When  I  hear  medical  men  denouncing  a  regulated 

dietary  in  indigestion,  my  surprise  is  excited.     Is 

•it  malady  to  be  combatted  by  drugs  only  ?     I  do 


I'HE   CANADA   MEDICAL  RECORD. 


6? 


not  think  anyone  will  support  that  proposition. 
Medicinal  agents  are  not  without  their  value ;  but 
the  medicinal  treatment  of  indigestion  is  surely  but 
ancillary  to  the  dietetic  management.  That  a  re- 
gulated dietary  is  too  often  a  restricted  dietary — 
so  restricted  indeed  that  the  i)atient  is  practically 
half-starved — may  be  admitted.  But  need  a  regu- 
lated dietary  necessarily  be  a  very  restricted  one  ? 
I  opine  not ;  if  the  matter  of  the  dietary  of  the 
dyspeptic  be  given  a  little  more  attention. 

And  for  this  it  is  well  to  keep  the  physiology  of 
indigestion  in  rnind.  Digestion  is  solution  by 
hydration  so  that  the  carbo-hydrates  and  albumi- 
noids may  pass  through  the  wall  of  the  alimentary 
canal ;  after  which  they  are  de-hydrated — else 
they  would  pass  out  by  the  kidney,  giving  glycos- 
uria and  peptonaria  and  leaving  the  body  unfed. 
But  a  preliminary  to  solution  is  disintegration.  If 
mastication  be  not  properly  performed  the 
"  lumps  ''  of  food  find  their  way  into  the  stomach 
and  offend  it. 

Pastry,  pieces  of  hard  potato,  cheese,  are 
notorious  offenders.  The  solvent  action  of  the 
gastric  juice  can  exercise  no  disintegrating 
effect  upon  the  substances,  while  they  act  as  irri- 
tants and  set  up  pain.  A  piece  of  meat  compar- 
atively unchewed  is  less  objectionable,  because  the 
gastric  juice  acting  upon  the  connective  tissue 
allows  the  muscular  fibriUs  to  fall  asunder.  But 
even  with  muscular  fibre  there  is  a  wide  difference. 
Pork  and  veal  are  hard  meats,  and  not  readily  fall- 
ing to  pieces  in  the  stomach  under  the  action  of 
the  gastric  juice  are  held,  and  rightly  too,  to  be 
indigestible.  On  the  other  hand  a  thin  slice  of 
well  boiled  ham,  cut  across  the  fibre,  is  very  diges- 
tible. So  is  the  loose  fibre  of  a  sheep's  head. 
This  is  the  mechanical  aspect  of  the  digestibility  of 
food.  Hard  stringy  meat  is  very  indigestible.  .So 
are  ill-cooked  vegetables,  and  especially  the 
cruciferse,  so  are  hard  boiled  eggs. 

Fish  and  especially  white  fish,  whose  fibres 
very  readily  fail  to  pieces,  are  in  repute  with  dys- 
peptics for  obvious  reasons.  Fish  which  are  latty 
are  indigestible  (because  the  fat  resists  the  action 
of  the  gastric  juice),  as  the  flesh  of  the  salmon,  the 
mackerel  and  the  herring.  The  short  fibre  of  the 
whiting,  "  the  chicken  of  the  sea,"  makes  this  fish 
especially  digestible.  Then  come  the  flat  fishes, 
the  haddock  and  the  cod.  They  all  are  best 
boiled,  for  if  fried,  care  is  requisite  that  the  flesh 
be  not  soaked  in  fat — when  it  is  highly  indigesti- 
ble. There  are  few  more  indigestible  matters  than 
a  fried  sole  which  has  not  been  skillfully  cooked. 
And  the  same  holds  good  of  birds.  Chicken  and 
game  are  indigestible,  while  the  duck  and  goose, 
greasy-fibred  meats,  are  as  certainly  indigestible. 

Potatoes  have  an  evil  reputation,  but  that  again 
is  largely  a  matter  of  cooking.  A  potato  which  is 
imperfectly  cooked  has  a  hard  centre.  A  "'  stone," 
an  Irishman  calls  it — and  if  palpable  pieces  of  such 
hard  indigestible  matter  be  swallowed  gastric  dis- 
tress is  the  intelligible  result.  But  if  the  potato  be 
well  cooked  and  put  through  a  seive  it  ceases  to 


be  indigestible  from  "  the  mechanical  point  of 
view."  It  is  the  question  of  disintegration  which 
militates  against  vegetables,  and  uncooked  fruit. 
Pieces  of  hard  apples  are  notoriously  indigestible  ; 
while  a  baked  apple  will  sit  lightly  on  the  most 
irritable  stomacli.  The  flesh  of  the  grape  is  in 
great  repute  in  all  conditions  of  gastric  irritability 
and  debility,  whether  primary  or  secondary  to  some 
general  sickness. 

Fat  is  an  oflence  to  a  susceptible  stomach, 
even  as  liquid  fat  floating  about  in  it ;  but  still 
more  as  lumps  of  fat  upon  which  the  stomach  can 
exercise  no  solvent  influence.  Hence  many  per- 
sons, children  and  adults  reject  sweet  pieces  of 
fat,  and  (after  the  meal)  take  some  fishy  oil.  As 
the  digestion  of  fat  does  not  commence  till  the 
food  has  left  the  stomach,  it  is  not  well  to  give  fat 
till  its  "  time  draws  nigh."  Thin  stale  bread  with 
butter  rubbed  well  in  and  doubled  is  much  more 
digestible  than  the  same  bread  cut  thick  with  a 
stout  layer  of  butter  plastered  over  it. 

Pastry,  when  fat  and  flour  are  well  rubbed  to- 
gether, forms  a  most  indigestible  compound  resist- 
ing all  disintegration  e-xcept  mastication.  Suet 
puddings  and  dumplings  also  are  indigestible. 

On  the  other  hand  milk  puddings,  especially  if 
made  without  an  egg,  are  in  repute,  and  not  with- 
out reason  for  dyspeptics.  They  are  light  and  sit 
easily  on  the  stomach,  the  farinaceous  matter  being 
readily  disintegrated,  and  what  escapes  disintegra- 
tion ;s  soft  and  does  not  give  oflence  to  the  stom- 
ach. 

There  is  another  matter  not  of  accult  but  of 
miscroscopic  disintegration,  or  actual  solution 
which  has  yet  to  be  discussed — a  matter  of  vital 
importance.  A  savage  man  sat  grinding  the 
cereals  which  form  so  large  a  factor  in  human  food, 
the  action  of  the  jaw  produced  a  free  flow  of  saliva, 
and  as  fast  as  the  finer  particles  were  broken  off 
the  seed,  by  the  crunching  of  the  teeth,  diastase 
of  the  saliva  converted  the  insoluble  starch  into  the 
soluble  dextrine  and  grapesugar.  The  toil  of  the 
miller  produces  disintegration  and  relieves  the 
jaws  of  much  of  the  labor.  But  disintegration  is 
only  the  precursor  of  solution.  The  starch  granule 
remains.  By  heat  the  cook  cracks  the  starch 
granule  so  that  the  solvent  diastase  can  readily  act 
upon  it.  So  far,  so  good  ;  but  heat  does  something 
more.  It  has  an  actual  solvent  action  ;  and  heat 
will,  if  sufficient,  cause  conversion  of  starch  into 
dextrine.  A  thoroughly  well  baken  flour,  if  sub- 
jected to  the  iodine  test  under  a  microscope,  will 
readily  show  this. 

When  a  large  quantity  of  raw  unconverted 
startch  enters  the  stomach  it  is  a  burden  to  that 
viscus.  'The  gastric  juice  has  no  effect  •  upon 
starch  and  the  starch  granules  merely  embarrass 
the  action  of  the  stomach  until  they  find  their  way 
out  of  it  by  die  pyloric  ring — and  sometimes  by 
the  way  they  entered,  viz.,  the  gullet.  Undigested 
starch  hampers  the  stomach  and  makes  the  labor 
of  that  viscus  a  painful  toil  to  it.  New  bread  is  a 
gross  mechanical  irritant,    resisting  disintegration. 


68 


THE  CANADA   MEDICAL   RECORD. 


The  impediment  caused  by  isolated  but  numerous 
starcli-granules  is  another  matter.  Biscuits  and 
crackers  if  insufficiently  masticated  cause  indiges- 
tion. So  do  cakes  which  have  not  long  been 
exposed  to  heat.  The  cakes  which  are  held  in 
such  favor  by  the  breakfast  table  in  American 
households  have  been  regarded  as  indigestible, 
and  a  glance  at  an  American  cooking  book  ex- 
plains why.  These  cakes  are  exposed  to  heat  for 
from  thirty  to  forty  minutes  only.  [The  language 
of  England  sometimes  requires  translation.  For 
cakes  read  rolls,  and  for  biscuits  read  crackers. — 
Ed.]  a  good  biscuit  or  loaf  is  much  longer  in  the 
oven.  Potatoes  are  indigestible  as  ordinarily 
eaten,  because  they  are  not  long  exposed  to  heat. 
But  if  well  mashed  potatoss  be  put  into  the  oven 
to  brown,  or  be  placed  before  the  fire  for  that  pur- 
pose, the  longer  exposure  to  heat  tells  upon  the 
starch-conversion. 

Hominy  that  is  well-boiled  or  subjected  to  the 
final  heating  process  of  cooking  is  decidedly 
digestible.  Cereals  that  have  been  steam-cooked 
are  in  repute  with  dyspeptics  either  for  adding  to 
meat  teas,  or  for  preparing  milk-puddings.  Some 
cooks  who  have  to  cater  for  dyspeptics  boil  all 
their  rice,  sago,  and  tapioca  thoroughly  before 
making  these  up  with  milk  for  a  milk-pudding.  In 
Germany  pearl-barley  thoroughly  well  boiled  and 
passed  through  a  seive  is  in  request  as  an  addition 
to  meat  teas  for  invalids.  The  porridge  of  Scotland 
being  made  with  coarse  oatmeal  is  boiled  a  long 
time,  while  in  England  a  short  boil  is  enough  with 
the  fine  ground  oatmeal  in  vogue  there. 

The  advantage  of  the  numerous  prepared  foods 
— whether  babies'  food  or  invalids'  foods — which 
are  all  more  or  less  compounds  of  starch  which 
has  been  to  ascertain  extent  predigested  either  by 
baking  or  the  malting  process,  lies  in  their  ready 
digestibhty  :  A  touch  of  saliva  is  enough  to  com- 
plete the  conversion  of  such  carbo-hydrates  and 
the  soluble  matters  pass  out  of  the  alimentary 
canal,  and  the  stomach  is  not  burdened  with  a 
weight  of  undigested  starch  impeding  its  work. 

Gross  and  fine  disintegration  of  food  and  car- 
dinal matters  in  the  dietary  of  dyspeptics. 

Mastication  r.-.ust  be  perfect  else  gross  particles 
embarrass  the  stomach.  Starch  granules  which 
have  escaped  the  saliva  interfere  with  the  solvent 
action  of  the  gastric  juice  on  albuminoids.  The 
dietary  of  dyspeptics  must  be  conducted  on  the 
above  lines  ;  and  if  the  dyspeptic  were  properly 
informed  he  could  find  a  sufficient  variety  of  food; 
but  if  he  be  told  to  diet  himself  upon  a  number 
of  articles  of  food  he  soon  begins  to  loathe  them 
and  often  goes  without  food  .sooner  than, partake 
of  them. 

Of  course  there  are  dyspeptics  and  dyspeptics  ! 
Some  only  require  to  give  a  sufliciency  of  time  to 
the  process  of  mastication  to  be  free  from  suffer- 
ing. Others  must  eschew  pastry,  veal  and  pork. 
Others  again  have  to  abandon  solid  meat  and 
vegetables  and  adhere  to  meat  broths,  with  cooked 


starch,  malt-extracts,  malted  preparations,  milk 
puddings  and  fish.  When  the  stomach  has  been 
outraged  or  offended  care  is  requisite  for  its  res- 
toration. When  there  is  present  condition  of  gen- 
eral exhaustion  food  will  disagree  which  ordinarily 
can  be  taken  with  impunity.  When  a  condition 
of  acute  indigestion  is  set  up  a  very  careful  dietary 
for  a  few  days  is  directly  curative. 

Ready  disintegration  and  solubility  of  food  con- 
stitute the  base  line  of  the  dietetic  treatment  of 
indigestion. 


SORE  NIPPLES. 

Dr.  Wilson,  of  Glasgow,  recommends  the  follow- 
ing for  sore  nipples : 

8-     Plumb,  nitrat gr-xxx. 

Glycerini |  j. 

M. — .Vpply  after  suckling,  the  nipples  being 
washed  before  the  child  is  again  put  to 
the  breast. 
Dr.  Playfair  recommends  : 

B-     Sulpliurous  acid }4  oz. 

Glycerin  of  tannin ^  oz. 

Water i  oz. 

M. — Apply  after  suckling. 
Dr.  Barnes  recommends : 

After  washing  away  remains  of  milk  after  nurs- 
ing, smear  with  salve  made  of: 

IJ.     Liquor  plumbi i  dr. 

Prepared  calamine  powder....   i  dr. 

Glycerini i  dr. 

M. — Vaseline 7  dr. 

— Qr.  Comp.  Med.  Sc'i. 


CAMPHOR,  CHLORAL,  AND  COCAINE 
IN  TOOTHACHE. 

Dr.  K.  Gsellfels  recommends  in  toothache,  with 
hollow  teeth,  a  plug  of  cotton  wool  saturated  with 
a  mixture  made  by  heating  five  parts  of  camphor, 
five  parts  of  chloral  hydrate,  and  one  part  of  hy- 
drochlorate  of  cocaine  to  boiling  for  some  minutes. 
An  oily  liquid  is  obtained. 


THE  USE  AND  ABUSE  OF  TE.A 

A  French  obsen^er  has  recently  tabulated  the 
evil  results  which,  in  many  cases,  follow  the 
excessive  use  of  what  is  now  the  favorite  beverage 
of  Teutonic  and  Sclavonic  nations.  The  list  is  a 
formidable  enumeration  of  neurotic  and  dyspeptic 
affections,  which  are  not  the  less  worthy  of  atten- 
tion because  they  .are  mainly  functional  disorders, 
tending  to  the  embittering  of  existence  rather  than 
the  shortening  of  life.  English  clinical  teachers 
are  somewhat  divided  on  this  question.  Some 
make  light  of  the  alleged  evils  of  tea-drinking, 
and  regard  the  prohibition  of  tea  as,  in  many 
cases,  merely  a  professional  fad.  Others  teach 
that  the  mischief,  of  which  they  admit  the  existence, 


THE   CANADA  MEDICAL  RECORD. 


69 


is  due  less  to  excessive  use  of  tea  than  to  the 
omission  from  the  regular  dietary  of  the  really 
nutritive  and  sustaining  elements.  A  third  class 
regard  tea-drinking  as  an  evil  a'most  cijmparable 
to  alcoholism. 

Tea  has  won  its  way  to  favor  among  civilized 
nations  mainly,  it  would  seem,  as  an  agreeable 
nervine  stimulant.  As  Sir  VVilluni  Roberts  points 
out,  in  his  interesting  lectures  upon  dietetics,  a 
crane-stimulation  is  one  of  the  most  marked  cha- 
racteristics of  advanced  civilization,  although 
savage  man  is  by  no  means  devoid  of  this  univer- 
sal human  instinct.  'I'he  stimulants  in  common 
use  are  tea,  coffee,  tobacco,  and  alcohol — not  to 
mention  such  agents  as  opium  or  hauhish,  which 
are  perhaps  less  stimulant  than  narcotic.  Of  this 
group,  tea  and  coffee  are  the  favorites,  as  they 
suit  the  taste  of  both  sexes  ;  and  their  beneficial 
effects  undoubtedly  far  outweigh  the  evils  which 
occasionally  spring  from  their  abuse. 

Tea  is  an  agreeable  cerebral  stimulant,  quicken- 
ing intellectual  operations,  removing  headache 
and  fatigue,  and  promoting  cheerfulness  and  a, 
sense  of  well-being.  It  is  known  to  all  English 
speaking  people  as  the  "  cu])  that  cheers  but  not 
inebriates  ;"  and  it  has  long  been  a  favorite  with 
studnts,  literary  men,  and  others  engaged  chiefly  in 
brain  work.  Tea  is  also  a  mild  stidorific,  and  is  large- 
ly consumed  in  hot  countries,  especially  our  Aus- 
tralia! colonies,  where  it  is  found  to  exercise  a 
cooling  influence,  after  -the  preliminary  effect  due 
to  the  imbibition  of  a  hot  fluid  has  passed  off. 
The  influence  of  tea  upon  the  digestive  tract  has 
not  been  so  definitely  made  out ,  but  the  most 
recent  observations  seem  to  shov/  that,  while  it 
somewhat  retards  primary  digestion,  it  aids  the 
absorption  and  metabolism  of  the  food-elements. 
From  such  physiological  facts,  it  is  clear  that  tea 
is  chiefly  of  service  during  or  after  physical  or 
intellectual  effort,  and  at  the  time  when  absorption 
of  the  products  of  primary  digestion  is  in  process. 
It  cannot  too  strongly  be  asserted  that  tea  is  not 
in  any  exact  sense  a  true  food,  and  that  its  nutritive 
value,  in  itself,  is  practically  naught. 

As  might  be  conjectured  from  the  nature  of  the 
physiological  action  of  tea,  the  effects  of  its  abuse 
fall  chiefly  on  the  nervous  and  digestive  systems. 
Nervous  irritability,  palpitation,  insomnia,  and 
sense  of  brain-fatigue  are  among  the  most  promi- 
nent of  the  neurotic  symptoms  ;  and,  although  it 
is  unquestionable  that  the  symptoms  are  often 
etiologically  connected  with  other  sources  of 
nervous  disturbance  as  well  as  tea-drinking,  it  is 
not  less  clear  that  they  are  greatly  aggravated  by 
the  excessive  use  of  tea.  The  dig^tive  symptoms 
are  impairment  of  the  appetite,  pain  and  flatulence 
during  the  process  of  digestion  and  defective 
intestinal  action — the  symptoms,  in  fact,  of  one 
of  the  varieties  of  atonic  dyspepsia.  How  far 
these  symptoms  are  due  the  thein  contained  in  tea, 
and  how  far  to  its  tannin,  is  a  question.  Sir 
William  Roberts  has  shown  that  the  most  rapid 


infusion  does  not  prevent  the  dissolving  out  of  a 
large  proportion  of  the  tannin,  and  we  are  dispos- 
ed to  conjecture  that  the  digestive  symi)toms  may 
to  a  large  degree  be  safely  attributed,  not  to  any 
chemical  action,  but  to  the  same  cause  which 
])roduces  the  neurotic  disturbance,  namely,  the 
thcin. 

The  sufferers  from  excessive  tea  drinking  may 
be  grouped  into  three  classes. 

First,  there  is  the  large  class  of  pure  brain- 
workers,  who  s|)eedily  discover  that,  while  alcohol 
is  pernicious  to  them,  tea  affords  the  stimulus 
which  they  desire.  They  indulge  in  it  without 
fear  of  mischief,  and  often  to  an  unlimited  extent. 
Dr.  Jolmston's  tea  drinking  was  proverbial,  and 
many  distinguislied  writers  could  tell  a  similar  tale. 
After  a  time,  the  neurotic  sytniJtoms  enumerated 
above  begin  to  make  their  appearance,  and,  in 
many  cases,  do  much  to  impair  temper,  and  to 
limit  the  capacity  for  sustained  intellectual  effort. 

Secondly,  there  is  the  large  class  of  women  of 
the  better  classes  who,  beginning  with  afternoon 
tea,  often  end  by  using  their  favorite  stimulant  in 
the  intervals  between  all  the  meals  of  the  day, 
and  as  often  as  the  humor  takes  them.  The  result 
is  that  appetite  becomes  impaired,  and  the 
prostration  due  to  insuflicient  nourishment  is 
(  ombated  with  more  potations  of  the  ever  welcome 
stimulant,  until  the  vicious  circle  is  well  established. 

Thirdly,  in  all  our  large  manufacturing  towns 
there  are  numbers  of  factory-operatives,  especially 
women,  finding  it  difficult  to  provide  a  cheap  and 
appetising  mid-day  meal,  fly  to  the  teapot,  and  do 
large  amount  of  severe  physical  labor  on  this 
miserable  dietary.  It  is  most  important  to  impress 
upon  this  class,  who  are  usually  profoundly 
ignorant  of  everj'thing  concerning  health  and  diet, 
that  tea  is  not  a  food,  and  that  the  delusive  sense 
of  satisfaction  which  it  bestows  is  a  dangerous 
snare. 

In  addition  to  the  above  classes,  there  is  a 
small  group  of  persons  to  whom  tea  seems  a 
positive  poison.  We  know  that  idiosyncrasy 
accounts  for  the  most  extraordinary  departures 
from  the  normal  rule  in  matters  of  diet  or  the 
action  of  medicine  ;  and  the  number  of  persons 
whose  idiosyncrasy  includes  an  intolerance  of  tea 
is  considerable  enough  to  make  the  subject  worthy 
of  professional  attention. 

Sufferers  from  the  abuse  of  tea  should  abstain 
from  its  use,  and  substitute  either  coffee  or  cocoa. 
It  will  be  found  that  many  of  those  who  are 
unfavorably  affected  by  tea  are  equall)'  suscepti- 
ble to  the  action  of  coffee ;  but  this  is  by  no 
means  universally  true,  and  the  substitution 
can  often  be  made  with  decided  advantage. 
Cocoa  suits  almost  all  cases,  and,  whatever  may 
be  its  deficiencies  on  the  score  of  palatability,  it  is 
a  genuine  food,  and  its  modem  preparations  are 
becoming  more  and  more  elegant  and  pleasing  to 
he  taste. — British  .heJical /ournal. 


70 


THE   CANADA    MEDICAL   RECORD. 


PHYTOLACCA  DECANDRA  IN  THE 
TREATMENT  OF  BRONCHOCELE. 

Dr.  J.  D.  Ely  thus  writes  in  the  Medical  A.ge  : 

Of  course  it  is  taken  for  granted  that  notice  of 
any  agent  that  is  suj)erior  to  iodine,  biniodide  of 
mercury,  and  other  time-honored  and  much-used 
remedies  in  the  treatment  of  bronchocele,  and 
especially  one  that  is  free  from  the  deleterious 
effect — such  as  iodism,  derangement  of  the  sto- 
mach, etc. — as  frequently  noticed  and  regretted  of 
them,  will  be  received  by  the  profession  with  in- 
terest and  profit. 

Therefore  it  is  with  pleasure  that  I  offer  a  few 
facts  in  regard  to  Phytolacca  decantra,  which,  I 
believe,  is  as  near  a  specitic  for  that  troublesome 
disease  as  we  have  for  any  other. 

In  doing  so,  I  wish  it  understood  that  I  have 
tested  thoroughly  about  all  the  remedies  recom- 
mended by  leading  authors,  and  after  comparing 
the  effects  and  results  of  phytolacca  with  them, 
much  prefer  it. 

It  has  been  a  favorite  remedy  with  my  father 
more  than  twenty  years  in  the  treatment  of  all 
glandular  diseases. 

It  has  never  failed,  in  his  hands,  to  care  all 
cases  of  bronchocele,  curable  by  any  means,  upon 
which  he  has  used  it,  and  he  has,  because  of  his 
success,  had  more  than  the  usual  number  to  treat. 

Before  giving  the  report  of  a  case  illustrating  its 
use,  which  I  select  from  a  number  I  have  treated 
successfully  during  the  past  two  years,  it  is  impor- 
tant to  note  that  much  of  the  tincture  and  fluid 
extract  of  phytolacca  on  the  market  is  worthless, 
and  I  liave,  from  necessity  rather  than  choice, 
prepared  most  of  the  tincture  which  I  have  used. 

I  would  advise  those  who  have  given  phytolacca 
a  trial  and  condemned  it,  and  any  who  may  try  it 
and  not  get  satisfactory  results  from  the  article 
purchased,  to  prepare  their  own  tincture. 

The  following  method  has  always  given  us  a 
reliable  and  satisfactory  article ;  but  before  it  I 
may  note,  for  the  benefit  of  those  not  acquainted 
with  Phytolacca,  that  it  grows  in  abundance  in 
nearly  all  parts  of  this  State,  and  is  known  to  most 
farmers  by  its  common  name,  "  poke  root." 

Procure  the  fresh  roots,  and,  after  washing  them 
clean,  slice  and  put  to  dry  where  they  will  get  the 
sun,  till  the  water  is  as  nearly  dried  out  as  possi- 
ble, then  pack  in  a  percolator — a  fruit  jar  will 
answer — and  cover  with  absolute  alcohol,  full 
strength. 

(It  is  probable  that  many  manufacturers  of  it  do 
not  get  a  good  article  because  they  use  old,  dry 
roots,  and  diluted  alcohol  as  the  menstruum.) 

Let  it  stand  at  least  fifteen  days,  press  out, 
filter,  and  it  is  ready  for  use.  Dose,  from  three 
to  ten  drops. 

It  should  be  borne  in  mind  that  it  acts  slowly, 
and  is  designed  to,  and  in  the  doses  recommended, 
aSgCxperience  has  proven,  that  in  so  using  it  the 
specific  alterative  effect  desired  is  more  safely  and 
satisfactorily  obtained. 


Recent  cases  yield  readily  to  the  remedy,  and 
are  cured  in  from  one  to  three  months.  Difficult 
cases  of  long  standing,  of  which  the  following  is 
a  sample,  will  need  treatment  for  a  year  or  more  : 

Lizzie  M.,  aged  1 6  years,  consulted  me  June  17, 
1885,  for  treatment  of  a  bronchocele,  the  first 
appearance  of  which  was  noticed  eight  years  pre- 
vious. On  examination,  I  found  both  glands  and 
the  isthmus  involved,  and  so  great  was  the  enlarge- 
ment that  the  circumference  of  the  neck  measured 
nineteen  and  one-fourth  inches. 

It  was  more  uniform  than  generally  seen,  was 
very  hard,  and  so  tightly  filled  the  skin  that  it 
could  not  be  moved.  Pressure  upon  the  laryngeal 
nerve  was  so  great  that  the  patient  wheezed  as  if 
suffering  from  asthma,  and  could  not  walk  rapidly 
because  of  the  interference  with  respiration. 

She  presented  the  characteristic  appearance 
peculiar  to  scrofulous  diseases,  and  there  was  his- 
tory of  similar  troubles  among  the  relatives. 

Bowels  were  regular,  kidneys  all  right,  and 
menstruation,  which  had  been  properly  established 
at  13  years  of  age,  was  regular,  and  had  always 
been  so. 

I  may  add  here  that  the  menstrual  irregularity, 
mentioned  by  some  authors  as  always  to  be  noticed 
in  th  se  cases,  has  not  been  found,  by  me,  to  exist 
in  any  I  have  treated,  and  I  do  not  believe  it  is 
common  or  that  the  disease  is,  in  any  way,  con- 
nected with  disease  of  the  reproductive  organs,  as 
claimed  by  some. 

Recognizing  this  as  a  most  difficult  case,  my 
prognosis  was  unfavorable  ;  but  the  patient  being 
anxious  to  try  treatment,  I  consented  to  give  it, 
and  prescribed  the  following,  which  was  used  for 
about  one  year  and  with  success  : 

5.    Tinct.  phytolac.  decand.,  5  ss. 

Syr.  simplicis,  3  iijss. 

M.  Sig. — One  teaspoonful  in  water  3  or  4  times 
a  day. 

Also — 

5.  Ferri  dialyzati  5j. 

Glycerini  puris. 
Syrup  simplicis,  aa  5  iss. 

M.  Sig — One  teaspoonful  in  water  after  each 
meal. 

Ordered  applications  of  the  tincture  to  the 
glands  night  and  morning,  to  be  diluted  with  pure 
rain  water  if  it  caused  much  irritation — as  it  will 
sometimes — and,  if  necessary,  to  discontinue  it 
for  a  few  days,  and  take  plenty  of  outdoor  exer- 
cise. 

The  only  change  noticed  the  first  two  months 
was  that  the  glands  had  softened  slightly.  After 
that  they  decreased  in  size  quite  rapidly,  and  the 
improvement  was  marked  in  every  respect,  contin- 
uing till  the  neck  became  normal  in  size,  the  diffi- 
culty of  breathing  disappeared,  and  the  patient 
considered  herself  cured,  one  year  after  beginning 
treatment. 

She  continued  the  application  and  tonic  for  a 
short  time  longer,  at  my  request,  however,  to  make 


THE   CANADA   MEDICAL   RECORD. 


71 


"  assurance  doubly  sure,"  and  to  prevent  any  recur- 
rence— a  plan  which  I  have  always  considered 
good,  and  recommend. 

I  have  under  observation  jxitients  who  were 
treated  with  Phytolacca  successfully  eleven  years 
ago,  and,  so  far,  the  cures  are  permanent. 

In  one  case  only  has  there  been  any  return  of 
the  trouble,  and  that  was  due  to  the  patient  con- 
sidering herself  cured  and  stopping  treatment  too 
early. 

It  is  is  very  important,  I  think,  to  always  use  a 
tonic,  when  giving  an  alterative,  and  I  never  omit 
it. 

I  have,  in  a  few  instances  where  there  was  diffi- 
culty in  getting  the  patient  to  take  the  separate 
prescriptions  regularly  for  a  long  time,  combined 
the  Phytolacca  with  the  prescription  containing 
the  dialyzed  iron,  apparently  with  as  good  results, 
but  prefer  to  give  them  singly,  and  generally  do. 


THE  TREATMENT  OF  BRONCHITIS. 

This  little  boy,  ten  years  of  age,  comes  to  us  with 
a  history  of  repeated  colds.  The  present  attack 
has  lasted  for  two  weeks,  and  is  accompanied  with 
cough  and  expectoration.  It  is  important,  where 
there  is  a  history  of  repeated  attacks  of  cough  to 
examine  with  especial  care  the  apices  of  the  lungs, 
and  observe  whether  or  not  there  is  percussion 
resonance  above  the  clavicles.  One  of  the  most 
important  signs  of  consumptive  disease,  whether 
of  the  tubercular  or  of  the  chronic  pneumonic  varie- 
ty, is  lack  of  resonance,above  one  or  other  clavicle. 
In  the  present  case  the  resonance  above  the  clavi- 
cles is  normal.  On  auscultation,  I  find  m\icous 
and  sonorous  rales.  We  have  here  a  case  of  bron- 
chitis tending  to  become  chronic.  This,  in  its  origin, 
was  acute ;  as  a  result  of  neglect,  it  has  not  been 
cured,  but  fresh  attacks  have  supervened. 

In  the  treatment  of  acute  bronchitis,  one  of  the 
first  principles  is  to  keep  the  jmtient  in  a  warm  room 
with  a  moist  atmosphere.  If  the  room  be  heated 
by  a  stove,  a  pan  of  water  should  be  kept  constant- 
ly boiling  upon  it.  If  the  room  be  heated  by  a 
furnace,  a  wet  towel  should  be  hung  in  front 
of  the  register,  with  the  lower  portion  dipping  into 
a  pan  of  water.  The  child  should  be  kept  in  this 
room  night  and  day.  There  is  no  principle  in  the 
treatment  of  bronchitis  which  is  so  important  as  this. 
If  this  be  attended  to,  expectorants  may  be  dis- 
carded. If  this  precaution  be  not  observed,  ipecac 
and  its  congeners  are  comparatively  useless,  and, 
in  fact,  their  utility  in  any  event  is  doubtful. 

The  indications  in  the  treatinent  of  acute  bron- 
chitis are  tt)  allay  the  fever,  if  present,  and  to 
soothe  the  irritated  mucous  membrane.  The  ob- 
ject is  not  to  stop  the  cough,  but  only  that  portion 
which  is  useless.  To  soothe  the  mucous  mem- 
brane and  to  allay  nervous  irritability,  the  remedy 
is  opium.  If  there  be  fever,  a  small  quantity  of 
aconite  may  be  given,  or  even  a  minute  dose  of 
antimony,  which  is  better  than  ipecac.  As  a  rule, 
it  is  not  necessary  to  give  much  medicine  during 


the  acute  stage,  provided  the  hygienic  treatment 
is  carried  out.  We  shall  give  this  child  three  grains 
of  Dover's  powder  to  be  taken  at  bedtime.  Dur- 
ing the  day  he  will  receive  a  small  quantity  of  jjo- 
tassium  citrate  with  a  little  syrup  of  lemon.  When 
the  disease  shows  a  tendency  to  become  chronic, 
we  must  give  something  that  will  invigorate  the 
mucous  membrane  and  enable  it  to  throw  off  the 
disease.  The  best  remedy  for  this  purpose  is  cod- 
liver  oil.  In  this  case,  I  should  order  a  teaspoon- 
ful  of  emulsion  of  codliver  oil  with  lime,  to  be  taken 
half  an  hour  after  each  meal.  It  would  be  of  .ser- 
vice to  have  the  chest  rubbed  with  a  stimulating 
liniment.  The  aminonia  and  sweet-oil  liniment 
will  answer  as  well  as  anything.  This  may  be  ap- 
plied three  times  a  day,  and  if  the  child  is  hoarse 
at  bedtime,  a  piece  of  llannel,  on  which  some  of 
the  liniment  is  spread,  may  be  applied  to  the  front 
of  the  chest.  The  most  important  element,  and 
the  one  to  be  insisted  on  most  strongly,  is  that 
the  child  shall  be  kept  in  a  warm  room. — Phila- 
delphia Polyclinic. 

The  Canada  Medical  Record. 

k  Monthly  Journal  of  Medicine  and  Surgery- 

EDITORS  : 

FRANCIS  '.V.JCAMPBELL,   M.A.,  M.D.,  I..U.C.P.  T.O'.'D, 

Editor  .^nd  Proprietor. 

K.  A.  KENNEDY,  M.A.,  M.D.,  Managiug  Editor. 

ASSISTANT  EDITORS: 
CASEY  A.  WOOD,  CM.,  MD. 
GEOIIGE  E.  AEMSTEONG,  CM.,  M.D. 

SUBSCRIPTIO.V    TWO    DOLLARS    PER    AN.vnM. 

All  communications  a)id  J^ichanges  must  be  aidreased  to 
(he  Editors,  OraioerZ5S ,  Post  Office,  Montreal. 

MONTREAL,  DECEMBER,  1886. 

COLLEGE    OF    PHYSICIANS    AND    SUR- 
GEONS PROVINCE  OF  QUEBEC. 

In  answer  to  very  many  enquiries  we  beg  to  say, 
that  the  provisions  of  the  preposed  new  Medi- 
cal Act-are  not  intended  to  come  into  effect  till 
after  January  ist,  1888, — that  portion  which  refers 
to  the  alteration  in  the  election  of  Governors  will 
not,  of  course,  take  effect  till  a  new  Board  requires 
election,  that  is,  not  till  the  summer  of  i88g. 


I 


CREDIT  WHERE  DUE. 
In  the  Record  for  November  three   articles  ap- 
pear, copied  from  the  Journal  of  Reconstruction 
of  New  York,  and  without  credit   being  given  to 


72 


THE   CANADA   MEDICAL  RECORD. 


it  for  them.  This  we  regret  and  apologize  for. 
The  articles  were  "  The  Dietary  of  Pulmonary 
Phthisis,"  by  Dr.  Loomis,  page  36.  "Shall 
patients  eat  what  they  crave,"  page  44.  "  The 
Milk  Treatment,"  page  46.  At  page  32  same 
number,  is  an  article  on  "  The  Treatment  for  the 
Vomiting  of  Pregnancy,"  which  should  be  credited 
to  the  "  Southern  California  Practitioner,"  pub- 
lished at  Los  Angelos. 


SMALL-POX  AT  KINGSTON,  JAMAICA. 
Kingston,  Jamaica,  has  been  suffering  from  a 
severe  epidemic  of  small-pox.  On  the  13th  of 
October  there  was  :i62  cases  under  treatment,  but 
under  the  energetic  measures  carried  out  by  our 
friend  Dr.  James  Ogilvie,  the  Health  officer,  the 
disease  has  been  gradually  declining.  Under  a 
late  date  Dr.  Ogilvie  writes  us  that  in  a  few  weeks 
the  disease  would  be  completely  stamped  out.  Dr. 
Bronstorph  (M.D.  Bishops  1884)  has  been  lectur- 
in-:'  before  the  Young  Men's  Christian  Association 
of  Jamaica  on  small-pox  and  vaccination.  .  His 
lecture  was  thought  so  well  of,  that  the  Associa- 
tion published  it,  and  distributed  it. 


Lady  Wilson,  the  widow  of  Sir  Erasmus  Wilson, 
died  recently.  The  Royal  College  of  Surgeons 
now  becomes  entitled  to  the  legacy  of  $r, 000, 000 
left  by  Sir  Erasmus. 


The  British  Medical  Association  have  decided 
t3  hold  their  annual  meeting  for  18S7  in  Dublin, 
and  Dr.  J.  T.  Banks,  professor  of  Physiology  in 
the  University  of  Dublin,  is  the  president-elect. 
The  meeting  will  be  held  on  August  2,  3,  4  and  5. 


Some  one  has  discovered  certain  points  of  simi- 
larity between  a  baby  and  a  widower :  he  cries  a 
"Treat  deal  the  first  three  months ;  after  this  he  be- 
com;s  quiet,  and  begins  to  notice;  and  it  is  with 
considerable  difficulty  that  he  is  made  to  survive 
his  second  summer. 


FORTY  THOUSAND  NEW  DOCTORS  IN 
TEN  YEARS. 
The  jMeiUcal  Record  says  that  in  the  last  nine 
years  103,598  persons  have  matriculated  as  med- 
ical students,  and  one-third  of  these,  or  33, 684^ 
have  become  doctors  of  medicine.  At  this  rate 
the  total  number  of  doctors  for  the  decade  will  be 


nearly  forty  thousand.  For  making  these,  the 
medical  colleges  must  have  received  over  twelve 
millions  of  dollars. 


A  CURIOUS  WAGER. 
The  following  is  extracted  from  the  Indian 
Medical  Journal  for  July  :  "  Two  Mahometans  in 
Hyderabad  City  made  a  curious  wager  the  other 
day,  which  resulted  in  the  death  of  one  of  them. 
The  deceased  accepted  a  challenge  that  he  would 
stand  facing  the  sun  from  8  a.  m.  to  6  p.  m.  A 
certain  day  was  appointed,  when  a  large  gathering 
assembled  to  witness  the  tamasha,  as  they  styled  it. 
The  deceased  took  his  stand,  gazing  at  tlie  sun 
from  the  agreed  time  up  to  3  p.  m.,  when  sud- 
denly he  dropped,  foaming  from  the  mouth. 
Medical  aid  was  soon  summoned,  but  before  assis- 
tance arrived  life  was  extinct. 


ON  A    MEANS   OF   RECOGNIZING  THAT 
THE  UMBILICAL  CORD  IS  ROUND 

THE  NECK  OFTHE  CHILD. 
Dr.  F.  R.  Humphrys,  in  the  Brit.  Med.  Jour., 
says  that  in  nearly  all  the  cases  of  this  occurrence 
he  has  come  across,  the  mother  has  cried  out, 
much  the  same  as  she  would  in  the  early  part  of 
the  first  stage  of  labor,  and  complained  of  sharp 
acute  pain,  which  stands  out  in  curious  contrast 
with  the  bearing  down  of  the  latter  part  of  the 
second  stage  of  labor  (when  the  head  is  on  the 
perineum),  at  which  it  is  obscured.  He  has  very 
rarely  noticed  this  cry  when  the  cord  was  not 
round  the  neck  of  the  child. 


TREATMENT  OF  INGROWING  TOE-NAIL. 
The  Philadelphia  Medical  Reporter  says  that, 
Dr.  Philip  Miall  writes  to  the  Brit.  Med  Jour. 
that  he  has  for  many  years  used.tannin  for  ingrow- 
ing nails,  and  does  not  find  rest  necessary.  A 
concentrated  solution  (an  ounce  of  perfectly  fresh 
tannic  acid  dissolved  in  six  drachms  of  pure  water, 
with  a  gentle  heat)  must  be  painted  on  the  soft 
parts  twice  a  day.  Two  cases  recently  had  no 
pain  or  lameness  after  the  first  application,  and 
went  about  tlieir  work  immediately,  which  they 
could  not  before.  After  about  three  weeks  of  this 
treatment,  the  nail  had  grown  to  its  proper  length 
and  breadth,  and  the  cure  was  complete.  No 
other  treatment  of  any  kind  was  used,  though 
formerly  he  introduced  lint  under  the  ingrowin  g 
edge  in  such  cases. 


THE  CANADA  MEDICAL  RECORD. 


Vol.  XV. 


MONTREAL,  JANUARY,  1887. 


No.  4. 


COIiTTEI^TS. 


ORI«INAL  COMMUNICATIONS. 

Clinical  Loi'turo  aolivernl  at  the  Mont- 
real General  Hospital 73 

Letter  from  the  Hub 74 

SOCIETY  PROCEEDINGS. 

Meiiico-Chirurgical     Society  of    Mont- 
real     77 


PROGRESS  OF  SCIENCE. 

Ou  the  use  of  Argemc  in  certain  lorms 
of  An.'omia 83 

Contributions  to  Pr.aotical  Surgery 

Nocturnal  Incontinence  of  Urine 90 

Internal  Hoemorrlioids,and  how  to  treat 
them 92 


The  Treatment  of  Gonorrhcea  by  Iodo- 
form     ^^ 

EDITORIAL. 

Sudden  Changes  of  Climate 95 

Personal 96 


0m^inui  6ommunimimnri. 


CLINICAL  LECTURE  DELIVERED  AT 

THE  MONTREAL   GENERAL   HOSPITAL. 

October  12th,  1886. 

liy  F.  Wavland  Campbell,  M.D.,  L.R.C.P.,  London, 

Dean  of,  and  Professor  of  Practice  of  Medicine 

in  the  Faculty  of  Medicine,  University  of 

Bishop's  College. 

Gentlemen, — The  patient  before  you  is  a 
young  man,  ttHo  by  trade  is  a  machinist,  and  he 
has  contracted  what  is  commonly  designated  "  a 
cold."  He  came  a  week  ago  to  the  out-door  clinic, 
complaining  as  his  chief  symptom — loss  of  roice* 
This  loss  of  voice  is  called  aphonia,  and  in  such 
cases  is  very  often  the  result  of  a  sub-acute  inflam- 
mation of  the  larynx,  indicated  by  slight  pain  or 
pressure  over  the  larynx.  There  is  generally  at 
first  hoarseness,  then  the  aphonia  follows,  succeed- 
ed by  cough  and  expectoration,  at  first  transparent 
and  viscid  and  aftenvards  opaque  and  thick.  Its 
only  danger  is  the  possibility  of  its  developing  into 
the  acute  form,  but  this  danger  is  small.  The 
treatment  is  very  simple  and  usually  very  effectual- 
■A  mustard  poultice  should  be  applied  over  the 
larynx  for  about  eight  minutes ;  the  patient  should 
inspire  either  the  vapor  of  pure  boiling  water,  or 
to  the  boiling  water,  from  ten  to  fifteen  drops  of 
tincture  of  iodine  may  be  added  and  thus  an  iodiz- 
ed vapor  is  inhaled.  Some  of  these  cases  seem  to 
depend'  upon  a  relaxed  condition  of  the  vocal 
cords,  and  in  such  cases  the  application  of  a 
sponge  probang,  saturated  with  a  twenty  grain  solu- 
tion of  nitrate  of  silver,  will  be  found  very  useful. 
I  made  this  application  to  this  man,  when  he  first 


came,  and  then  used  the  moist  iodine  vapor.  He 
has  decidedly  improved,  and  he  is  in  a  fair  way  to 
make  a  speedy  recovery.  In  addition  to  the 
local  treatment,  tonics  will  be  found  very  useful. 
In  females  there  is  a  form  of  functional  aphonia, 
which  is  of  an  hysterical  character.  The  char- 
acter of  the  voice  is  different.  In  aphonia,  due  to 
laryngitis,  it  is  coarse  and  husky;  when  it  is 
hysterical  it  is  a  soft  whisper.  We  also  sometimes 
have  tphonia  feigned,  with  a  view  of  producing 
sympathy;  but  if  the  cases  be  watched,  they  will  at 
an  unguarded  moment  forget  their  supposed  mal- 
ady and  speak  out  in  tlie  full  tones  of  their  voice. 

The  old  man  over  60  years  of  age,  I  now  pre- 
sent to  you,  came  to  the  Hospital  a  week  ago, 
complaining  of  great  difficulty  in  swallowing  food. 
He  says  that  for  a  considerable  time  he  has  noticed 
that  after  swallowing  food,  when  it  reached  a  cer- 
tain point  in  the  oesophagus  he  felt  it  stop,  and  that 
it  remained  there  till  he  made  repeated  efforts  at 
swallowing, when  it  seemed  to  get  dislodged  and  pass 
onward.  Obstruction  in  the  oesophagus  may  be 
pui-posely'of  a  functional  character,or  it  may  be  due 
to  organic  disease,  or  it  may  be  due  to  pressure  of 
a  tumor  on  the  tube.  The  most  common  cause  of 
the  functional  variety  is  generally  some  nervous 
condition,  as  hysteria  and  hypochondriasis.  In  the 
organic  form  the  most  frequent  cause  is  cancer  ; 
and  when  due  to  pressure  it  may  be  from  an  en- 
larged thyroid  gland,  or  enlarged  lymphatic  glands 
in  the  neck  or  chest,  or  an  aneurism.  Dysphagia 
is  the  principal  symptom  of  organic  obstruction, 
and  the  sensation  that  food  is  arrested  is  generally 
situated  just  behind  the  upper  part  pf  the  sternum. 
The  difficulty  is  slight  at  first,but  giaduallj'  increases 


74 


THE   CANADA   MEDICAL   EECORD. 


until  nothing  whatever  will  pass.  Liquids  and  soft 
food,  of  course,  pass  more  readily  than  does  soft 
food.  The  food  is  either  immediately  regurgitated 
or  spasmodically  rejected.  Sometimes  a  consider- 
able quantity  of  food  is  retained  for  some  time  in  a 
dilatation,  when  it  is  discharged,  alkaline  in  reaction 
and  much  decomposed.  In  consequence  of  the 
reduced  quantity  of  food  entering  the  stomach  the 
patient  emaciates, becomes  weak  and  has  a  retracted 
abdomen.  The  use  of  the  bougie  or  probang  will 
enable  you  to  establish  a  diagnosis  as  to  functional 
or  organic  structure.  In  the  functional  variety — 
although  the  probang  may  meet  with  resistance, 
this  can  with  steady  pressure  be  overcome.  In  the 
organic  variety  the  bougie  cannot  be  passed,  when 
the  disease  has  reached  a  point  sufficient  to  attract 
strongly  the  attention  of  the  patient  to  the  obstruc- 
tion. The  patient  before  you  is  quite  convinced  that 
there  is  obstruction  to  the  passage  of  the  food.  I  am 
equally  convinced  that  there  is  no  obstruction  other 
than  that  which  is  functional,  and  the  result  of  a 
neurotic  or  nervous  affection.  In  proof  of  this  I 
at  the  time  of  his  first  visit  passed  a  probang  the  full 
length  of  the  cesophagial  canal,  and  will  now  do  so 
again.  The  passage  of  the  instrument  in  the  first 
instance  seems  to  have  convinced  this  patient 
food  should  pass  more  freely  after  the  passage  of  such 
an  mstrument,  and  the  consequence  is  that  he 
expresses  himself  to-day  as  feeling  somewhat  better. 
If  he  does  not  improve  rapidly  I  will  give  him  iron 
and  valerian  ;  but  in  the  meantime  have  placed  him 
on  one  of  the  vegetable  tinctures — viz.,  gentian  as 
a  tonic,  which  will  assist  in  giving  tone  to  his  sys- 
tem,"which,  as  you  can  judge  from  the  man's  appear- 
ance, he  stands  much  in  need  of.  In  the  organic 
variety  little  can  be  done  in  the  way  of  treatment, 
though  gradual  dilatation  may  be  attempted  by 
bougies.  If  the  cause  of  the  organic  stricture  is 
cancer  of  course  the  case  is  hopeless  ;  you  can,  how- 
ever, do  much  to  relieve  the  patient's  suffering  by 
the  administration  of  anodyne,  while  at  the  same 
time  the  patient's  strength  must  be  kept  up,  when 
required,  by  rectal  alimentation,  in  which  must  not 
be  forgotten  the  injection  into  the  rectum  of 
defibrinated  blood. 


{From  our  Boston  Corres/'Oiu/c/it.) 
LETTER  FROM  THE  HUB. 
Editors  Canada  Medical  Record. 

Dear  Sirs, — The    nearness  of    the  good  old 
Puritan  city  of  Boston  to  Montreal   (a  half  day's 


journey)  makes  it  to  be  frequently  visited  by  deni- 
zens of  the  latter.  Its  many  places  of  interest 
and  objects  of  attraction,  such  as  the  Dome  of  the 
State  House,  the  Pleasure  Gardens  and  Common, 
Beacon  Street,  Commonwealth  avenue,  Trinity 
Church  and  the  New  Old  South,  the  Art  Gallery, 
its  crooked  streets,  Forest  Hills  and  Mount 
Auburn,  etc.,  are  as  familiar  to  the  Canadian: 
almost  as  to  the  American,  and  are,  as  it  were,, 
"  Forever  photographed  on  the  mind."  Then,  too,. 
Boston  holds  a  warm  place  in  the  heart  of  a  great 
many  married  men,  as  it  is  seldom  left  out  in  a 
wedding  tour  ;  and  although  on  such  an  occasion 
the  groom  is  supposed  to  be  oblivious  of  all  else 
but  his  blooming  bride,  he  no  doubt  manages,  or 
it  may  be  the  attractive  force  of  the  surroundings 
exert  their  overpowering  influence  on  his  cerebral 
cells,  and  live  ever  green  in  his  memory.  But  it 
is  not  the  beautiful  city  of  Boston  itself,  the 
Modern  Athens,  as  it  has  been  styled,  that  I  wish 
to  describe,  this  would  be  altogether  unnecessary ; 
but  I  thought  it  might  not  be  uninteresting  to  the 
readers  of  the  Record  to  give  them  a  glimpse  of 
Boston  from  a  medical  point  of  view,  to  inform 
you  as  to  the  nature  and  doings  of  things  medical 
here,  its  medical  school,  hospitals,  profession,  and 
medical  societies.  Although  perhaps  not  such  a 
medical  centre  as  New  York,  or  Philadelphia,  the 
Hub  of  the  Universe,  as  Bostonians  delight  to  call 
their  native  city,  offers  many  advantages  to  the 
follower  of  QEsculapius.  The  larger  size  of  New 
York  and  Philadelphia  and,  as  a  consequence, 
larger  clinical  experience  and  more  central  posi- 
tion, attracts  more  students  to  the  latter  cities ; 
but  one  need  not  go  out  of  Boston  to  get  all  the 
instruction,  theoretical  or  practical,  required.  It 
can  boast  of  one  of  the  oldest  and  one  of  the  best, 
if  not  the  best  medical  schools  in  the  United  States, 
of  large  and  well  appointed  hospitals,  of  distin- 
guished and  learned  professional  men,  a  large  well 
stocked  medical  library,  and  well  conducted  Medi- 
cal Societies  ;  'in  fact  the  medical  student  or  practi- 
tioner can  have  his  every  desire  or  ambition  satis- 
fied in  Boston.  I  purpose  in  this  my  first  letter 
dwelling  briefly  on  the  Harvard  Medical  school. 
To  write  the  history  of  the  School  would  be  to 
write  the  history  of  medicine  in  the  United  States. 
I  will,  therefore,  limit  myself  to  the  Harvard  of  the 
present,  not  of  the  past.  The  old  Medical  school 
still  stands  in  the  west  end  of  the  city,  near  the 
Massachusetts  General  Hospital,  a  monument 
redolent  of  the  past.     It  was  here  where  most  of 


THE   CANADA   MEDICAL   RECORD. 


75 


the  Boston  and  New  England  men  were  initiated 
into  the  mysteries  of  medicine  ;  and,  no  doubt,  to 
most  Boston  men,  a  great  many  pleasant  associa- 
tions cling  around  the  old  i)lace.  The  old  building 
is  there,  but  the  life,  the  energy,  the  jovial  shouts 
of  the  medicos,  and  learned  tones  of  the  professors, 
are  heard  no  more,  but  have  betaken  themselves 
to  a  new  and  superb  building  on  the  corner  of 
Boylston  and  Exeter  streets.  This  is,  I  believe,  the 
largest  and  finest  medical  building  on  this  contin- 
ent. It  cost  $350,000.  The  Harvard  Medical 
school  cclc!)ratcd  their  centennial  here  three  or  four 
years  ago.  Dr.  Holmes  giving  the  opening  address. 
It  is  plain  in  architecture,  solid  in  structure,  not 
very  imposing  in  external  appearance,  save  as  a 
large  square  red  brick  building,  with  the  names  of 
the  Fathers  of  Medicine  figuring  over  the  entrance  i 
but  its  internal  arrangements  and  finish  are 
splendid  and  unexcelled.  A  large  hall  extend- 
ing from  top  to  bottom,  lighted  by  a  sky-light, 
runs  through  the  centre  of  the  building ;  off 
this  leads  the  various  lecture  and  other  rooms. 
Flights  of  massive  stairway  lead  to  the  different 
stories,  square  galleries  extend  from  story  to  story. 
The  view  from  the  top  gallery  is  impressive. 
Stairways  remind  one  somewhat  of  the  stairways 
in  the  Grand  Opera  House,  Paris.  The  ground 
floor  is  marble,  with  numerous  corinthian  pillars, 
resembling  in  appearance  an  ancient  temple.  The 
college  notices  are  posted  up  in  neat  glass  cases  ; 
on  the  lower  floor  here  are,  also,  the  Janitor's 
apartments,  reading  and  smoking  rooms.  Behind 
the  stairway  is  the  coat-room,  and  books  for  refer- 
ence are  at  hand,  also  the  various  Medical  periodi- 
cals. The  reading  room  is  large,  well  lighted,  with 
numerous  reading  desks  scattered  over  it ;  it 
contains  specimens  of  Materia  Medica  for  refer- 
ence. On  the  second  Hoor  is  a  lecture  room  for 
Chemistry  and  Physiology,  built  in  the  form  of 
an  amphitheatre.  The  students  enter  from  a 
gallery  at  the  top,  a  large  sliding  black  board  is 
placed  in  the  wall,  back  of  where  the  professor 
lecturesand  facing  the  students.  On  the  ground  floor 
of  the  room  on  either  side  are  doors;  the  one  on  the 
right  entering  into  a  Chemical  Laboratory,  where 
the  lecturer  on  chemistry  prepares  his  experiments 
for  the  class,  that  on  the  left  into  the  Physiological 
Laboratory,  where  the  professor  of  Physiology  has 
every  facility  for  illustrating  his  lecture.  The 
Physiological  Laboratory  is  superb  in  its  appoint- 
ments, every  device  or  implement  necessary  for 
the  practical  study  of  Physiology  being  at  hand ; 


leading  off  this  is  a  Mechanical  room,  which  has 
a  small  engine,  and  skilled  workmen,  where  almost 
anything  can  be  made.  Dr.  Bowditch,  Dean  of  the 
Faculty,  lectures  on  Physiology.  There  is  a  large 
Laboratory  extending  the  whole  of  one  side  of  the 
building,  for  practical  chemistry,  students  being 
provided  with  all  necessary  materials.  On  the 
top  story  is  a  very  large  anatomical  Lecture  room, 
capable  of  seating  a  great  many  students,  similar 
to  the  Physiological  room  but  larger.  On  the  wall 
hangs  a  large  oil  painting  of  Dr.  Holmes.  There  is 
also  an  excellent  bust  of  Bigelow  in  this  room. 
There  is  another  large  lecture  room  for  the  final 
branches,  and  several  other  smaller  rooms.  The 
dissecting  room  is  at  the  top  of  the  building,  capa- 
cious, well  ventilated,  and,  unlike  most  dissecting 
rooms,  cleanly.  There  is  no  scarcity  of  subjects, 
the  Anatomy  Act  having  been  long  in  force  here. 

The  Museum  called  the  "Warren  Museum" 
is  a  very  fine  one,  and  compares  favorably  with 
the  museums  of  the  larger  Hospitals  in  London. 
Like  them  it  has  a  gallery  surrounding  it.  There 
are  many  interesting  medical  curios  here,  among 
the  most  notable  may  be  mentioned  the  skull  that 
was  pierced  by  a  crow-bar  ;  both  skull  and  crow- 
bar are  on  exhibition.  This  case  is  recorded  in 
most  works  on  Medical  Jurisprudence.  The  man 
lived  12  years  after  having  his  skull  pierced.  The 
crow-bar  entered  the  skull  near  the  orbit,  and  came 
out  in  the  occipital  region,  thus  piercing  the  most 
vital  parts  of  the  brain.  In  the  gallery  is  a  well 
stocked  museum  of  Materia  Medica.  The  Har- 
vard School  is  replete  in  everything  that  a  medi- 
cal school  requires. 

To  become  a  professor  in  Harvard  is  the  beau 
ideal  of  a  Boston,  man.  Once  he  has  won  this 
coveted  honor  he  has  reached  the  acme  of  his 
ambition.  The  names  of  the  men  constituting  the 
Faculty  of  Medicine  of  Harvard  is  sufficient  guar- 
antee for  the  efficient  education  of  the  student. 
Two  eminent  men  have  of  late  resigned  from  the 
Faculty  :  Doctor  Oliver  Weadell  Holmes,  whose 
reputation  is  world  wide,  and  Doctor  Henry  I. Bige- 
low of  Litholopacy  fame  ;  both  have  left  gaps  hard 
to  fill.  The  poet  doctor  had  an  inimitable  way 
of  lecturing  on  anatomy,  peculiarly  his  own,  ren- 
dering this  somewhat  dry  subject  interesting  by 
his  sparkling  wit.  I  might  mention,  in  passing, 
that  the  living  skeleton  that  Doctor  Holmes  used 
to  exhibit  before  his  class  is  dead,  oetat.  46,  weight 
40  lbs.  He  has  bequeathed  his  body  to  Harvard 
College ;  while  he  was  living  it  was  llioiight  he  had 


76 


TUE   CANADA   MEDICAL   RECORD. 


some  derangement  of  the  Thoracic  Duct.  Bigelovv 
had  a  charming  way  of  lecturing.  I  had  the  pleas- 
ure of  an  introduction  to  Doctor  Dwight,  Doctor 
Holmes'  successor  in  Anatomy.  He  is  a  clear  and 
forcible  lecturer,  and  is  destined  to  become  a  noted 
anatomist.  He  has  already  added  some  beautiful 
sections  of  bone  to  the  Warren  Museum,  delinea- 
ting their  anatomical  and  histological  characters. 
He  showed  me  a  way  he  had  of  illustrating  his  lec- 
tures, which  may  be  a  useful  hint  to  professors  of 
anatomy  in  Montreal,  if  they  are  not  already  aware 
of  it.  It  is  somewhat  after  the  small  transparent 
slates  that  children  learn  to  draw  with,  only  on  a 
larger  scale.  He  uses  a  slate  of  this  kind  about  3 
feet  by  4.  In  it  he  puts  a  bare  outline  of  a  certain 
portion  of  the  body,  say  head  and  neck  ;  this 
shows  through  the  glass.  He  then  fills  this  up  with 
the  muscles,  arteries,  nerves,  as  the  case  may  be, 
with  different  colored  chalks.  These  may  be  seen 
by  all  the  class,  and  can  be  rubbed  out  or  put  in 
as  required.  The  various  extremities  of  the  body 
can  be  taken  up  in  this  manner.  The  veteran  op- 
thalmologist,  Dr.  Williams,  still  lectures  with  una- 
bated vigor  on  opthalmology.  His  distinguished 
figure  still  graces  the  streets  of  Boston.  Long  may 
he  continue  so  to  do.  Doctor  Edes  has  resigned  the 
chair  of  Clinical  Medicine  and  gone  to  Washington 
to  practice.  Great  things  were  expected  of  Doctor 
Edes.  The  chair  of  clinical  medicine  is  now  va- 
cant. 

Dr.  Minot    the    Nestor   in    "  practice  "  here  is 
professor  of  Practice  of  Medicine.     The  chair  of 
mental  diseases  is  filled  by  Dr.  Charles  F.  Folsom, 
a  man  of  distinguished  attainments  whom  to  know 
is  to  admire.     Dr.  Folsom  lectures  in  a  clear  and 
scholarly  style.    The  Canadian  schools  might  take 
a  lesson  from  Harvard  in  establishing  a  chair   of 
mental  diseases,  as  I  believe  none  of  them  have 
one  as  yet.    That  it  is  an  important  and  necessary 
chair  cannot  be  doubted.    To  quote  Dr.  Folsom  in 
his  work  on  the  mind  :     "  The  ink  on  our  diplomas 
is  scarcely  dry,  and  we  called  upon  to  sign  a  paper 
which  will  send  a  woman  to  an  insane  asylum  for 
hfe,  or  deprive   a  man  of  the   power  to  make   his 
will  ;  when  we  cannot  for  our  lives  tell  the  dif- 
ference between  folic  circulaire  and  general  paraly- 
sis ;  when  we  cannot  recognize  many  of  the  simplest 
forms  of  mental  diseases  in  their  early  stages,  and 
when  we  do  not  kno#  whether  ihe  best  treatment 
consists  in  sending  our  patients'    to  the  inactivity 
ofan  asylum  or  for  a  tjamp    ami>ng  the  hills,    or  ! 
whether  he  can  as  well  or  better  be  ca^ed  for  aj  j 
home  ?     an  uncertainty:  ■which  deprivijs  many  of  the 


benefit  of  early  treatment.  " 

Dr.  Durgin  lectures  in  an  admirable  manner  on 
Hygiene.  Dr.  Durgin  enjoys  much  popularity 
among  his  professional  brethren,  and  is  a  man  of 
most  imassuming  manner?.  It  is  said  that  merit 
always  wears  a  modest  mien. 

The  chairs  of  Surgery,  Obstetrics,  Dermatology, 
Chemistry,  Pathology  are  ably  filled  by  Drs. 
Cheeves,  Richardson,  White,  Wood,  Fitz.  Besides. 
the  full  professorships  there  are  a  number  of  assis- 
tant-professors in  all  the  various  branches — very- 
able  men.  Har\-ard  has  also  a  large  number  of  well 
qualified  instructors  in  the  different  departments, 
assisting  the  professors  and  assistant-professors. 
Instruction  is  given  by  lectures,  recitations, 
clinical  teaching,  and  practical  exercises.  Har- 
vard is  recognizing  more  and  more  every  day  the 
fact  that  students  require  practical  rather  than 
theoretical  teaching ;  hence  she  has  established 
splendid  laboratories,and  frequent  demonstrations 
are  given  in  Bacteriology,  Histology,  Physiology, 
Pathological,  Anatomy,  etc.  Practical  demons- 
trations are  given  in  Hygiene,  examination  of 
water,  houses,  etc.  I  shall  refer  to  the  clinical 
advantages  of  Harv,ird  when  writing  of  the  Hos- 
pitals. Harvard  has  a  nine  months  session,  the 
course  extends  over  three  years,  there  is  a  fourth 
year  but  it  is  optional ;  but  I  opine  in  the  near  future 
that  the  fourth  year  will  be  compulsory,  mak- 
ing it  a  four  years  course.  The  special  branches 
as  Opthalmology,  Dermatology,  Otology,  etc.,  are 
taken  up  the  fourth  year.  j\Iost  students  take  the 
fourth  year,  although  it  is  not  necessary  for  gra- 
duation. The  Harvard  commencement  is  held  in 
June.  The  word  "  commencement "  is  used  here 
in  contradistinction  to  your  convocation.  Convoca- 
tion has  certainly  a  more  dignified  ring  about  it,^ 
but  to  my  mind  "commencement  "  seems  a  move 
appropriate  term.  We  but  commence  our  career 
when  we  finish  at  College.  We  get  but  the  outlines 
at  College  which  we  fill  up  with  the  ripe  expierience 
of  after  years.  I  notice  in  looking  over  the 
calendar  that  the  Harvard  students  are  given  two 
hours  twice  a  week  for  one  month  practical 
instruction  in  cookery.  This  is  an  excellent  thing. 
Every  medical  man  should  be  a  good  cook  or 
understand  something  about  cooking.  The  Har- 
vard medical  students  have  no  lack  of  reading 
matter  ;  they  are  at  liberty  to  consult  the  library 
at  Cambridge,  the  public  library  which  contains 
over  4,000  medical  works,  the  library  in  the  Medi- 
cal School  itself 


"THE   CANADA   MEDICAL   RECORD. 


77 


There  are  four  scholarships  worth  $200  dollars 
each  given  yearly. 

Harvard  has  established  a_Post-graduatc  course 
to   enable   graduates   to   further    prosecute   their 
studies  and  to  take  the  place  of  those  courses  which 
one  was  formerly  obliged  to  go  to  Europe  for.  Short 
courses  are  given  in  all  the  practical  branches  of 
Medicine,   either  separately  or  the   whole  course 
may  be  taken.     Each  course  runs  from  815  to  $30' 
The  men^who  give  these  courses  have  all  studied 
in  London,  Berlin,  Vienna,  etc.,  and  absorbed  the 
ideas  of  the  eminent  men  in  these  places, so  that  one 
learns  almost  as  much  here  as  in  the  above  places  ; 
but  tiien  one  does  not  have  the  reputation  of  study- 
ing in  Europe  and  the  mere  mention  of  having 
seen  or  studied  under  Virchow,  Billroth,  Kock,  &c., 
a.t  once  raises  one  in  the  estimation  of  the  Medical 
fraternity,    their    very    name  seeming   to   reflect 
medical  skill.     And  then  how  could  one  get  along 
at  the  Society  if  one  did  not  quote  German  authori- 
ties, and/efer  to  one's  experience  in  Wien  every  op- 
portunity .that    offers.     The    students    attending 
Harvard  are  of  a  superior  class,  resembling  those 
seen  in  the  London  Hospitals.     The  standard  be- 
ing high  none  but  the  best  study  here.     It  struck 
me  that  the   students    seemed  some  what   older 
here  than  in  Canada  or  London,  men  seem  to  enter 
the  study  of  Medicine  for  the  most  part  later   in 
life.     The  number  of  students  this  session  is  271  ; 
Harvard  graduates  yearly  about  35  to  60.     This  is 
somewhat  small  when  we  consider  the  100  or  200 
graduates  that  other  schools  in  the  State  send  forth ; 
but  Harvard  looks  to  the  quality  not  the  quantity. 
She  graduates  first-rate  men,  and  there  is  scarcely 
a  town  in  the  United  Statess  where  there  is  not  one 
who  is  proud  to  call  himself  a  graduate  of  Harvard. 
Each  year  she  adds   a  number   of  well  educated 
physicians  to  the  profession,  who  are  sure  in  the 
long  run  to  have  an  elevating  influence  throughout 
the  broad  American  continent. 

J.  L.  F. 
Boston,  Jan.  sth,  1887. 

iSociedj  J^mceedm^^. 

MEDICO  CHIRURGICAL  SOCIETY  OF 

MONTREAL. 

Siaied  Meeting,  Nov.   19M,   1886. 

J.  C.  Cameron,  M.D.,  President,  in  the  Chair. 

Dr.  Major  exhibited  the  following  cases,  taken 

from  his    cHnic   for    Diseases    of  the    Nose    and 

Throat  at  the  Montreal  General  Hospital : 


1,  Complete  paralysis  of  the  right  vocal 
band,  the  result  of  pressure  exerted  by  a  fibroid 
on  the  right  recurrent  laryngeal  nerve.  The  pa- 
tient, aged  47,_  a  painter  by  trade,  applied  for  treat- 
ment. On  examination  the  right  vocal  cord  was 
found  in  a  state  of  complete  immobility,  and 
occupied  a  position  midway  between  that  of  "full 
inspiration  and  phonation.  A  blue  line  on  the 
gums,  and  abdominal  colic  pointed  also  to  lead 
poisoning.  This  latter  complication,  however,  in 
no  way  nor  at  any  time  influenced  the  laryngeal 
condition. 

2.  Early  Laryngeal  CEdema  (^tuberculous), 
with  no  recognizable  pulmonary  infection.  The 
patient,  aged  50,  applied  for  relief  of  dyspnoea  and 
a  barking  choking  cough.  OEdema  of  the  left 
arytenoid  body  alone  was  present,  the  swelling 
was  grey  in  color  and  of  the  size  of  an  acorn, 
and  interfered  with  voice  production  and  deglu- 
tition. After  a  lapse  of  a  couple  of  weeks  a 
similar  condition  developed  in  the  right  region. 
Some,  days  later  the  epiglottis  showed  signs  of 
swelling  and  thickening,  and  later  on  pulmonary 
signs  became  apparent.  The  lactic  acid  treat- 
ment was  adopted,  and  local  improvement  followed. 
The  condition  of  the  chest  would  lead  to  the 
opinion  that  temporary  arrest  of  the  disease  had 
taken  place  there  also.  The  gradual  development 
and  extent  of  the  cedema  and  subsequently  lung 
signs  are  the  interesting  features  of  the  case,  as 
was  also  the  general  improvement  under  purely 
local  treatment. 

3.  Three  cases  of  Laryngeal  Papillomata.— [a) 
*In  May  1880,  Dr.  M.  performed  a  tracheotomy 
on  this  child,  then  in  her  third  year,  for  relief  o 
suffocation  paroxysms  that  endangered  life.  At 
an  examination  preceding  the  operation  the 
larynx  was  found  filled  with  watery  growths. 
Canulae  have  been  worn  constantly  since,  and  no 
evil  results  have  arisen  therefrom.  The  physio- 
logical rest  afforded  the  larynx  has  had  a  marked 
effect  in  arresting  the  development  of  the  growths 
as  has  been  proved  experimentally  during  periods 
of  temporary  improvement  by  plugging  the  tube, 
when  increased  activity  of  the  excrescences  in- 
variably followed.  Absolute  alcohol  has  been 
used  daily  as  a  spray  in  the  larynx  by  the  child's 
mother  with  the  very  best  results.  At  two  recent 
sittings     evulsion  by   cutting    forceps    had   been 


*    Vide  writer's  paper,  "  Rest  and  Tracheotomy,  "  Canada 
Med.  and.  Surg.  Journal,  December,  1882. 


78 


THE   CANADA   MEDICAL   RECORD. 


practised,  removing  any  remaining  neoplasms. 
Particular  attention  was  requested  to  the  healthy 
condition  presented  by  the  vocal  cords,  there  be- 
ing no  alteration  of  color,  diminution  of  lustre, 
abrasion  of  surface,  or  impairment  of  movement 
perceptible.  The  writer  attributed  the  satis, 
factory  state  of  the  patient  to  the  spray  of  absolute 
alcohol  and  the  employment  of  the  quarter  circle 
tube,  which  litter  he  considered  less  liable  to 
produce  tracheal  disturbance  than  any  of  the 
many  other  makes  in  general  use.  The  tube  has 
not  been  withdrawn  and  good  voice  is  produced. 

(d)  A  female  patient,  aged  20,  was  first  seen  in 
October,  1885  >  complained  of  loss  of  voice, 
hoarse,  and  painful  cough,  and  great  general 
debility.  The  larynx  was  found  to  be  intensely 
congested  as  also  the  traches,  which  latter  was  of 
a  raw-beef,  purplish  hue.  The  vocal  cords  were 
rough,  granular-looking  and  swollen,  showed  no 
loss  of  surface,  and  there  were  no  growths  present. 
The  case  was  treated  locally  by  astringents,  etc., 
imtil  May,  1886,  with  little,  if  any,  improvement, 
when  attendance  ceased,  owing  to  the  writer's 
absence  in  Germany. 

In  September,  1886,  when  the  case  was  again 
seen,  extensive  papillomata  of  large  size  were 
found  springing  from  the  vocal  cords  in  all  direc- 
tions and  from  the  epiglottis.  These  growths  were 
removed  at  two  sittings,  when  local  treatment  was 
again  resumed,  with  the  satisfactory  results 
demonstrated. 

(c)  A  lady,  aged  24  (a  private  patient),  was 
referred  by  Dr.  James  Stewart  of  Pictou,  Nova 
Scotia,  in  August,  1883,  and  so  closely  resembles 
the  preceding  one  in  several  important  particu- 
lars, that,  although  she  could  not  be  induced  to 
be  present,  the  history  was  recorded.  When  first 
seen  in  August,  1883,  there  "'as  aphonia,  or  more 
correctly,  dysphonia  only.  The  history  given  was 
that  of  ordinary  cold,  and  had  so  continued  with- 
out improvement  for  two  years.  On  laryngoscopic 
examination  the  vocal  cords  were  thickened,  red 
and  granular-looking ;  there  were  no  growths 
present.  Local  applications  of  a  very  thorough 
nature  were  employed  over  a  period  of  two  months, 
with  but  litde  benefit.  In  September,  1886,  the 
patient,  who  meantime  had  passed  through  a  num- 
ber of  hands,  placed  herself  for  the  second  time 
under  treatment.  On"  examination,  papillomata 
were  found  on  the^laryngeal  face  of  the  epiglottis, 
and  the^vocal^  cords  were  completely  obscured 
from   view   by  them.     There  was  now    complete 


aphonia,  the  breathing  was  much  embarrassed, 
and  coughing  was  almost  incessant.  The  trachea 
presented  an  appearance  such  as  described  in  the 
preceding  history.  The  cords  also  showed  at 
such  points  along  their  edges  as  were  visible  evi- 
dence of  erosions  and  irregularities  of  surface. 
After  the  removal  of  these  neoplasms  by  means  of 
cutting  and  crushing  forceps,  cold  iron  snare,  and 
V.  Schrotter's  guillotine,  for  no  one  method  was 
in  itself  sufficient,  a  very  unsatisfactory  state  of 
the  vocal  cords  was  found.  Under  local  applica- 
tions of  powerful  astringents,  etc.,  improvement 
followed,  and  a  very  fair  quality  of  voice  has  been 
established. 

In  the  two  latter  cases  nasal  respiration  was 
very  much  impeded,  and  it  Yi^as  only  after  the 
reduction  of  the  hypertrophied  turbinated  tissue 
and  the  restoration  of  healthy  nasal  respiration 
that  the  local  medication  of  the  larynx  showed  any 
good  result.  This  fact  should  not  be  lost  sight  of 
in  the  treatment  of  all  chronic  laryngeal  disease. 
These  were  at  first  cases  of  chronic  catarrhal 
laryngitis,  and  if  nasal  hypertrophies  had  been  at 
first  removed,  convalescence  would  most  probably 
have  resulted  without  the  transition  to  papillomata 
having  first  to  be  undergone.  In  this  respect 
papillomata  should  form  no  exception  to  all  other 
laryngeal  conditions,  and  the  dependence  of  a 
healthy  larynx  upon  normal  nasal  respiration  can- 
not be  too  strongly  emphasized.  The  growths 
were  examined  by  Dr.  Wyatt  Johnston,  and  on 
section  were  seen  to  be  radiating  papillae  covered 
with  a  thick  layer  of  epithelium  and  having  vessels 
in  the  centre.  No  hyperplasia  of  submucous 
tissues  and  no  lymphoid  nodules  were  to  be  seen. 
The  epithelial  cells  in  c  were  larger  and  more 
loosely  arranged  than  in  l>. 

Dr.  Major  also  showed  the  following  instru- 
ments : — 

1.  An  improved  nasal  traction  snare  and  ecra- 
seur. 

2.  A  nasal  spud  or  denuder. 

3.  An  improved  nasal  ecraseur. 

4.  A  laryngometer.  A  laryngeal  mirror  engraved 
on  its  reflecting  surface  with  a  scale  for  the  pur- 
pose of  measuring  movements  or  spaces  in  the 
larynx  or  composing  them  relatively. 

T];ie  nasal  snares  are  both  angular,  and  among 
other  improvements  introduce  a  novel  feature  in 
a  revolving  wheel  or  pulley  placed  at  the  angle  of 
junction  of  the  canula  with  the  shank  over  which 
the  wire  plays,  thus  reducing  friction,   increasing 


*rHE   CANADA  MEDICAL   RECOED. 


79 


power  and  imparting  strength  to  the  instrument 
at  its  point  of  greatest  weakness.  The  mechanical 
principal  involved  requires  no  vindication. 


Perforation  of  the  Gall  bladder.— T)x.  W.  G. 
Johnston  gave  an  account  of  an  autopsy  he  had 
performed  for  Dr.  R.  P.  Howard.  The  abdomen 
was  found  distended,  panniculus  and  omental,  fat 
excessive.  The  abdominal  cavity  contained  several 
quarts  of  thick  sero-fibrinous  fluid  mixed  with 
bile  and  of  a  deep  brown  yellow  color,  not  foetid. 
(A  small  incision  made  by  undertaker  for  injecting 
a  small  quantity  of  preservation  fluid  was  found 
in  left  loin.  This  fluid,  readily  recognized  by  its 
aromatic  smell,  was  not  found  in  general  peritoneal 
cavity.)  The  coils  of  intestines  glued  together  by 
recent  adhesions  formed  numerous  sacculi.  In 
the  right  hypochondrium  the  hepatic  flexure  of  tlie 
colon  was  found  imbedded  in  a  mass  of  firm  old 
adhesions,  attaching  it  to  the  lesser  omentum  and 
tissues  about  gall  bladder,  which  could  not  be  seen 
till  adhesions  were  dissected  off.  Near  the  neck 
of  the  gall  bladder  a  small  orifice  was  found, 
through  which  thick  greyish-brown  bile  was  escap- 
ing. On  opening  the  gall  bladder  this  orifice  was 
valvular  in  character,  its  size  that  of  a  No.  4 
sound,  and  it  corresponded  to  a  spot  where  the 
mucosa  is  eroded  and  the  walls  thinned.  Else- 
where the  walls  of  gall-bladder  are  flaccid,  some- 
what thickened  and  firm,  and  contained  about  an 
ounce  of  bile  mixed  with  mucopus.  Its  cavity 
was  divided  into  three  sacculi  by  the  contraction 
of  fibrous  tissues  in  the  wall.  The  middle  one  of 
these  contained  a  gall-stone  the  shape  of  a  bean 
and  about  the  size  of  a  pigeon's  egg  ;  close  beside 
this  is  a  spot  where  the  wall  has  been  eroded,  but 
was  secured  against  the  surface  of  liver  by  inflam- 
matory fibrous  tissue.  In  a  pocket  near  the  per- 
foration, but  not  corresponding  to  it  exactly,  was  a 
small  gall-stone  the  size  of  a  pea.  The  cystic  and 
common  ducts  were  thickened.  Just  at  their 
junction,  lying  really  within  the  cystic  duct,  but 
partly  obstructing  the  common  duct  by  its  pres- 
sure laterally,  was  a  gall-stone  the  size  of  a  pi- 
geon's egg,  A  probe  could  be  passed  through 
either  duct  beside  it.  No  other  gall-stones  in  peri- 
toneal cavity.  Duodenum  contained  gray,  clay- 
colored  faeces,  but  bile  exudes  from  the  papilla  on 
pressure.  No  signs  of  bile  anywhere  in  intestines. 
Some  slight  intestinal  catarrh.  Liver  a  little  fi- 
brous and  fatty.  Other  organs  normal. 

Dr.  Howard,  in  reporting  the  case,  said  its 


clinical  features  were  of  unusual  interest.  It  was 
a  cace  of  acute  general  peritonitis  from  perforation 
of  the  gall-bladder  in  a  man  aged  65.  The  patient 
was  in  good  health  at  the  beginning  of  the  month. 
After  four  days  of  epigastric  pain, never  very  .severe, 
patient  become  jaundiced.  Next  day  there  was 
vomiting ;  pain  in  the  epigastrium  became  more 
marked,  especially  in  region  of  gall-bladder. 

There  was  not  very  marked  tenderness  on  pres- 
sure,but  pain  and  symptoms  of  peritonitis  extended 
over  entire  abdomen.  Pain  was  not  suffieient- 
however,  to  necessitate  an  opiate.  The  tempera, 
ture  on  the  morning  of  the  sixth  day  was  100.  8  ° 
and  99.  S  °  at  night;  on  seventh  day,  100.  6  °  ; 
eighth  day  100  °  ;  and  ninth  day. 98. 8  °  .  The  abdo- 
men gradually  became  enlarged  and  tympanitic, but 
still  no  severe  pain.  After  third  day  jaundice  gra- 
dually increased.  The  diagnosis  was  very  obscure. 
Cancer  could  be  excluded,  and  as  there  was  no 
history  of  gall-stones,  a  diagnosis  of  peritonitis 
spreading  from  the  gall-bladder  was  made.  It  was 
strange  that  the  escape  of  so  irritating  a  fluid  as 
the  contents  of  the  gall-bladder  should  have  cau- 
sed no  collapse  or  severe  pain.  No  perforation 
was  diagnosed.  It  is  an  important  question  for 
consideration  whether  surgical  interference  in 
this  case  would  have  availed  anything.  The  gall- 
bladder was  so  deeply  imbedded  in  old  adhesior.s 
that  it  would  be  hardly  possible  for  a  surgeon  to 
have  reached  it.  The  gradual  invasion  of  the 
symptoms  was  probably  due  to  the  slow  oozing'out 
of  the  contents  of  the  gall-blader. 

Dr.  WiLKiNS  asked  if  non-action  of  bowels  in 
such  a  case  would  not  be  due  to  spasm  of  the 
muscular  coat  owing  to  the  peritonitis,  and  whether 
an  opiate  treatment  would  not  be  most  successful 
in  relieving  constipation. 

Dr.  Howard  stated  that  the  treatment  had  been 
mainly  an' opiate  one. 

Dr.  Geo.  Ross  had  been  struck,  on  seeing  the 
the  case,  by  the  absence  of  the  usual  marked 
features  of  acute  peritonitis,  the  obstinate  con- 
stipation and  suggested  intestinal  obstruction.  He 
called  attention  to  the  fact  that  severe  acute  pe- 
ritonitis may  co-exist  with  a  normal  or  only  sub- 
febrile  temperature,  the  idea  that  acute  peritonitis 
necessitated  a  high  temperature  being  quite  falla 
cious. 

Dr.  Shepherd  thought  that  surgically  nothing 
could  have  been  done.  The  anatomical  features 
of  the  case  placed  it  out  of  the  reach  of  surgical 
interference.     Excision  of  the  gall-bladder  could 


80 


THE   CANADA   MEDICAL   RECORD. 


not  have  been    successfully   performed,  owing   to 
mechanical  difficulties. 

Dr.  R.  J.  B.  Howard  suggested  that  perhaps 
in  a  similar  case  simple  ligature  of  the  cystic 
duct,  by  preventing  the  passage  of  bile  from  the 
liver  to  the  gall-bladder,  would  change  the  dis- 
charge of  acrid  bile  into  the  peritoneal  cavity  to 
one  of  a  little  harmless  mucus. 

Dr.  WiLKiNs  asked  when  the  perforation  pioba- 
bly  took  place. 

Dr.  Howard,  in  reply,  said  the  perforation 
probably  occurred  early.  There  was  nothing  in 
the  history  of  the  case  to  indicate  sudden  rupture. 

Bile  entered  peritoneum  gradually. 

Dr.  A.  F.  ScH.MiDT  showed  a  case  of  cancer  of 
stomach,  apparently  the  vyhole  stomach  was  trans- 
formed into  cancerous  tissue.  There  was  also  an 
extensive  diffuse  cancer  of  the  head  of  the  pan- 
creas. The  tissues  in  the  neighborhood  were  exten- 
sively infiltrated.  The  liver  contained  numerous 
soft  secondary  nodules.  Bile  duct  slightly  ob- 
structed.    Secondary  cancer  of  lungs. 

Dr.  Johnston  thought  it  difficult  to  say  whether 
the  disease  originated  primarily  in  stomach  or  in 
pancreas.  No  definite  ulcer  nodule,  looking  like 
a  starting-place,  could  be  discovered.  The  sur- 
rounding infiltration  might  afford  some  clue,  as 
this  infiltration  was  much  more  directly  continuous 
with  the  growth  in  the  pancreas  than  with  that  in 
the  stomach. 

Cancer  of  CEsophagus. — Dr.  Ross  showed  an 
oesophagus  the  seat  of  malignant  disease.  The 
symptoms  during  life  were  marked  and  gradually 
increasing  difficulty  m  deglutition.  The  stricture 
admitted  a  No.  3  bougie.  There  was  no  marked 
emaciation.  The  patient  had  died  suddenly  and 
unexpectedly,  death  being  due  to  the  bursting  of  a 
cerebral  abscess.  There  were  no  symptoms  of 
brain    disease. 

Autopsy  by  Dr.  Johnson. — Epithelioma  of 
oesophagus,  forming  ulcerated  surface  five  inches 
long.  Calibre  of  gullet  not  much  narrowed.  In 
brain,  an  abscess  was  found  just  above  the  roof  of 
right  lateral  ventricle,  at  its  anterior  and  external 
part,  anterior  to  the  motor  area.  This  had  burst 
into  the  lateral  ventricle.  Abscess  appeared  chron- 
ic in  nature  ;  did  not  appear  to  be  connected  with 
the  cajicer.  

Stated  Meeting,  December  yd,  1886. 
J.  C.  Cameron,  M.D.,  President,  in  the 

Chair. 
Csaeof  Leukcemia. — Dr.  Stewart  showed  a  man. 


aged  32  years,  who  is  suffering  from  enlargement 
of  the  cervical,  axillary  and  inguinal  glands.  The 
patient,  who  is  a  farmer,  first  noticed  a  su'elling  un- 
der his  left  lower  jaw  nine  months  ago.  The  glands 
along  the  sterno-mastoids  and  above  the  clavicles 
are  very  much  enlarged.  The  swelling  is  painless, 
and  in  some  parts  has  a  scrai-fluctuating  character. 
Several  glands  in  both  axillary  regions  are  the  size 
of  hen's  eggs.  The  groin  glands  are  much  en- 
larged also.  The  patient  also  comijlains  of  weak- 
ness, palpitation  and  breathlessness  on  exertion. 
He  is  decidedly  ancemic.  He  never  had  any 
previous  illness.  Has  lost  three  sisters  from  pul- 
monary consumption.  There  is  no  evidence  of 
enlargement  of  the  bronchial  or  mediastinal  glands. 
His  breathlessness  can  be  accounted  for  by  his 
anaemia,  and  the  pressure  exerted  by  the  enlarged 
cervical  glands  on  the  trachea.  There  is  no  en- 
largement of  the  thyroid  glands  or  tonsils.  No 
pain,  tenderness  or  swelling  over  any  of  the  bones. 
Biood — Dr.  Wyatt  Johnston  kindly  undertook  the 
examination  of  the  blood.  It  is  as  follows  :  "  Red 
corpuscles  are  well  formed,  uniform  in  size,  and 
nummulate  normally.  White  are  considerably 
increased  in  number.  There  are  numerous  small 
colorless  cells  (blood  plaques  ?).  On  staining  the 
blood  (Ehrich's  hjematoxylin  eosin  method),  the 
leucocytes  are  seen  to  be  mostly  small  and  with 
mono-morphic  nuclei.  A  very  few  eosinophile 
cells  and  one  or  two  nucleated  red  corpuscles 
noticed,  but  both  these  elements  are  very  infre- 
quent. By  Cowers'  hsemocytometer,  red  cells 
3,570,000  per  cm.  (71  per  cent,  of  normal)  ;  white 
cells,  200,000  per  c.  m.  Proportion  of  white  to  red, 
I  20  (an  increase  absolutely  of  13  times  and  rela- 
tively of  15  times  the  normal).  Haemoglobin 
index  58  per  cent."  Spleen — There  is  a  consider- 
able increase  in  the  size  of  the  spleen,  its  vertical 
dullness  extending  from  the  upper  border  of  the 
ninth  rib  downwards,  a  distance  of  five  inches. 
Its  surface  is  smooth.  Liver  is  also  somewhat 
enlarged,  its  vertical  dullness  (in  the  line  of  the 
nipple)  reaching  from  the  fifth  rib  to  two  inches 
below  the  ribs,  a  distance  of  six  inches.  During 
the  last  two  or  three  weeks  he  has  been  complain- 
ing of  a  dull,  aching  pain  over  the  lower  part  of 
his  back.  There  is  no  pain  or  oedema  of  the  lower 
limbs.  Nothing  abnormal  to  be  detected  in  the 
abdominal  cavity. 

Remarks.  —The  case  presents  some  difficulty  in 
diagnosis.  Its  marked  clinical  features  are  the 
hyperplasia    of  the    superficial  lymphatic  glands 


THE  CANADA   MEDICAL   RECORD. 


81 


So  marked  is  this  enlargement  that  at  first  sight 
one  would  be  inclined  to  at  once  come  to  the 
conclusion  that  it  is  a  case  of  Hodgkin's  disease. 
The  very  considerable  increase  in  the  number  of 
the  while-blood  cells,  together  with  the  increase  in 
size  of  both  spleen  and  liver,  make  it  more  pro- 
bable that  the  case  is  one  of  lymphatic  leukemia. 
Osier,  in  his  article  on  leukaemia,  in  "  Pepper's 
System,"  says  that  when  the  white  cells  increase  to 
such  an  extent  as  to  bring  about  a  proportion  of 
one  white  to  fifty  red,  then  we  have  to  do  with 
leukaemia.  He  draws  particular  attention,  however 
to  the  variableness  of  this  proportion  from  day  to 
day.  A  case,  therefore,  might  be  diagnosed  one 
day  as  lympha  ic  leukasmia  and  another  day  as 
Hodgkin's  disease,  if  we  were  to  rely  solely  on  the 
proportion  which  the  cellular  elements  of  the  blood 
bear  to  each  other.  There  are  cases,  and  the  one 
exhibited  belongs  to  this  class,  where  it  takes  some 
time  to  come  to  a  conclusion  whether  we  have  to 
do  with  lymphatic  anaemia  or  Hodgkin's  disease. 
Is  it  possible  that  a  case  of  Hodgkin's  may  end  in 
what  we  call  lymphatic  leukaemia. 

Dr.  Bell  referred  to  cases  which  he  had  seen 
in  hospital.  Cases  of  Hodgkin's  disease  lived 
many  years ;  those  of  leukaemia  died  within  two 
years.  He  thought  the  present  one  a  case  o^ 
leuksemia  in  an  early  stage. 

Dr.  Shepherd  spoke  of  difficulty  in  diagnosing 
between  Hodgkin's  disease  and  scrofulous  glands 
of  the  neck. 

Dr.  A.  Lapthorn  Smith  referred  to  a  case  of 
Torticollis,  previously  shown,  saying  that  a  histor)' 
of  syphilis  had  been  found.  He  also  exhibited  a 
case  of  doubtful  psoriasis  following  vaccination. 
The  eruption  came  out  a  year  ago,  soon  after  the 
patient  had  been  vaccinated. 

Dr.  Shepherd  regarded  the  case  as  one  of 
eczema. 

Dr.  Mills  said  that  the  case  was  of  interest, 
because  of  the  recent  evidence  that  lymphatic 
glands  are  producers  of  red  blood  corpuscules, 
and  this  case  would  support  it  from  the  patholo- 
gical side. 

Case  of  Leprosy. — Dr.  Shepherd  exhibited  the 
case,  occurring  in  a  man  aged  19,  a  native  of 
Trinidad.  He  had  a  well-marked  tubercular  erup- 
tion on  the  face  and  hands,  and  a  copious  macular 
eruption  on  the  legs  and  buttocks.  The  maculse 
were  of  the  size  of  ten  cent  pieces,  of  a  bronzed 
color,  and  showed  some  infiltration.  The  finf^ers 
of   both   hands  were  crooked  and    swollen,   and 


patient  could  not  use  them.  The  claw-like  appear- 
ance of  the  hands  was  very  marked.  Large  bullae 
were  seen  on  the  hands  and  wrists,  which  when 
evacuated  left  troublesome  ulcers.  The  patient's 
face  was  very  characteristic  of  leprosy,  the  thick- 
ened tissues,  dull  expression,  and  tubercular 
nodules,  also  loss  of  eyebrows,  and  injected  con- 
junctiva, gave  the  individual  an  ajjpearance  sui 
generis.  There  were  also  a  number  of  anaesthetic 
])atches,  viz.,  on  the  inside  of  each  thigh  with 
atrophy  of  the  skin  on  right  elbow,  and  on  dorsal 
surface  of  fingers  and  toes.  The  anaesthetic 
patches  have  only  appeared  within  the  last  year. 
The  right  ulnar  nerve  could  be  easily  felt,  and  was 
slightly  enlarged.  The  mucous  membranes  were 
not  affected.  The  patient  had  been  in  this  country 
four  years  and  had  been  treated  for  syphilis ;  he 
came  to  Canada  by  the  advice  of  physicians  who 
thought  his  disease  would  improve  in  a  colder 
climate.  He  was  affected  with  the  disease  two 
years  before  he  left  Trinidad ;  the  eruption  was 
then  principally  on  the  chest,  and  disappeared 
with  the  use  of  chaulmoogra  oil  internally  and 
externally.  He  said  the  disease  is  common  in 
Trinidad,  and  exists  chiefly  amcng  the  Portuguese, 
There  was  no  history  of  leprosy  in  his  family.  Dr. 
Wyatt  Johnston  had  excised  one  of  the  tubercles 
on  the  nose  and  had  obtained  from  it  the  bacilli 
of  leprosy  in  abundance,  a  beautiful  preparaticn 
of  which  was  shown. 

Dr.  Mills  said  that  in  the  skin,  as  in  the  eye, 
it  had  been  demonstrated  that  blind  spots  occur- 
red, and  thought  it  would  be  interesting  to  see  if 
these  corresponded  with  the  anaesthetic  areas  in 
leprosy  and  in  other  pathological  conditions. 

In  answer  to  Dr.  Smith  as  to  whether  the 
disease  was  contagious,  Dr.  Shepherd  said  that, 
like  syphilis,  it  was  inoculable,  but  not  contagious. 
Leprous  men  have  lived  for  twenty  years  without 
conveying  it  to  their  wives.  It  was  hereditary, 
usually  skipping  a  generation.  Great  diversity  of 
opinion  exists  as  to  the  contagiousness  and  the 
heredity  of  the  disease.  This  is  well  shown  in 
the  reports  from  the  different  leper  stations. 

Cases  of  Cancer  of  Pylorus.— Y)x.  Johnston 
showed  two  cases.  The  first  case  was  from  a 
woman  aged  49,  a  patient  of  Dr.  T.  A.  Rodger. 
She  always  was  dyspeptic.  A  distinct  tumor  was 
felt  in  right  hypochondriac  region  about  a  year 
ago.  Symptoms  of  gradual  e.Khaustion  were  experi- 
enced, accompanied  with  dilatation  of  the  stomach. 
At  the  autopsy,  the  pyloius  was  found  involved 


82 


THE   CANADA   MEDICAL   RECORD. 


for  2^  inches  in  a  scirrhus  growth,  lumen  still 
admitting  little  finger  readily ;  three  small  ulcers 
with  infiltrated  edges  were  situated  near  the  ring  ; 
hyperplasia  of  mucosa  in  region  of  pylorus  to  a 
distance  of  five  inches  fron  ring ;  walls  of  stomach 
hypertrophied  ;  cavity  not  markedly  dilated  ;  no 
infiltration  of  tissues  in  neighborhood  ;  no  second- 
ary growths  anywhere.  The  second  case  was  from 
a  man  aged  50,  a  patient  of  Dr.  Geo.  Ross.  The 
stomach  was  enormously  dilated  ;  pylorus  was 
involved  in  a  dense  cancerous  mass,  wall  greatly 
thickened,  and  lumen  narrowed,  only  admitting  a 
No.  8  catheter;  a  little  infiltration  in  neighbor- 
hood, but  no  compression  of  bile  ducts  and  no 
secondary  cancer ;  walls  of  stomach  at  fundus 
not  so  thick  as  in  preceding  case. 

Dr.  Ross  stated  that  his  patient's  symptoms 
were  those  of  excessive  dilatation  of  the  stomach, 
requiring  the  stomach  tube  to  get  relief.  At  the 
autopsy,  a  quantity  of  fibrous  pulp  was  found 
within  the  stomach,  being  the  remains  of  some 
oranges  patient  had  eaten  some  time  previously. 
He  thought  the  clinical  distinction  between  this 
case  and  the  preceding  one  was  accounted  for  by 
the  much  greater  degree  of  constriction  at  pylorus. 

Dilated  Stomach. — Dr.  Bell  reported  a  case 
of  dilatation  of  stomach  caused  by  fibrous  con  g. 
friction  of  an  inflammatory  origin  at  pylorus.  An 
abscess  filling  lesser  omentum  had  burst  and  caused 
fatal  general  peritonitis.  It  communicated  with 
the  stomach  through  an  ulcer  in  the  pylorus.  He 
thought  the  disease  began  as  the  result  of  an 
injury  to  abdomen  received  in  a  fall  eighteen 
months  before,  and  that  the  patient's  life  would 
have  been  saved  by  an  operation  proposed  to 
him,  but  refused. 

Bifid  Meckel's  Diverticulum.— Y)x.  Johnston 
showed  a  case  of  Meckel's  dirverticulum  ilei  hav 
ing  a  bifid  extremity.  He  did  not  know  of  its 
having  any  anatomical  significance. 

Dr.  Shepherd  stated  that  this  was  the  first 
example  he  had  seen  of  a  bifid  Meckel's  dirverti- 
culum. 

Extreme  Dilatation  of  the  Heart. — Dr.  John- 
ston also  exhibited  a  specimen  of  extreme  dilata- 
tion of  the  right  side  of  the  heart,  from  a  man 
aged  40.  The  right  chambers  contained  2  7  ounces 
of  blood  and  a  soft  clot.  Tricuspid  orifice  meas- 
ured 9  mm.  in  circumference.  Pulmonary  orifice 
slighdy  dilated  ;  valve  competent ;  other  valves 
normal.  Dilatation  of  left  ventricle  only  trifling. 
No  hypertrophy   of  heart   wall  and  no   marked 


degeneration  of  the  muscle.  Patient  had  also 
right-sided  chronic  tubercular  pleurisy  with  the 
dense  fibrous  exudation  and  acute  unifonn  miliary 
tuberculosis  of  both  lungs  in  an  extreme  grade  in 
connection  with  the  arterioles.  The  case  was  • 
considered  puzzling  as  to  causation.  No  caseating 
mass  was  discovered  anywhere,  and  no  communi- 
cation of  any  such  mass  with  the  veins  or  thoracic- 
duct.  The  adhesions  could  not  embarrass  the  cir- 
culation in  any  way,  unless  by  interfering  with  the 
contraction  of  the  right  auricle.  He  thought  the 
obstruction  to  pulmonary  circulation  in- arterioles 
would  have  aggravated  the  dilatation  of  the  right 
heart. 

Dr.  Geo.  Ross  said  the  clinical  history  was  that 
of  an  acute  pleurisy  four  months  ago  not  well 
recovered  from.  A  prominent  feature  was  the 
marked  heaving  pulsation  in  epigastrium. 

Dr.  Stewart  thought  that  the  above  explana- 
tion did  not  account  for  so  extreme  a  dilatation. 
The  patient  might  previously  have  had  parenchy- 
matous changes  in  heart  muscle  which  were  not 
now  to  be  recognized. 

Puerperal  Cerebral  Embolism. — Dr.  Ross, 
exhibited  specimens  from  a  case  in  which  an 
abortion  was  followed  three  months  ago  by  embo-. 
lism  of  left  Sylvian  artery,  causing  right  hemi- 
plegia with  aphasia.  A  presystolic  murmur 
existed.  The  autopsy  by  Dr.  Johnston  showed 
extensive  warfy  vegetations,  but  no  sclerosis  of 
mitral  valve.  The  left  Sylvian  artery  was  oblite- 
rated and  transformed  into  a  fibrous  cord.  There 
was  softening  of  the  left  corpus  striatum  and 
interior  capsule. 

Dr.  Shepherd  thought  the  embolism  was  ex- 
cited by  fibrous  condition  of  the  blood  at  parturi- 
tion. He  had  reported  a  similar  case  to  the 
Society,  with  embolism  at  three  successive  labors. 

Tuberculous  Disease  of  Bladder  and  Kidney. — 
Dr.  Johnston  exhibited  for  Dr.  Bell  specimens 
from  a  case,  a  boy  aged  19,  where  a  cystotomy 
wound  had  remained  unhealed.  Death  followed 
in  one  year  with  symptoms  of  pyelo-nephritis. 
Autopsy  showed  old  tubercular  disease  of  right 
kidney  and  ureter ;  the  bladder  was  nearly  free 
from  disease,  but  prostate  was  extensively  in- 
volved. The  granulations  of  the  wound  were  tuber- 
cular, and  sections  showed  tubercle  bacilli  in 
them.  The  other  kidney  and  ureter  were  healthy, 
The  lungs  showed  acute  tuberculosis. 

Dr.  Bell  said  the  patient  had  chronic  disease 
of  knee-joint,  apparently  tubercular. 


TUB   CANADA   MEDICAL   RECORD. 


83 


Tail's  Operation. — Dr.  Wm.  Gardner  exhi- 
bited the  uterine  appendages  removed  from  two 
■patients  during  the  past  three  weeks.  In  the  first 
case  the  ovaries  were  cirrhotic  and  densely  adher- 
ent behind  a  retroflcxed  uterus.  Free  bleeding 
followed  the  separation  of  .the  adhesions,  treated 
by  the  drainage-tube.  The  patient  had  been  an 
invalid  for  fourteen  years  from  pelvic  pain  and 
profuse  and  painful  menstruation,  with  severe 
headaches.  She  is  slowly  recovering.  In  the 
second  case,  both  ovaries  were  enlarged  and  cystic, 
the  left  the  size  of  a  hen's  egg;  no  adhesions. 
The  symptoms  were  profuse,  and  painful  mens- 
truation and  constant  pelvic  pain.  Patient  reco. 
vered  without  a  single  bad  symptom.  In  both 
cases  the  abdominal  incision  was  an  inch  and  a 
half  in  length  only. 

Dr.  Gardner  also  reported  that  a  lady,  on 
whom  he  had  performed  ovariotomy  in  the  fourth 
month  of  pregnancy,  had  been  confined  a  week 
ago,  at  full  term,  of  a  male  child  weighing  ten 
pounds.  The  patient  was  the  mother  of  two 
children,  and  had  suffered  for  many  years  from 
cough,  haemoptysis,  and  purdent  expectora- 
tion. The  labor  of  six  hours'  duration.  It  was 
followed  by  inertia  of  the  uterus,  with  alarming 
hemorrhage.  She  is  now  recovering  without  any 
complication.  The  cough  and  expectoration  con- 
tinue. Dr.  Gardner  remarked  that  operative 
measures  were  much  preferable  and  safer  than  the 
old  treatment  of  tapping  the  tumor  or  bringing  on 
premature  labor. 

Dr.  Trenholme  asked  for  the  symptoms  which 
led  to  the  operation. 

Dr.  Gardner  replied — Intense  pain  in  pelvis 
and  back,  vomiting,  and  headache.  Last  preg" 
nancy  fourteen  years  ago,  and  suffered  ever  since. 
Patient  was  very  neurotic. 

Dr.  Mills  read  a  paper  upon  "  The  Cause  of 
Heart-beat  and  other  Problems  in  Cardiac  Physio- 
logy." 

Dr.  .\rmstrong  congratulated  Dr.  Mills  upon 
having  performed  so  important  a  service  to  science 
in  doing  this  original  work,  and  also  congratulated 
the  Society  in  being  able  to  receive  so  valuable  a 
paper. 

Dr.  Stewart  had  until  now  always  cherished 
hard  feelings  against  Mills,  Gaskell  and  the  others 
who  had  recently  overthrown  the  old  cardiac 
physiology  which  had  appeared  so  complete.  In 
studying  the  action  of  drugs  the  new  researches 
had  had  a  most  unsettling  effect  upon  his  views ; 


but  he  thought  that  when  the  theories  advanced 
by  Dr.  Mills  were  formulated  the  matter  would  be 
l)ut  on  a  sound  and  at  the  same  time  simple  and 
comprehensible  basis. 

3^m§i/e6S  i^f  Scimce. 

ON  THE  USE  OF  ARSENIC  IN  CERTAIN 

FORMS  OP  ANEMIA.* 

By  William  OsLER.t 

In  an  address  last  year.  Dr.  Wilks  remarked 
that  in  therapeutics  we  do  not  so  much  need  new 
remedies  as  a  fuller  knowledge  of  when  and  how 
to  use  the  old  ones.  I  do  not  know  a  more  strik- 
ing illustration  of  this  than  is  afforded  by  arsenic, 
a  good  old  remedy,  for  which  an  almost  new  use 
has  arisen  in  certain  cases  if  pernicious  anaemia. 
The  attention  of  the  profession  was  directed  to  the 
subject  by  Bramwell  in  1877,  and  although  various 
reports  bearing  witness  to  the  value  of  this  drug 
have  appeared  from  time  to  time,  the  knowledge 
of  its  efticacy  does  not  appear  to  be  very  wide- 
spread, and  there  are  still  points  in  connection 
with  its  employment  upon  which  we  need  infor- 
mation. These,  I  trust,  discussion  may  bring 
out,  and  render  clear  the  direction  which  future 
observation  should  take. 

In  treating  a  case  of  ansemia,  it  is  of  the  first 
importance  to  ascertain,  if  possible,  the  cause. 
For  convenience,  and  until  the  present  complex 
pathology  is  simplified,  we  may  classify  the 
anemias  into  secondary  and  primary ;  the  former 
induced  by  causes  acting  upon  the  blood  itself, 
the  latter  the  result  of  disturbance  in  the  blood- 
making  organs.  This  distinction,  not  always  clear, 
serves  to  separate  two  clinical  and  pathological 
groups  of  cases. 

The  secondary  anemias  are  the  most  common, 
and  arise  from  a  variety  of  causes,  as  haemorrhage, 
prolonged  drain  of  albuminous  material  in  chronic 
disease,  and  the  action  of  toxic  agents  in  the 
blood.  In  very  many  of  these  conditions  a  return 
to  the  normal  state  follows  naturally  upon  removal 
of  the  cause,  and  the  regeneration  of  the  cor- 
puscles may  take  place  with  extraordinary 
rapidity,  as  after  a  copious  bleeding  or  a  sharp 
fever ;  but,  as  a  rule,  iron  in  some  form  will  be 
found  useful  or  indispensable.  In  three  of  these 
secondary  anaemias  I  have  found  arsenic  very 
beneficial. 

I.  Iheanamia  of  Heart- Disease. — In  chronic 
valvular  trouble  we  not  infrequently  meet  with  an 
impoverished  condition  of  the  blood,  which  materi- 
ally aggravates  the  cardiac  distress.  The  comfort 
of  such  patients  is  in  direct  proportion  to  their 
corpuscular  richness,  and   without   any   apparent 

•  Read  before  the  Philadelphia  County  Medical  So- 
ciety, September  22,  1886. 

t  Professor  of  Clinical  Medicine  in  the  University  of 
Pennsylvania, 


84 


THE   CANADA   MEDICAL   RECORD. 


increase  in  the  valve  mischief,  a  reduction  in  the 
ratio  of  the  corpuscles  is  followed  by  shortness  of 
breath,  palpitation,  and  signs  of  heart-failure.  The 
value  of  iron  in  this  condition  is  well  known,  and 
its  combination  with  digitalis  a  universal  practice. 
Arsenic  is  also  indicated  in  these  cases,  particu- 
larly in  children,  or  if,  as  sometimes  happens,  iron 
does  not  agree.  In  June  of  this  year  I  saw  a  lad 
J.  VV.,  St.  14,  who  had  had  chronic  valve-disease 
for  four  years.  He  had  been  wintering  in  the 
South,  and  went  afterwards  to  the  Arkansas  Hot 
Springs.  When  I  saw  him  the  anemia  was  very 
marked,  and  he  suffered  from  breathlessness  on 
the  slightest  exertion.  There  was  no  cardiac 
distress,  and  the  compensation  was  not  seriously 
disturbed.  At  the  Hot  Springs  he  had  several 
chills,  with  fever,  for  which  he  had  taken  quinine. 
He  was  ordered  Fowler's  solution  of  arsenic,  be- 
ginning with  M  iii,  three  times  a  day,  and  increas- 
ing to  M  vi,  if  well  borne.  He  had  been  taking 
an  iron  and  strychnine  pill  for  several  weeks,  and 
had  with  him  a  boxful,  which  he  was  advised  to 
finish.  Digitalis  was  prescribed,  but  was  not  to 
be  taken  unless  there  were  signs  of  heart-failure. 
The  diet  was  carefully-  regulated.  The  lad  im- 
proved rapidly,  and  within  six  weeks  had  a  good 
color,  and  had  gained  several  pounds  in  weight. 
He  had  not  needed  tlie  digitalis.  The  arsenic 
was  well  borne.  The  improvement  had  continued 
on  the  3rd  of  this  month.  Possibly  here  there  was 
a  malarial  taint  but,  in  any  case,  if  medicinal 
agents  had  anything  to  do  with  the  rapid  improve- 
ment, the  credit  is  due  to  the  Fowler's  solution. 

2.  ]?i  Malarial  ancemia. — The  value  of  arsenic 
in  chronic  ague  poisoning  is  so  well  recognized 
that  I  need  scarcely  detain  you  with  the  narration 
of  cases  in  support.  There  have  been  several  at 
my  clinic  during  the  jxist  year  in  which  the  im- 
provement in  the  blood  condition,  as  tested  by 
the  hasmacytometer,  has  been  very  remarkable. 
One  case  in  particular  from  Cape  May,  I  may 
refer  to,  as  the  patient,  with  enlarged  spleen,  had 
on  two  occasions  ha;morrhage  from  the  stomach. 
The  arsenic  in  this  case  was  pushed  for  several 
months  in  increasing  doses.  At  one  time  he  took 
Mxxxvi  of  the  Fowler's  solution  daily.  When 
last  heard  from,  in  July,  he  was  at  work,  and  had 
gained  in  flesh  and  strength.  On  May  12,  the 
date  of  the  last  blood  count,  the  percentage  was 
over  eighty  (it  had  been  scarcely  fifty),  and  the 
spleen  had  diminished  materially  in  volume.  In 
certain  of  these  cases  the  ratio  of  the  corpuscles 
may  increase  rapidly  without  any  essential  change 
in  the  volume  of  the  spleen.  In  the  case  of  M.D., 
a  girl  of  15,  who  has  been  in  the  University  Hos- 
pital on  several  occasions  for  the  past  two  years, 
the  arsenic,  which  was  very  persistently  employed, 
does  not  appear  to  have  reduced  the  spleen  in  the 
slightest  degree,  and  yet  under  its  use  the  cor- 
puscles rose  to  eighty-five  per  cent.  In  this  in- 
stance, with  a  history  of  malaria,  there  is  evidence 
also  of  congenital  syphilis,  to  which  may  possibly 
be  due   the   splenic   enlargement.     Injections  of 


I  arsenic  into  the  substance  of  the  organ  were  tried 

,  without  benefit. 

3.   Certain  Ancemias  "0/  Gastric  Origin. — As 

'  a  tonic  in  debilitated  states  of  the  stomach, 
arsenic  has  long  been  a  favorite  remedy  with 
many  practitioners.  It  is  sometimes  also  of 
great  service  in  the  ansemia  of  chronic  gastric 
catarrh,  particularly  in  alcoholic  patients.  A 
good  illustration  of  this  was  under  my  care  at 
the  Philadelphia  Hospital  this  spring.  W.  G., 
aged  25,  waiter,  hard  drinker,  history  of  dyspep- 
sia for  several  years.  Admitted  April  5  with 
anaemia  and  attacks  of  giddiness.  Ill  for  ten  days  ; 
vomiting,  pain  in  stomach,  and  fainting  spells  on 
attempting  to  stand.  Had  been  failing  in  strength 
for  some  time  and  getting  pale.  Had  suffered 
from  palpitation,  and  said  he  had  vomited  blood. 
He  was  profoundly  anaemic,  and  could  not  stand 
without  danger  of  fainting.  Tongue  coated  ;  great 
irritability  of  stomach  ;  vomiting  on  the  slightest 
provocation  ;  great  throbbing  of  abdominal  aorta. 
He  was  kept  at  rest,  given  a  milk  diet,  and  Fow- 
ler's solution  in  3  drop  doses.  The  red  corpuscles 
were  not  more  than  twenty-five  per  cent.,  and  the 
coloring  matter  about  the  same.  The  improvement 
was  rapid,  and  by  the  2  ist  the  corpuscles  had  risen 
to  over  forty  per  cent.,  and  the  gastric  irritation 
had  almost  disappeared.  The  arsenic  was  well 
borne,  and  was  gradually  increased  to  Mvii  t.  i. 
d.,  and  on  May  4  he  was  ordered  small  doses  of 
nitromuriatic  acid.  On  May  17  he  left  the  hospi- 
tal with  a  fair  digestion  and,  for  him,  tolerably 
good  color.  On  June  24,  when  re-admitted  with 
extensive  pleuro-pneumonia,  he  stated  that  he  had 
recovered  strength  rapidly,  and  had  been  at  work. 
Possibly  in  this  case,  there  was  ulceration  of  the 
stomach  in  addition  to  the  chronic  catarrh  ;  but, 
whatever  the  condition,  it  was  one  in  which  the 
arsenic  seemed  to  be  highly  beneficial,  and,  as  he 
received  no  other  medication,  we  may  reasonably 
attribute  to  it  the  stimulation  of  the  blood-making 
function.  As  we  shall  see,  there  are  anaemias  of 
gastric  origin  in  which  this  drug  is  powerless. 
There  are  some  of  the  secondary  anaemias  which 
have,  in  my  experience,  been  apparently  benefited 
by  the  use  of  arsenic. 

Turning  now  to  the  primary  group,  we  have 
here  again  for  convenience  to  make  a  division  of 
the  cases.  There  is,  first,  a  large  section  of  what 
may  be  called  cytogenic  ansmiaSj  in  which  the 
reduction  and  alteration  in  the  corpuscles  is  associ- 
ated with  evident  changes  in  the  hasmatogenous 
tissues,  — the  spleen,  lymph-glands,  and  bone  mar- 
row. Sometimes  these  changes  are  accompanied 
by  an  increase  in  the  colorless  corpuscles  of  the 
blood  ;  and,  depending  on  the  organ  involved,  we 
then  speak  of  splenic,  lymphatic,  or  medullary 
leukfemia.  If  there  is  no  marked  increase  in  the 
white  corpuscles  we  call  the  cases  splenic  auKmia, 
lymphatic  anaemia  (Hodgkin's  disease),  and 
medullary  ansmia.  The  pronounced  leucocytosis 
in  certain  of  the  cases,  which  gives  a  special  char- 
acter  to  the  blood,   is  probably    not    such    an 


I'UE   CANADA   MEDICAL   RECoHO. 


85 


important  factor  as  we  have  hitherto  supposed, 
and  there  are  such  insensible  gradations  between 
the  cases  that  in  a  strict  classification  they  may 
be  appropriately  grouped  together.  Secondly, 
there  is  the  cinious  primary  ana;niia  known  as 
ciilorosis,  characterized  by  well-marked  etiological 
and  anatomical  peculiarities ;  and,  thirdly,  we 
have  the  much-discussed  affection,  pernicious  or 
essential  an;cmia. 

'I'ne  anaemias  of  this  primary  group  offer  a 
remarkable  therapeutic  study,  embracing  cases  of 
the  most  hopetul  and  the  most  hopeless  character. 
.\  clearer  kuowledj<e  of  the  etiology  and  pathology 
of  certain  of  these  forms  may  give  a  clue  to  lines 
of  treatment  more  fortunate  than  those  we  now 
possess  ;  for,  if  we  except  chlorosis,  the  majority 
of  the  cases  of  this  class  of  anaemias  prove  fatal. 
Leukemia,  splenic  anaemia,  when  non-malarial, 
Hodgkin's  disease,  are  considered  incurable  affec- 
tions, and  very  many  of  the  cases  of  pernicious 
anaemia  prove  obstinate  to  all  treatment. 

The  relation  of  arsenic,  as  a  remedy,  to  this  group 
of  primary  anajmias  is  worthy  of  our  closest  study, 
more  particulaly  as  of  late  years  remarkable 
results  have  been  reported  from  its  use.  Chlorosis 
may  here  be  excluded  from  our  consideration,  as 
it  would  only  be  in  a  strangely  obstinate  case  that 
a  practitioner  would  require  to  employ  arsenic. 
The  specific  action  of  iron  in  increasing  the  defec- 
tive haimoglobin  of  the  corpuscles,  and  doubtless, 
also,  in  stimulating  the  formation  of  new  ones,  is 
one  of  the  few  instances  in  therapeutics  in  which 
definite  tissue-changes,  under  the  influence  of  a 
drug,  may  be  followed  with  scientific  accuracy 
from  day  to  day  and  from  week  to  week. 

In  leukix.mia  and  Hodgkin  s  disease  arsenic  has 
been  extensively  tried,  occasionally  with  temporary 
success.  We  must  bear  in  mind  in  these  affections 
that  there  are  natural  periods  of  improvement 
without  any  special  medication.  I  have  met 
with  this  in  leukaemia,  and  it  must  be  taken  into 
account  in  our  estimation  of  the  effect  of  a  remedy. 
Personally,  I  have  not  seen  any  benefit  from  the 
use  of  arsenic  in  this  disease.  It  was  given  in 
several  of  the  eleven  cases  which  I  saw  in  Mont- 
real, all  of  which  were  fatal.  In  Hodgkin's  disease 
the  report  is  more  favorable.  In  1S83  I  had  two 
cases  both  in  women,  in  which  the  large  glands  of 
the  neck  and  armpits  reduced  materially  under  the 
prolonged  use  of  Fowler's  solution,  but  I  do  not 
know  the  subsequent  history  of  the  cases.  Several 
writers  have  reported  most  satisfactory  results. 
Karewski*  had  three  recoveries,  and  of  eleven 
cases  treated  at  the  Stockholm  Hospital  five  were 
benefited. f  The  persistent  use  of  it  in  full  doses 
for  many  months  is  probably  the  most  efficacious 
remedy  we  possess  in  this  disease. 

In  cases  of  splenic  ancemia  of  non-malarial 
origin,  I  cannot  say  that  I  have  seen  any  special 
benefit  from  arsenic. 

•^\Berliner  Klin.    IVochenschrift,  1884,  17  and  18. 
\  Abstract  in  Year  Book  of  Tie.-itment  for  1884. 


We  come  now  to  pernicious  ancemia,  in  which 
so  mucii  has  been  gained  by  the  judicious  use  of 
this  drug.  Pernicious  anaemia  includes  cases  of 
very  diverse  etiology.  Any  severe  anaemia  tending 
to  a  fatal  termination  may  well  be  termed  progres- 
sive and  pernicious.  In  a  considerable  proportion 
pregnancy  and  parturition  appear  to  have  been 
determining  factors,  while  others  can  be  directly 
traced  to  defective  food,  as  in  many  of  the  Zurich 
and  Berne  observations.  Excluding  these,  we 
have  a  group  of  cases  of  which  the  etio- 
logy is  obscure,  and  to  which,  in  our  present 
knowledge,  the  terms  idiopathic  of  Addison  and 
essential  of  Lebert  are  applicable.  Every  year, 
however,  we  are  reducing  the  number  of  cases 
which  we  can  strictly  call  idiojjathic.  It  is  rea- 
sonable to  suppose  that  the  extensive  changes  in 
the  bone  marrow  found  in  certain  instances  are 
directly  related  to  the  profound  disturbance  in 
blood  formation,  just  as  is  the  case  in  hyperplasia 
of  the  spleen  or  of  the  lymph-glands.  An  ansemia 
medullaris  is  now  very  generally  recognized. 
Then  there  are  the  cases  of  pernicious  antemia  in 
which  the  primary  disturbance  seems  to  be  in  the 
gastro-intestinal  canal,  and  the  condition  of  the 
blood  the  direct  consequence  of  the  impaired 
nutrition.  I'here  remain  cases  in  which  none  of 
these  conditions  prevail,  and  neither  during  life 
nor  after  death  do  we  find  any  clue  to  the  origin 
of  the  anaemia.  To  such,  for  the  time,  the  desig- 
nation idiopathic  is  applicable.  Clinically,  it  may 
be  impossible  to  distinguish  between  these  various 
forms,  and  the  etiology  is  often  very  obscure  and 
gives  us  no  help.  The  cases  which  come  on 
during  or  after  pregnancy,  or  which  result  from 
inanition,  are  readily  recognized,  and  ofter,  as  a 
rule,  a  more  hopeful  prognosis ;  but  we  cannot 
yet  with  any  accuracy  separate  during  life  the 
cases  in  which  there  is  atrophy  of  the  mucous 
membrane  of  the  stomach,  or  extensive  medullary 
changes,  from  those  in  which  these  conditions  are 
absent.  A  more  careful  study  may  in  the  future 
enable  us  to  do  so,  and  I  have  laid  stress  upon 
these  differences  in  etiology  and  pathology,  because 
in  them  will  possibly  be  found  the  explanation  of 
the  success  or  failure  of  certain  remedies. 

Prior  to  1877  arsenic  was  not  systematically 
employed  in  pernicious  ansmia,  and  to  Bramwell 
is  undoubtedly  due  the  credit  of  its  introduction. 
Neither  MiillerJ  nor  Eichorst,§  in  their  elaborate 
monographs  published  in  1S77  and  1878,  speak  of 
its  use.  Padley,||  in  an  interesting  review  of  the 
question,  has  carefully  analyzed  the  cases  in  which 
arsenic  was  not  employed,  and  finds  that  of  forty- 
eight,  forty-two  were  fatal,  while  twenty-two  cases 
treated  with  arsenic  sixteen  recovered,  two  im- 
proved, and  four  proved  fatal ;  and  he  remarks, 
that  "  in  the  whole  list  there  is  not,  with  one 
exception,  a  single   authentic  case  of  recovery  in 

J  De  Progressive  Pevniciose  Anemia.     Zurich,  1877. 
§  De  Progressive  Perniciose  Araemia.     Leipzig,  1878, 
II  Lancet,  1883,  ii. 


■8^6 


THE  CANADA  MEDICAL  RECORD. 


which  arsenic  did  not  form  the  chief  part  of  the 
treatment."  Certainly  the  reports  of  this  affection 
since  1880  have  been  much  more  encouraging, 
and  it  need  not  necessarily  be  regarded  as  "  almost 
invariably  fatal,"  to  use  the  words  of  a  leading 
•text-book.  Of  three  cases  of  pernicious  anaemia 
which  I  have  seen  this  year  two  have  already 
^proved  fatal,  and  one  in  a  fair  way  to  recovery. 

Case  I. — A  man,  aged  42,  I  saw  with  Dr. 
Henry.  We  reported  it  in  full  in  the  April  num- 
ber of  the  Aniet  ican  Jonrnal  of  Medical  Sciences, 
and  it  is  remarkable  as  an  instance  of  pernicious 
•anaemia,  with  advanced  atrophy  of  the  mucous 
membrane  of  the  stomach.  Arsenic  was  given 
during  the  course  of  the  disease,  but  not  for  any 
length  of  time,  as  it  seemed  to  bring  on  diarrhcea. 

Case  II. — A  woman,  aged  about  45,  I  saw 
with  Dr.  Weir  JVIitchell  on  January  20.  She  had 
been  the  subject  of  dyspeptic  attacks  for  some 
years,  and  had  become  very  pale,  and  during  last 
year  the  anjemia  reached  an  e.xtreme  degree. 
With  rest,  systematic  feeding,  iron,  and  arsenic 
she  improved,  and  was  able  to  go  home  and  attend 
to  her  household  duties.  I  saw  her  in  January  on 
her  way  South.  She  returned  in  March  very  much 
worse  ;  was  again  placed  on  the  plan  of  treatment 
which  had  proved  so  successful  in  the  first  attack, 
but  the  stomach  was  so  irritable  and  the  digestive 
power  so  enfeebled  that  she  sank,  and  died  on  the 
18th  of  April.  The  improvement  in  her  first 
attack  was  attributed  by  Dr.  Mitchell  to  the  care- 
ful feeding  and  rest  as  much  as  to  the  medicine. 

Case  III. — An  active  business  man,  aged  43  ; 
seen  March  4.  History  of  dyspepsia,  and  for  the 
p.\st  si.x  months  failure  in  strength.  Shortness  of 
breath  on  the  slightest  exertion,  and  at  times  at- 
tacks of  agonizing  pain  at  the  heart  resembUng 
angina.  He  had  not  lost  much  flesh  ;  indeed,  as  is 
usual  in  these  cases,  the  subcutaneous  fat  was  well 
developed.  When  first  seen,  the  anjemia  was 
marked;  lips  and  tongue  very  pale,  and  sclerotics 
pearly.  The  general  surface  did  not  look  so  pale, 
on  account  of  his  dark  color  and  a  decided  saftron- 
yellow,  sub-icteroid  tint  of  the  skin.  The  tempera- 
ture was  a  little  elevated;  pulse  100,  and  of  mod- 
erate volume.  With  the  exception  of  heart-mur- 
mur, there  were  no  symptoms  elicited  in  the 
■examination  of  thoracic  and  abdominal  viscera. 
The  blood  showed  in  a  marked  manner  the  cor- 
puscular changes  of  advanced  anaemia.  The  blood 
count  could  not  be  made  at  the  time,  but  when  I 
next  saw  him,  two  weeks  later,  there  were  only 
700,000  red  corpuscles  to  the  cubic  millimetre, and 
the  color  presentage  was  only  about  twenty.  He 
was  put  to  bed,  absolute  rest,  given  a  milk  diet, 
ordered  massage  once  a  day,  and  as  medicines  bis- 
muth and  carbonate  of  sodium,  with  Fowler's 
solution  Mv,  three  times  a  day,  to  be  increased 
one  minim  daily  at  the  end  of  a  week.  He  had 
been  taking,  by  the  advice  of  his  physician^  an 
elixir  of  iron  and  strychnine,  which  was  continued. 
For  two  months  there  was  not  much  apparent 
change,  though  the  ratio  of  the  colored  corpuscles 


increased  to  over  1,500,000  per  cubic  millimetre. 
The  arsenic  had  beep  pushed  to  15  drops  three 
times  a  day,  when  puffiness  of  the  eyelids  and 
forehead  came  on,  and  it  was  omitted  for  a  week, 
and  started  again  with  Mv.  On  reaching  Mxiii  a 
slight  red  rash  appeared,  and  it  was  stopped,  and, 
after  beginning  at  Mv  again,  he  reached  Mxx  t.  i. 
d.  On  these  large  doses  he  seemed  to  improve 
more  rapidly,  and  he  bore  them  for  two  weeks  or 
more,  when  gastric  irritation  supervened,  with 
diarrhcea.  The  drug  was  then  stopped  for  ten 
days,  and  pills  of  y|-„  of  a  grain  of  arsenious  acid 
ordered.  On  January  31  he  was  allowed  to  get 
up.  By  June  13  he  was  able  to  move  to  Cape 
Alay.  The  blood  condition  has  rapidly  improved, 
and  at  the  last  count  the  corpuscles  were  nearly 
4,000,000  to  the  cubic  millimetre.  When  seen  on 
September  7  he  looked  remarkably  vigorous,  had 
a  good  appetite,  was  at  business,  and  feeling  very 
well.  It  would  be  incorrect  to  attribute  the  suc- 
cess in  this  case  entirely  to  the  arsenic,  but  rather 
to  the  plan  of  treatment,  in  which  it  was  a  very 
important  factor.  It  will  be  found,  I  think,  that 
absolute  rest  in  bed,  with  daily  massage,  and  the 
strictest  attention  to  feeding,  are  most  important 
features  in  the  successful  management  of  these 
cases. 

Arsenic  has  been  spoken  of  as  a  specific  in 
pernicious  anaemia.  This  is  a  mistake.  The  dis- 
ease, as  I  have  indicated,  is  so  varied,  and  results 
from  the  operation  of  such  diverse  causes,  that  we 
cannot  expect  any  one  remedy  to  be  uniformly  ac- 
tive. In  a  majority  of  the  cases  iron  is  useless, 
but  it  sometimes  succeeds  after  arsenic  has  failed 
absolutely.  Such  a  case  was  reported  by  Finlay* 
last  year,  which  was  cured  by  iron  after  a  thorough 
and  but  ineffectual  use  of  arsenic.  I  do  not  think 
we  understand  fully  the  conditions  in  which  it  is 
most  serviceable,  and  for  the  time  we  must  be 
content  to  employ  it  empirically,  on  faith  of  the 
success  which  has  attended  its  administration  in  so 
many  cases.  Ultimately,  we  may  hope  to  be  able 
to  discriminate  between  the  cases  which  call  for 
iron  and  those  in  which  arsenic  is  indicated,  and 
with  this  object  in  view  the  cases  which  come  under 
observation  should  be  carefully  studied. 

Mode  of  Administration. —  I  usually  give  the 
liquor  arsenicalis  (liquor  potassii  arsenitis),  begin- 
ning, in  an  adult,  with  Mv  three  times  a  day. 
Occasionally  this  is  found  too  much,  and  I  reduce 
the  amount  to  2  or  3  minims.  After  ten  days,  if 
well  borne,  I  order  an  increase  of  a  minim  each 
day,  so  that  by  the  end  of  the  second  week  the 
patient  is  taking  10  or  12  minims  three  times  a  day. 
This  is  kept  up  for  a  week,  and  then  gradually  in- 
creased until  the  physiologicafeffects  are  obtained. 
The  amount  which  will  induce  these  varies  with 
different  individuals,  and  those  who  bear  it  best 
seem  to  improve  the  most  rapidly.  I  have  thought 
sometimes  that  the  small  doses  are  not  so  well 
borne  as  larger  ones,  and  are  more  likely  to  cause 


^  Lancit,  1885,  i. 


THE   CANADA   MEDICAL  RECORD, 


87' 


gastric  irritation.  Young  people  hear  it  remarkably 
well.  Within  the  phy.siological  effects  there  is  no 
special  limit  to  the  quantity,  and,  as  in  chorea,  I 
make  them  my  guide  in  the  administration.  A  very 
important  point  is  the  continuous  use  for  many 
weeks  or  months,  omitting  for  a  few  days  if  un- 
pleasant effects  arise.  Even  after  apparent  recov- 
ery I  advise  the  continuance  of  the  drug.  When 
the  liquor  arseniealis  is  not  well  borne, the  arsenious 
acid  in  pills  may  be  tried,  or  the  solution  may  be 
given  hypodermically.  In  these  cases  of  severe 
anaimia  I  never  care  to  use  hypodermic  injections 
systematically,  as  I  have  seen  ecciiymosis  of  the 
tissues  follow,  and  in  several  instances  distressing 
small  abscesses.  By  the  rectum,  it  is  usually  well 
borne. 

The  three  points  I  would  indicate  for  this  are  : — 

1.  In  what  secondary  anremia  is  arsenic  benefi- 
cial, and  under  what  conditions  is  it  preferable  to 
iron  ? 

2.  In  pernicious  anremia  what  cases  are  bene- 
fited by  arsenic  ?  What  by  iron  ?  How  shall  we 
frame  rules  for  our  guidance  in  the  matter,  or  must 
we  still  work  empirically  ? 

3.  In  the  administration  of  arsenic,  what  is  the 
best  form  and  method  ? — Therapeutic  Gazette. 


CONTRIBUTIONS   TO   PRACTICAL  SUR- 
GERY. 

By  Prof.  John  Chiene. 

Amputations  of  the  Hand.  In  partial  amputa- 
tion of  the  fingers  and  thumb,  utilize  any  available 
skin  for  the  flap.s.  Let  your  main  object  be  to 
leave  as  long  a  stump  as  possible  ;  do  not  sacrifice 
length  in  order  to  follow  any  special  method  of 
amputation.  Let  the  cicatrix  be,  if  possible, 
posterior,  using  the  tissue  on  the  anterior  aspect 
of  the  digit  for  the  principal  covering  to  the  divid- 
ed bone.  When  the  injury  or  disease  is  such  as 
to  necessitate  amputation  at  a  higher  level  than  the 
attachments  of  the  flexor  and  extensor  tendons  to 
the  second  phalanx,  is  it  right  to  go  at  once  to  the 
knuckle  and  perform  complete  amputation  of  the 
finger  ?  If  the  tendons  can  be  saved  and  attached 
to  the  bone  then  the  first  phalanx  should  be  left. 
If  this  cannot  be  done,  then  amputate  at  the 
metacarpo-phalangeal  joint. 

In  amputating  a  digit,  or  a  digit  along  with  a  portion 
of  its  metacarpal,  avoid,  if  possible,  any  interference 
with  the  palm  of  the  hand  ;  avoid  a  cicatrix  in  the 
palm ;  a  cicatrix  in  this  situation  is  apt  to  be  ten- 
der, and  this  interferes  with  the  grasping  power 
of  the  hand. 

In  amputating  a  finger  do  not  interfere  with  the 
breadth  of  the  hand.  In  a  case  requiring  removal 
of  one  or  more  metacarpals  leave,  if  possible, 
healthy  periosteum ;  new  bone  is  formed,  and  a 
more  useful  hand  is  the  result.  Let  this  rule 
regarding  the  periosteum  hold  good,  very  specially 
in  connexion  with  the  metacarpal  bone  of  the 
thumb.  Any  osseous  projection  at  the  radial  edge 
of  the  hand  is  a  point  of  attachment  for  the  muscles 


of  the  ball  of  the  thumb,  and  is  of  the  greatest  use 
as  an  opposing  point  to  the  fingers. 

In  patients  in  whom  manual  labor  is  their  source 
of  income,  do  not,  in  amputating  the  fore  and  lit- 
tle fingers,  interfere  with  the  heads  of  the  corires- 
])onding  metacarpals,  if  a  sufficient  covering  cain 
be  obtained.  In  other  cases,  for  the  sake  of;' 
appearance,  the  head  of  the  metacarpal  may  be-- 
removed  obliquely. 

Take,  if  possible,  your  main  flap  in  amputating  ' 
any  of  the  fingers  from  the  flexor  aspect  of  the- 
finger.  Do  not  approach  the  palm  in  your  incisions. 
In  the  middle  aiid  ring  fingers  the  best  result — 
looking  to  use  and  not  to  appearance — is  obtained 
in  the  following  way  :  Enter  the  knife  at  the  knuckle,  - 
carry  it  outwards  and  forwards  towards  the  web 
tmtil   a  point  midway   between    the  anterior  and 
jjosterior  aspects  of  the  web  is  reached.     Do  the 
same  on    the    other  side  of  the  finger ;  these  two 
incisions  form  a  right  angle  with  each  other.     A 
flapjs  then  made  from  the  anterior  aspect  of  the 
first  phalanx.     The  finger  is  removed,  and  the  flap, 
i.s  turned  back  into  posit,ion,  the  apex  of  the  flap, 
fitting   into   the   angle  where  the  incisions  begiiv 
over  the  knuckle.     \!>y  this  method,  the  incisions- 
do  not  approach  the  palm,  the  breadth  of  the  hand 
is  not  interfered  with,  and  the  resulting  cicatrix  is- 
posterior. 

In  crushes  of  the  hand  save  as  much  as  possible;, 
save  a  finger  or  a  portion  of  a  finger;  save  any 
part  of  the  thumb ;  save  any  portions  of  the  meta- 
carpals. The  most  useless  natural  hand  is  more 
useful  than  any  artificial  substitute. 

In  contractions  of  the  palmar  fascia  Busch's 
operation  in  severe  cases  affords  the  best  result. 
In  simple  cases  the  subcutaneous  division  otthe 
tense  fibres  is  generally  sufficient.  It  is  to  be 
remembered  that  there  are  two  directions  in  which 
the  contracted  fascial  fibres  must  be  divided 
parallel  to  the  skin  surface,  and  at  right  angles  to 
the  skin  surface  ;  by  the  first,  the  fibres  at  right 
angles  to  the  skin  surface,  which  dip  down  between, 
the  flexor  tendons,  are  divided  ;  by  the  second,  the 
longitudinal  fibres  of  the  contracted  palmar  fascia 
are  divided. 

Busch's  operation  consists  in  dissecting  the  con- 
tracted fascia  from  the  flexor  sheaths  by  a  Vshap- 
ed  flap,  the  apex  of  the  flap  looking  to  the  wrist;; 
the  fingers  are  then  extended,  and  the  flap  attached 
with  horse  hair  stitches  to  the  incision,  while  the 
opposing  edges  of  the  proximal  portion  of  the 
raw  surface  are  accurately  stitched  together.  The 
result  is  a  Y-shaped  cicatrix,  and  an  extended  finger 
or  fingers  with  no  tendency  to  subsequent  con- 
traction. 

In  wounds  of  the  palm  the  persistent  haemorr- 
hage is  often  due  to  the  palmar  vessels  being  simply 
punctured,  and  not  cut  fairly  across.  Divide  the 
artery  wounded  by  deepening  the  accidental 
wound.  Retraction  of  the  wounded  vessel  takes 
place,  and  simple  pressure  is  sufficient  to  arrest  the 
haemorrhage.  Check  the  force  of  the  blood  flow 
by  fully  flexing  the  forearm  on  the  upper  arm  with 


88 


THE   CANADA   MEDICAL   RECORD. 


a  pad  at  the  bend  of  the  elbow.  By  these  means 
the  haemorrhage  is  arrested  ;  if  it  still  persists, 
plug  the  wound  in  the  palm ;  if  this  fails,  tie  the 
brachial  artery. 

Whitlow.  In  deep-seated  digital  inflammations 
over  the  first  and  second  phalanges,  the  cause  is 
either  an  inflammation  of  the  flexor  sheath,  or  it 
may  have  a  periosteal  origin.  In  inflammation 
over  the  anterior  aspect  of  the  terminal  phalanx, 
the  cause  is  periosteal,  and  the  worst  that  can  haj)- 
pen  is  necrosis  of  the  terminal  phalanx. 

In  all  cases  make  your  incision  early,  central 
and  in  the  long  axis  of  the  finger.  Relieve  tension, 
and  prevent  spread  of  the  inflammation  from  the 
flexor  sheath  on  the  finger  to  the  common  flexor 
sheath  on  the  anterior  aspect  of  the  wrist.  In 
periosteal  cases  early  incisions  prevent  necrosis 
of  the  affected  phalanx.  'Whitlows  are  infective 
conditions,  and  are  due  to  a  colony  of  micrococci. 
The  periosteal  whitlows  are  cases  of  acute  sup- 
purative periostitis. 

Relieve  the  tension,  and  the  evil  effects  of  the 
pathogenic  micrococci  will  soon  subside  ;  prevent 
sepsis  caused  by  the  entrance  of  septic  organisms 
from  the  external  air,  and  rapid  healing  will  be  the 
result.  In  patients  who  are  liable  to  whitlows,  as 
in  people  who  suffer  from  boils  and  carbuncles, 
administer  corrosive  sublimate  internally,  it  is  a 
most  powerful  antifermentative. 

In  inflammation  of  the  common  flexor  sheath 
relieve  the  tension  by  making  an  incision  into  the 
sheath  in  the  forearm  above  the  angular  ligament. 
Take  care  and  not  injure  in  your  incision  the  med- 
ian nerve  ;  adopt  Hilton's  method  to  avoid  the  risk. 
After  opening  the  flexor  sheath  in  the  forearm,  pass 
a  curved  probe-pointed  bistoury  from  the  wound 
under  the  angular  ligament,  divide  it  with  the  knife, 
and  in  this  way  the  palmar  tension  is  effectually 
relieved. 

In  amputation  for  injury  or  disease  in  the  upper 
extremity,  do  not  follow,  at  the  cost  of  length,  any 
special  method  of  amputation  ;  get  your  flaps  as 
best  you  can,  so  as  to  obtain  as  long  a  stump  as 
])Ossible.  The  longer  the  stump  the  easier  it  is  to 
fit  on  an  artificial  substitute.  In  severe  injuries 
of  the  upper  extremity  in  which  an  endeavor  is 
made  to  save  thelirnb,  more  especially  in  cases  in 
which  the  line  of  fracture  is  oblique,  or  in  which, 
from  comminution  of  the  bones,  it  is  difficult  to 
keep  the  fragments  in  accurate  position,  remember 
that  the  use  of  the  extension  apparatus  is  as  val- 
uable in  the  upper  as  it  is  universally  acknowledged 
to  be  in  the  lower  extremity.  Thick  sheet  lead 
makes  a  most  efiicient  splint,  it  can  be  easily 
moulded  to  the  injured  limb  over  the  dressing;  by 
iis  weight  it  steadies  the  limb  and  keeps  it  at  rest. 

In  sW  fractures  near  the  joints  the  soft  tissues 
are  to  a  certain  extent  saved  from  injury  when  the 
bone  gives  way,  but  still  in  all  cases  there  must  be 
some  injury  to  the  tendons,  muscles,  joint,  and 
ligaments.  These  structures  require,  for  the  pro- 
per performance  of  their  functions,  nobility  ;  jjro- 
loni^ed  rest  to  prevent  any  risk  of  non-union  of  the 


fractured  bone,  may  be  followed  by  stiffness  of  the 
neighboring  joint,  by  adhesions  of  the  ligaments, 
and  organized  effusiop  into  the  sheaths  of  the 
tendons.  Tlie  result  is  a  united  fracture  with  a 
stiffened  joint. 

Non-union  of  bone  does  not  occur  in  con- 
sequence of  occasional  gentle  passive  movement 
along  with  massage,  if  in  the  intervals  the  parts 
are  kept  at  perfect  rest.  Non-union  is  much  more 
likely  to  occur  if  slight  constant  movement  is 
allowed  between  the  broken  ends.  For  example 
in  fracture  of  the  shaft  of  the  humerus,  and  in 
fracture  of  the  shafts  of  the  radius  and  ulna,  it  is 
important  to  keep  the  elbow-joint  at  rest  by  means 
of  a  rectangular  splint.  If  the  elbow-joint  is  not 
kept  quiet,  there  is  more  or  less  constant  move- 
ment at  the  seat  of  fracture.  This  movement  is 
very  different  from  gentle  passive  movement  every 
second  day,  with  perfect  rest  in  the  intervals,  as 
in  fractures  in  the  region  of  the  wrist,  elbow,  and 
shoulder. 

In  Colles'  fracture  allow  the  patient  to  move 
his  fingers  and  thumb  after  the  first  week,  and  after 
ten  days  take  off  the  splints  every  second  day  and 
move  the  fingers,  thumb,  and  wrist-joint  gently. 
Take  off  all  splints  at  the  end  of  4  weeks.  Too 
prolonged  rest  in  this  injury  often  ends,  more 
especially  in  old  people,  in  irremediable  stiffening 
of  the  fingers,  thumb,  and  wrist-joint. 

In  fractures  into  the  elbow-joint  early  gentle 
passive  movement  at  the  end  of  a  fortnight  every 
second  day  prevents  stiffness  of  the  elbow-joints. 

In  fractures  of  the  upper  extremity  of  the  humer- 
us begin  passive  movement  after  a  fortnight. 

In  dislocation  of  the  thumb,  backwards  at  the 
metacarpophalangeal  joint,  dorsi-flexion  of  the 
thumb,  with  pressure  on  the  head  of  the  dislocated 
phalanx,  is  the  simplest  way  to  treat  the  case. 
In  dislocation  of  the  fingers  the  extension  is  best 
made  by  means  of  a  toy  made  of  plaited  strong 
grass,  so  arranged  that  it  can  be  easily  slipped  over 
the  finger,  but  when  it  is  pulled  upon  it  grasps  the 
finger   tightly. 

Fractures  of  the  third  and  fourth  metacarpals 
are  diagnosed  with  difficulty.  They  are  best  treated 
by  an  anterior  splint.  Oblique  fractures  of  the 
phalanges  are  most  troublesome.  It  may  be 
necessary,  in  such  cases,  to  apply  extension.  An 
anterior  splint,  carefully  padded  so  that  there  may 
be  no  pressure  on  the  ball  of  the  thumb,  stretching 
from  the  bend  of  the  elbow  well  beyond  the  tips  of 
the  fingers,  is  fixed  to  the  fore-arm  by  sticking-plas- 
ter. An  elastic  band  is  attached  to  the  injured  finger 
by  sticking-plaster,  and  extension  is  kept  up  by 
fixing  it  to  the  extremity  of  the  anterior  splint. 

In  fractures  of  the  phalanges  utilize  the  neigh- 
boring fingers  as  lateral  splints,  padding  carefully 
between  the  fingers  so  as  to  prevent  discomfort, 
excoriation,  and  itching.  Skin  should  never  be 
allowed  to  remain  any  length  of  time  in  contact 
with  skin.  In  fixing  the  arm  to  the  trunk  in  frac- 
ture of  the  clavicle  and  in  fracture  of  the  upper 
extremity  of  the  humerus,  if  a  layer  of  lint  is  not 


THE   CANADA    MEDICAL   RECORD 


89 


placed  between   the  arm  and  the  chest  much  dis- 
comfort will  follow. 

In  these  tractiires  it  will  generally  be  found  that 
the  broken  ends  of  the  fractured  bone  are  best 
brought  into  ajiposition  by  bringing  the  arm  well 
across  the  cheNt,  so  that  the  hand  lies  on  the 
opposite    shoulder. 

in  fixing  the  arm  the  u.'.e  of  a  long  strip  of  stick- 
ing-plaster fixing  the  limb  to  th;  trunk  is  a  simple 
way  of  treating  these  injuries.  In  green-stick 
fracture  of  the  clavicle,  a  common  accident  often 
overlooked  at  the  time  of  the  injury,  the  strip  of 
sticking-plaster  is  the  best  method  of  treatment. 

In  the  fracture  of  the  clavicle  at  the  coraco-cla- 
vicular  ligament  there  is  no  deplacement.  In  frac- 
ture of  the  clavicle  external  to  the  coraco-clavicu- 
lar  ligament  t  here  is  no  downward  displacement, 
aad  the  forward  displacement  is  not  observed  at  the 
time  of  the  fracture,  but  becomes  very  evident  at 
subsequent  date.  Treat  all  fractures  by  simple 
means  ;  let  wood,  pasteboard,  and  lead  (in  cases  in 
which  the  patient  is  confined  to  bed)  be  your  main- 
stays, avoid  all  special  forms  of  appartus. 

In  sprains,  carefully  applied  elastic  pressure, 
with  wadding,  combined  with  massage  and  pas- 
sive movement,  gives  the  best  results. 

In  diagnosing  an  injury  look  before  you  touch 
the  limb.  Remember  the  normal  relations  of  the 
styloid  i)rocesses  in  diagnosing  injuries  in  the  re- 
gion of  the  wrist;  the  relations  of  the  head  of  the 
radius  to  the  external  condyle,  the  relations  of  the 
olecranon  to  the  internal  condyle  of  the  humerus 
in  the  elbow-joint ;  and  let  the  coracoid  process 
and  its  relation  to  the  head  of  the  humerus  be  the 
principal  guiding  landmark  in  injuries  of  the  region 
of  the  shoulder. 

Always  expose  the  uninjured  corresponding 
region,  examine  it  in  the  first  instance,  and  let  it 
be  your  standard  (having  statisfied  yourself  that 
it  is  normal)  in  diagnosing  the  injury  on  the  oppo- 
site side. 

In  amputations  of  the  toes,  a  partial  amputation 
may  be  performed  in  the  great  toe  ;  in  the  other 
toes  partial  amputations  are  inadmissible  ;  avoid 
any  incision  in  the  sole  of  the  foot.  Remember 
that  the  foot  is  a  tripod,  and  that  its  stability  rests 
on  the  integrity  of  three  points  of  support — the 
ball  of  the  great  toe,  the  ball  of  the  little  toe  and 
OS  calcis;  interference  with  any  one  of  these  lessens 
the  value  of  the  foot  as  a  basis  of  support. 
Any  narrowing  of  the  foot  approximating  the  two 
anterior  points  of  support  also  renders  the  foot 
less  stable. 

Utilize  the  plantar  surface  for  the  principal  flap 
in  amputations  through  the  tarsus  and  at  the  ankle 
joint.  In  amputation  at  the  tarsometatarsal  joints 
and  in  amputation  through  the  centre  of  the  tarsus, 
after  marking  out  the  flaps  by  incision  down  to  the 
bones,  it  is  oest  to  disarticulate  and  dissect  the 
bones  off  the  long  plantar  flap  from  behind  for- 
wards. 

In  all  amputations  in  the  lower  extremity  sacri- 
fice length  in  order  to  obtain  a  stump  that  will 


bear  pressure.  A  painful  slump  is  worse  than 
useless  ;  with  it  the  patient  has  no  comfort,  and 
cannot  wear  an  artificial  support. 

In  aminitations  above  the  ankle  the  long  anterior 
flaps  give  the  best  result.  In  amputation  below 
the  knee  the  modified  circular  is,  as  a  rule,  prefer- 
able to  the  long  posterior  flap.  If  the  latter 
method  is  adopted  a  posterior  leaden  splint,  curv- 
ed so  as  to  support  the  long  posterior  flap  is  the 
best  means  of  preventing  retraction.  In  all  am- 
putations the  jjosterior  leaden  splint  is  the  best 
steadier  of  the  stump.  Lead  as  a  splint,  from  its 
weight  and  plasticity,  makes  an  excellent  splint  in 
many  injuries,  and  after  operations,  both  in  upper 
and  lower  extremities. 

In  sawing  the  bones  in  amputations  in  the  leg 
always  enter  the  saw  upon  both  bones  at  once,  so 
that  the  fidula  may  be  divided  before  the  tibia. 
In  amputation  below  the  knee  it  is  often  difficult 
to  secure  the  arteries.  When  such  difficulty  arises 
take  a  curved  needle,  threaded  with  catgut,  and  pass 
it  into  the  tissues  behind  the  bleeding  point  so  as  to 
include  the  tissues  around  the  vessel  in  the  ligature. 

In  amputation  for  injury  through  the  shaft  of  a 
long  bone  the  periosteum  may  be  divided  at  a 
lower  level  than  the  bone ;  if  this  is  done  it  is  best 
to  save  the  periosteum  on  the  anterior  surface  of 
the  bone,  and  allow  a  flap  of  periosteum  to  hang 
over  the  divided  medullary  cavity.  Do  not  stitch 
it  for  fear  of  deep-seated  tension. 

In  amputation  at  the  hip-joint  amputate  by  the 
circular  method  below  the  trochanters,  lie  the 
vessels,  turn  the  patient  round  so  that  he  lies  on 
the  uninjured  side,  make  a  vertical  incision  over 
the  trochanter,  keeping  well  back  where  the  vessels 
are  not  important  and  the  trochanter  is  most 
superficial,  and  disarticulate  the  head  of  the  bone. 

In  all  amputations  for  injury,  in  which  the  patient 
has  lost  much  blood,  save  any  blood  escaping  at 
the  time  of  the  amputation,  and  mixing  it  with  a 
5  per  cent,  solution  of  phosphate  of  soda,  as 
described  by  Mr.  John  Duncan  (Med.  Abs.,  p.  59), 
inject  it  into  the  main  vein  Ijefore  stitching  together 
the  flaps. 

Ulcers  are  due  to  a  local  or  constitutional  cause ; 
in  most  cases  the  local  cause  is  the  direct  excitant, 
the  constitutional  cause  rendeiing  the  patient  more 
liable  to  evil  consequences  from  the  local  irritation. 
Unless  in  the  case  of  a  burn  or  other  distinct  trau- 
matic cause,  always  be  supiclous  of  a  constitutional 
cause  if  the  ulcer  is  situated  on  any  part  of  the 
body  except  the  lower  half  of  the  leg,  and  even 
then  be  suspicious  if  the  ulcer  is  on  the  posterior 
aspect  of  the  limb.  Ulcers  are  prevented  from 
healing  either  by  a  congested  or  an  injurated  state 
of  the  limb.  Simple  rest  in  the  recumbent  posture, 
elevation  of  the  limb,  and  careful  elastic  pressure 
are  the  indications  for  treatment  under  which 
painful,  foetid,  and  spreading  ulcers  will,  with  few 
exceptions,  become  painless,  sweet,  and  clean. 
Improve  the  vitality  of  the  soil,  and  the  putrefactive 
organisms  will  die  out,  not  finding  a  suitable  nidus 
or  their  further  growth  and  development.     The  use 


90 


THE  CANADA  MEDICAL  HeCORD, 


of  antiseptics,  such  as  iodoform  and  chloride  of 
zinc  (4ogrs.  to  the  ounce)  is  of  secondary  import- 
ance to  an  improvement  in  the  vitality  of  the  limb. 
They  are,  however,  very  valuable  as  adjuncts  to  the 
elevation  treatment.  After  the  ulcer  has  assumed 
a  healthy  appearance,  if  the  patient  must  go  about, 
apply  elastic  pressure  before  the  patient  arises  from 
bed.  This  is  a  most  important  point,  which 
possibly  Dr.  Martin  was  the  first  to  insist  upon. 

When  a  patient  is  brought  under  your  notice 
with  pain  in  the  knee,  for  which  you  cannot  find 
any  evident  local  reason,  always  carefully  examine 
the  hip  ;  and  in  a  patient  who  limps  as  if  from  hip- 
joint  disease,  if  you  do  not  find  in  the  hip  evident 
objective  symptoms  of  joint  disease,  always  care- 
fully examine  the  back.  He  may  be  suffering  fiom 
vertebral  disease,  with  eftusion  into  the  psoas  mus- 
cle under  the  psoas  fascia. 

In  fractures  of  the  leg  use  the  box  splint — two 
pieces  of  wood  rolled  in  a  sheet.  See  tliat  the  foot 
is  kept  at  right  angles  to  the  leg,  and  thus  retraction 
of  the  heel  is  prevented.  Take  care  that  there  is 
no  eversion  of  the  foot.  In  oblique  fractures  use 
extension. 

In  fractures  of  the  patella  fix  to  the  anterior 
aspect  of  thigh  a  large  piece  of  sticking-plaster, 
and  make  through  it  extension  on  the  quadriceps 
extensor  cruris — elevating  the  limb  on  an  inclined 
plane  with  a  foot  piece. 

In  fractures  of  the  thigh  use  extension  with  the 
weight  and  pulley,  take  care  that  the  weight  is  not 
too  heavy,  and  measure  the  limb  every  third  day, 
so  that  the  weight  may  be  reduced.  The  too 
prolonged  use  of  the  weight  may  result  in  delayed 
unicm  or  in  non-union.  In  children,  in  restless 
adults,  and  in  cases  of  delayed  union,  use  a  double 
long  splint  with  a  transverse  cross  piece.  In  other 
cases  a  single  long  splint  is  sufficient ;  with  the 
double  long  splint  the  patient  is  fixed  in  a  wooden 
box,  so  that  he  can  only  move  his  arms  and  his 
head. — Edinburgh  Medical  Journal,  June,  1886. 


NOCTURNAL  INCONTINENCE  OF  URINE. 

BY  DR.  H.  PICARD. 

(Le  Progris  Medical,  May  15.^ 
In  order  to  form  an  exact  idea  of  the  mechanism 
of  nocturnal  incontinence — which  belongs  almost 
exclusively  to  young  children — it  is  necessary  to 
thoroughly  understand  in  what  micturition  consists. 
The  urinary  apparatus  has  two  functions  to  fill  : 
The  production  of  urine  and  its  expulsion.  We 
now  speak  only  of  the  latter  function.  In  the  nor- 
mal condition  the  urine  which  fills  the  bladder 
cannot  flow  back  through  the  ureters  because  their 
orifices  are  closed  by  a  sort  of  valve  whose  occlusion 
becomes  more  and  more  hermetic  as  the  bladder 
becomes  full.  On  the  other  hand  the  bladder, 
when  full,  contracts  without  our  consciousness,  and 
in  compressing  its  contents  against  the  uretro-vesi- 
cal  orifice,  which  it  distends,  gives  rise  to  the  de- 
sire tour  inate.  The  urine  does  not  run  forward, 
firstly  because  the  tonicity  of  the  muscular  fibres 


of  the  vesical  sphincter  and  the  urethral  orifice 
suffices  to  retain  it  in  the  bladder  when  a  flow  is 
not  needed  ;  and  seconcTly,  if  the  desire  is  marked, 
and  we  wish  to  resist  it,  the  contraction  of  the 
muscles  of  Guthrie  and  of  Wilson  comes  under  the 
influence  of  the  will,  reinforces  the  involuntary 
muscles,  and  maintains  the  urine  in  the  bladder. 
In  the  contrary  case  we  make,  in  the  first  place,  a 
light  effort,  which,  in  contracting  the  diaphragm, 
supports  the  intestines  upon  the  bladder  and  aids 
its  contractions  ;  and  then  we  relax  the  voluntary 
muscles  of  the  deeper  parts  of  the  urethra  so  that 
the  involuntary  muscles  being  no  longer  sustained, 
the  urine  cannot  fail  of  expulsion.  Here  is  then,  in 
the  physiological  state— and  this  is  a  capital  point 
in  the  subject  which  occupies  us — an  opposition 
between  the  action  of  the  bladder  and  that  of  the 
urethra.  The  contraction  of  the  latter,  it  is  seen, 
is  indispensable  to  the  distention  of  the  former 
during  its  time  of  repletion.  Urethral  relaxation, 
however,  is  voluntarily  effected  when  the  bladder 
contracts  for  micturition.  Now,  it  does  not  matter 
in  how  small  a  degree  the  equilibrium  may  be  inter- 
rupted between  these  two  forces — the  urethral 
which  retains  and  the  bladder  which  expels — the 
disturbance  must  result  in  incontinence.  Well,  in 
the  infant  up  to  15  or  18  months,  this  equilibrium 
is  absent,  the  contractility  of  the  bladder  being 
very  great,  whilst  that  of  the  urethro-vesical  sphinc- 
ters does  not  exist.  The  involuntary  muscles  are 
too  weak  at  this  time  and  the  will  is  still  incapable 
of  causing  the  voluntary  muscles  to  contract.  So, 
in  early  infancy,  incontinence  is  normal,  and  is 
diurnal  as  well  as  nocturnal. 

When  incontinence  is  prolonged  after  aj^  to  3 
years  it  is  abnormal,  and  at  4  years  it  has  already 
become  an  infirmity,  only,  it  ordinarily  becomes  at 
that  age,  wholly  nocturnal.  This  abnormal  pro- 
longation of  a  normal  condition  is  not  invariably 
the  origin  of  nocturnal  incontinence,  and  some- 
times we  see  cases  of  children  who,  although  they 
have  adopted  correct  habits  at  3  or  4  years,  become 
nocturnal  urinators  at  7  or  8. 

Why  does  incontinence  cease  in  the  daytime  in 
children  who  have  it  at  night  ?  Because  in  the 
waking  condition  the  will  intervenes  in  contracting 
the  urethral  muscles  subjected  to  its  influence. 
Also,  it  is  observed  that  some  children  sleep  so 
profoundly  that  the  desire  to  urinate  is  powerless 
to  awaken  them.  In  these  cases  the  sensation 
goes  to  the  medulla  which  conducts  it  to  the  brain  ; 
but  this  organ,  made  insensible  by  sleep,  does  not 
perceive  the  impression  and,  therefore,  does  not 
make  any  effort  to  contract  the  voluntary  muscles. 
But  the  medulla,  which  perceives  the  sensations 
and  responds  to  them  as  well  during  the  night  as 
during  the  day,  relaxes  the  muscular  fibres  so  that 
the  neck  of  the  bladder  being  no  longer  closed  by 
either,  allows  the  urine  to  escape  without  the 
knowledge  of  the  individual.  In  children  within 
this  category  the  emission  takes  place  at  the  time 
when  sleep  is  most  profound.  Trousseau  cites  a 
striking  example   in   the  case  of  a  girl   who  was 


The  CANADA  MEDICAL  RECOBD. 


01 


always  awakened  during  the  first  half  of  her  sleep 
and  caused  to  urinate,  but  who,  nevertheless,  urin- 
ated in  her  bed  during  the  remaining  half  of  her 
slumber.  As  she  explained  it,  slie  urinated  during 
the  second  part  of  her  sleep  because  it  was  then 
that  she  slept  most  heavily. 

In  many  urinary  incontinents,  the  vesicle  con- 
traction is  so  prompt  and  energetic  that  the  urine 
emerges  almost  before  they  have  been  conscious  of 
the  desire,  and  without  their  having  been  able  to 
arrest  its  flow.  So,  during  the  day,  if  by  idleness 
or  distraction,  these  children  do  not  attend  to  the 
first  sensation  of  a  desire  to  urinate,  they  soon  be- 
come suddenly  pressed  by  the  necessity,  and  often 
let  the  urine  flow  into  their  clothing.  The  equili- 
brium is  broken,  the  expulsive  force  of  the  bladder 
having  been  augmented,  whilst  the  retaining  force 
of  the  urethra  had  remained  tlie  same,  or  had  be- 
come weakened.  'J'his  is  shown  clearly  in  the 
fact  that  if  you  make  an  incontinent  child  urinate 
in  your  presence  at  the  time  they  usually  feel  the 
desire,  you  will  see  the  urine  thrown  out  by  a  vio- 
lent impulsion.  Again,  if  we  introduce  a  catheter 
into  the  bladder,  and  gently  throw  in  an  injection, 
we  find  that  it  returns  with  force  through  the  in- 
strument, though  we  had  no  trouble  whatever  in 
introducing  the  instrument  itself;  and  this  shows 
how  vesical  power,  when  conjoined  to  sphincterian 
weakness,  upsets  the  equilibrium. 

In  certain  cases  of  incontinence  of  urine,  sleep 
is  normal,  but  the  impression  of  the  desire  to  urin- 
ate appears  so  weak  that  it  is  powerless  to  cause 
the  contraction  of  the  sphincters.  The  same  con- 
sequences follow,  the  child  urinates  without 
awaking.  In  this  kind  of  incontinence  the  urine 
sometimes  flows  involuntarily  during  the  day,  but 
without  the  jet  being  thrown  out  more  energetic- 
ally than  in  the  normal  state. 

Whatever  may  be  the  result  of  too  forcible 
vesical  contractions,  of  powerlessness  in  the  neck, 
of  too  profound  sleep,  or  of  weakness  of  sensational 
impression,  these  are  not  the  only  occasional 
causes  of  incontinence.  A  too  dense  condition  of 
the  urine  will  produce  the  same  effect  because  its 
acidity  excites  vesical  contractility  and  makes  the 
desire  to  urinate  livelier  and,  therefore,  more  press- 
ing. This  kind  of  urine  is  easily  recognized 
without  scientific  examination.  Ordinarily  limpid, 
though  sometimes  nebulous,  we  find  that  at  the  time 
of  its  emission  it  thickens  in  proportion  to  its  low- 
ness  of  temperature.  When  cooled  it  leaves  thick 
deposits  which  are  often  taken  for  pus  but  are 
chiefly  urates.  The  urine  becomes  clear  again 
when  subjected  to  heat. 

Some  of  the  vermicular  inhabitants  of  the 
rectum,  which  emerge  at  night,  and  invest  the 
genito-urinary  organs,  provoke  an  irritation  which 
gives  rise  to  a  desire  to  urinate  by  contracting  the 
bladder,  thus  acting  in  the  same  way  as  acid 
urine. 

A  contracted  prepuce  or  meatus  is  often 
accompanied  by  incontinence  of  urine.  But  in 
these  cases  the  mechanism  of  the  trouble  is  differ- 


ent. It  is  generally  an  incontinence  caused  by 
engorgement.  The  bladder  is  full,  and  the  little 
patient  retains  his  urine  on  account  of  the  pain 
which  micturition  causes  him,  so  that  the  urine 
escapes  from  time  to  time  in  spite  of  his  efforts  to 
retain  it.  If  you  introduce  the  catheter  after  he 
has  urinated  you  will  find  that  a  considerable 
amount  of  urine  has  been  left  in  the  bladder. 

Inflammation  of  the  deejier  parts  of  the  urethra 
produces  the  same  results,  whilst  inflammation  of 
the  bladder  does  not  permit  any  accumulation 
of  urine. 

All  of  these  causes  may  also  have  the  effect  of 
giving  rise  to  dreams  during  the  course  of  which 
the  child  urinates  in  the  belief  that  he  is  doing  so 
in  his  vessel.  I  say  nothing  about  children  who 
urinate  in  bed  from  pure  laziness  ;  that  kind  of 
incontinence  is  not  a  malady. 

Has  the  general  condition  an  influence  upon 
the  incontinence  of  urine  ?  The  question  is  much 
discussed.  To  me  it  is  evident  that  delicate 
children  are  more  subject  to  the  trouble  than 
others.  But  an  undeniable  cause  lies  in  heredity. 
The  children  of  nervous  parents,  and  especially 
those  suffering  from  nervous  diseases,  are  often 
predisposed  to  incontinence.  This  is  not  surpris- 
ing in  a  malady  which,  whatever  idea  we  may 
form  of  its  mechanism,  can  be  little  else  than  a 
neurosis  of  sensibility  or  motility. 

Nocturnal  incontinence  of  urine  generally  ceases 
with  puberty,  but  we  not  unfrequently  meet  with 
cases  of  persons  of  20  to  25  who  are  troubled 
with  it  more  or  less  constantly. 

The  principal  medicaments  used  in  this  affection 
are  :  Belladonna,  when  the  trouble  results  from  an 
exaggerated  contraction  of  the  bladder;  and  nux 
vomica,  when  it  proceeds  from  weakness  of  the 
peri-urethral  muscles. 

The  rules  for  the  giving  of  belladonna  have 
recently  been  laid  down  by  Trousseau.  He  com- 
menced by  giving  a  pill  of  i  centigramme  of  the 
extract  at  bedtime  ;  this  was  continued  for  several 
days.  Then,  without  stopping  on  account  either 
of  the  cessation  or  persistence  of  the  malady,  he 
augmented  the  doses  to  6,  7,  8,  9  and  10,  and  in 
some  cases  to  15  or  20  centigrammes.  If  there 
was  no  intolerance  he  pursued  the  treatment  for  a 
month  or  two,  or  for  a  considerable  time  after  the 
cure  seemed  to  be  effected.  Where  the  pills  are 
not  well  borne  a  syru]i  of  equal  parts  of  syrup  01 
belladonna  and  syrup  of  tolu  is  used. 

Where  belladonna  causes  congestion  of  the  face 
and  eyes,  we  may  use  bromide  of  potassium  in 
doses  of  15  centigrammes  for  a  child  of  4,  and  50 
for  one  of  12  years.  Ver)'  much  larger  doses  may 
be  given  if  they  do  not  disagree.  A  good  way  to 
give  it  to  children  is  in  soup. 

Nux  vomica  is  usually  given  to  children  in 
syrup,  containing  5  centigrammes  of  sulphate  of 
strychnia  and  100  grammes  of  simple  syrup.  The 
dose  is  a  dessertspoonful  (containing  5  milli- 
grammes of  the  drug)  for  children  of  5  to  10  years, 
and  it  is  given  morning  and  night  for  two  days.  If 


92 


THE   CANADA   MEDICAL   RECORD. 


it  is  well  supported,  an  interval  of  two  days  is 
allowed,  and  then  3  teaspoonfuls  are  given  morn- 
ing and  night  for  two  days.  Then  follows  another 
interval  and  a  further  augmentation  of  dose  until 
the  amount  has  reached  to  6  teaspoo  nfuls.  Care 
must  be  taken  to  make  the  intervals  with  exacti- 
tude. This  accomplished,  the  doses  are  raised  by 
a  dessertspoonful,  and  continued  in  the  same  way 
up  to  si.\  dessertspoonfuls  (containing  60  grammes 
of  syrup  and  3  centigrammes  of  strychnia).  A 
tablespoon  is  then  substituted  and  the  dose  aug- 
mented until  it  reaches  120  grammes  of  syrup. 
Above  the  age  of  to  we  commence  by  giving  a 
dessertspoonful,  and  progress  in  the^same  way  to 
200  grammes  of  the  syrup,  or  10  centigrammes  of 
its  active  principle. 

Strychnia  in  augmenting  reflex  actions  may,  in 
high  and  long  continued  doses,  create  a  tendency  to 
spasm.  The  patients  must  be  watched,  and  the 
treatment  interrupted  when  they  complain  of 
stiffness  in  the  jaws  and  the  muscles  of  the  neck, 
of  headache,  vertigo  or  visual  troubles.  The  ac- 
cumulative properties  of  the  medicament  must 
also  be  borne  in  mind,  and  proper  intervals  made 
when  necessary. 

Owing  to  the  care  needed  in  the  administration 
of  strychnia,  some  practitioners  are  now  making 
successful  use  of  ergot  in  these  cases.  Like  strych- 
nia it  certainly  has  the  power  of  causing  mus- 
cular contraction.  It  is  given  in  powder,  20 
centigrammes  in  sweetened  water  morning  and 
night  for  a  child  of  4,  25  cent,  for  those  of  5  to  6, 
and  30  to  50  for  those  of  14  or  15  years.  These 
doses  may  be  continued  for  10  or  15  days  and 
interrupted  for  a  few  days  during  a  month,  or  a 
little  over,  when  it  will  usually  be  found  that  the 
medicine  has  produced  its  effects.  Of  ergotin  be 
preferred  it  may  be  given  in  pills  of  10  centi- 
grammes, of  which  2,  3  and  even  5  may  be  taken 
daily  at  proper  intervals.  In  certain  cases  where 
the  augmentation  of  the  vesical  contractility  ap- 
pears to  be  associated  with  a  weakness  of  the 
urethral  muscles,  strychnia  or  ergot — which  would 
here  be  better— may  be  used  in  conjunction  with 
the  belladonna. 

Of  all  the  remedies  used  for  the  incontinence 
caused  by  contractile  insufficiency  in  the  urethral 
muscles,  electricity  is  perhaps  the  most  efticacious. 
One  of  the  poles  may  be  applied  over  the  perineum 
and  the  other  upon  the  abdomen  over  the  bladder, 
or  in  the  rectum.  Grusse  reports  very  many  cures 
by  this  method.  In  obstinate  cases  one  of  the 
poles  is  introduced  into  the  urethra  and  the  other 
is  applied  to  the  hypogastrium,  the  perineum,  or 
is  introduced  into  the  rectum.  The  use  of  this 
method  sometimes  frightens  children  and  their 
parents,  but  it  is  not  painful.  Its  effects,  when  it 
cures,  is  almost  immediate,  and  when  it  does  not 
cure  it  affords  great  relief.  The  peptonate  of  iron 
is  a  proper  adjuvant  to  use  simultaneously  with 
ergot,  strychnia  or  electricity,  for  if  these  give 
special  tone  to  the  muscular  fibre,  the  albuminate 
fortifies  the-  general  system  and  reconstitutes  the 


blood  corpuscles.  Hydropathy,  like  iron,  is  a 
powerful  tonic,  but  should  be  used  prudently.  Sea 
baths  are  often  successful  with  lymphatic  and 
scrofulous  subjects,  and 'sulphur  baths  in  cases  of 
nervous  affections. 

Where  incontinence  is  caused  by  inflammation 
of  the  bladder  the  best  means  is  to  inject  the  organ 
with  a  few  drops  of  nitrate  of  silver  of  i  to  200  or 
I  to  500,  according  to  age  and  the  severity  of  the 
case.  Soothing  drinks,  with  a  little  bicarbonate 
of  soda  added,  act  well  incases  where  the  urine  is 
too  dense,  or  too  acid.  Incontinent  children  should 
take  their  evening  meal  early,  and  be  some- 
what restricted  in  .the  use  of  drinking  water  at 
night. 

Parents  should  be  directed  to  find  out  the  hour 
at  which  the  child  is  likely  to  urinate  in  bed,  and 
wake  him  up  a  short  time  before  it  arrives.  In 
the  daytime  care  should  be  taken  to  encourage 
him  to  urinate  only  at  certain  hours  fixed  at  a 
reasonable  time  apart.  This  is  the  best  way  to 
habituate  the  bladder  to  retaining  urine.  Where 
it  is  certain  that  incontinence  is  caused  by  care- 
lessness,prudent  correction  should  be  administered. 
Trousseau  tells  of  an  obstinate  case  of  incontinence 
in  a  full-grown  girl,  whose  malady  had  resisted  all 
medicaments,  but  who  gave  way  at  last  to  the 
nightly  attacks  of  a  determined  mother  armed 
with  a  whip. 


INTERNAL  HAEMORRHOIDS  AND  HOW 

TO  TREAT  THEM. 

By  C.  B.  Nancrede,  M.  D., 

Prof,  of  Gener.il  and  Orthopedic  Surgei y  ;  Surgeon  to  the 

Episcopal  Hospital  and  St.  Clusitopher's  Hospital  for 

Children. 

Unless  indurated,  an  internal  hemorrhoid  of- 
ten escapes  detection  by  the  examining  finger  if 
the  patient  is  recumbent.  An  injection  of  warm 
water,  followed  by  straining  efforts,  or  a  gentle 
diliatation  of  the  sphincter  under  an  anjesthetic,  is 
the  most  satisfactory  method  of  detecting  them  ; 
sometimes  a  speculum  will  suffice,  without  either 
injection  or  diliatation.  Careful  examination  by 
the  finger  should  be  made  of  the  rectimt  higher 
up,  since  the  piles  may  be  symptomatic  of  a  stric- 
ture of  the  rectum.  If,  after  inspection,  there 
remains  any  doubt  as  to  whether  a  pile  be  external 
or  internal,  or  whether  it  is  both,  Allingham's  advice 
of  returning  all  the  protrusion  possible  within  the 
sphincter  ani  by  gentle  pressure,  while  the  patient 
is  directed  to  draw  up  the  lower  part  of  the  gut, 
will  resolve  all  doubts,  i.e.,  that  which  remains 
outside  is  external  pile. 

For  the  radical  cure  of  internal  haemorrhoids 
these  procedures  are  available,  viz.  :  i,  injection  ;  2, 
strangulation  with  the  ligature  ;  3,  the  clamp  and 
cautery  ;  and  4,  screw  crushing.  Excision  must 
never  be  contemplated,  since  fatal  hemorrhage  has 
often  followed  it.  The  ecraseur  is  only  mentioned 
to  be  condemned. 

Injection For  this  purpose  pure  carbolic  acid 

is  far  superior  to  all  other  agents.     Although  some 


TUE    CANADA   MEDICAL    RECORD. 


93 


authorities  contend  that  all  varieties  of  internal 
piles  are  adapted  for  the  carbolic  acid  treatment, 
we  consider  this  to  be  an  error,  and  one  calculated 
to  bring  this  method  of  operating  into  disrepute, 
as  it  has  done  that  by  nitric  acid  in  the  past.  Only 
those  piles  which  are  but  slightly  hyperplastic, 
and  situated  well  above  the  sphincter,  sliould  be  in- 
jected. These  piles  may  prolapse,  but  when  return- 
ed, lie  well  above  the  sphincter.  In  this  form  they 
are  merely  varicose  blood  vessels,  whose  contents 
can  be  coagulated,  or  whose  walls  can  be  stimul- 
ated to  contraction  after  partial  or  complete  throm- 
bosis of  some  of  their  tributaries  has  decreased  the 
intravascular  tension.  Perhaps,  in  addition,  some 
hyperplasia  of  the  submucous  tissue  may  be  set 
up,  which  will  prevent  any  future  tendency  to 
prolapse,  and  strangulate  also  some  few  vessels. 
Restricted  as  I  have  said,  this  method  will  prove 
useful,  especially  in  cases  with  regurgitant  heart 
lesions  or  enlarged  prostate.  It  should  never  be 
used  for  indurated  piles,  since,  unless  sloughing  is 
set  up,  the  tumors — and  with  them  the  tendency 
to  prolapse— cannot  be  removed,  and  if  the  tumors 
are  to  be  removed,  more  exact  and  controllable 
methods  should  be  employed.  Although  often 
unattended  with  discomfort,  this  method  sometimes 
gives  agonizing  pain.  Small  marginal  tistute  may 
result,  requiring  splitting  up  if  they  do  not  spon- 
taneously heal.  If  the  injection,  especially  if 
strong,  be  thrown  beneath  the  pile  into  the  general 
submucous  tissue,  or  if  too  strong  a  solution  be 
used  for  a  small  pile,  a  most  serious  ischio-rectal 
abscess  often  results.  Ulceration  is  said  to  be  not 
uncommon,  but  tractable.  I  believe  most  of  these 
accidents  can  be  avoided  by  care,  and  by  only 
injecting  piles  such  as   I  have  described. 

Operation. — The  tumors  must  be  well  exposed 
by  a  previous  warm-water  enema,  aided  by  the 
patient's  straining.  If  this  do  not  suflice,  use  a 
speculum  (the  small  end  of  a  Sims'  uterine  acts 
admirably  when  not  too  large),  or  draw  down  the 
tumors  by  toothed  forceps  or  a  tenaculum.  An 
ordinary  hypodermic  syringe  will  do,  but  the  one 
specially  constructed  for  the  purpose,  as  sold  by 
most  instrument  makers,  is  better.  The  needle 
point  "  must  be  entered  perpendicularly  from  the 
apex,  and  not  passed  upward  under  the  mucous 
membrane  in  a  longitudinal  direction,  so  that  the 
injection  reaches  the  central  tissue  of  the  pile.  " 
After  injection,  the  pile,  if  prolapsed,  must  be  gent- 
ly replaced,  and  each  injection  had  better  be 
followed  by  a  day's  rest  in  the  horizontal  posture. 
In  some  cases  all  rest  may  be  dispensed  with, 
but  quiet  is  better.  Provided  the  patient's  bowels 
act  regularly,  no  after  treatment  is  required.  The 
strength  of  the  solution  must  vary  with  the  result 
aimed  at.  Kelsey  advocates  the  injection  of  five 
drops  of  pure  carbolic  acid  into  large,  vascular, 
well-defined  prolapsing  tumors,  "  expecting  to 
produce  a  circumscribed  slough  resulting  in  a 
radical  cure."  Such  an  injection  will,  in  some 
instances,  produce  evanescent  toxic  effects.  I 
have  never  myself  used  the  pure  acid,  and  should 


hesitate  to  do  so  with  my  present  experience  of 
other  methods.  A  solution  containing  one-third 
carbolic  acid,  repeated  several  times,  will,  accord- 
ing to  this  author,  produce  a  cure  without  slough. 
"  A  small,  slightly-protruding,  non-pedunculated 
tumor,  merely  felt  as  a  ])rominence  on  the  mucous 
membrane,  may  be  cured  by  a  single  injection  of  a 
five  per  cent,  solution,  which  will  cause  it  to  harden 
and  shrink,  while  a  fifty  per  cent,  solution  might 
give  a  good  deal  of  trouble."  With  the  weaker 
solutions  the  treatment  will  last  from  three  to 
four  months,  the  injections  to  be  repeated  twice 
weekly,  iniless  sloughing  is  produced.  One  pile 
only  should  be  treated  at  a  sitting,  but  if  very 
large,  two  or  more  injections  may  be  used  of  a 
solution  varying  from  five  to  twenty  per  cent., 
introduced  some  distance  apart.  As  can  be 
gathered  from  the  foregoing  sentences,  even  in  the 
hands  of  its  most  ardent  advocates,  this  method 
is  neither  always  painless,  nor  does  it  insure 
against  confinement  to  the  house,  and,  more 
rarely,  serious  sequelre  follow.  I  must  confess  to 
considerable  disappointmeni  following  my  own  use 
of  the  method;  still,  I  consider,  for  soft,  non-pro- 
lapsing or  only  slighly  prolapsing  piles,  especially 
in  those  with  chronic  hepatic  or  cardiac  trouble,  it 
is  the  best,  if  not  the  only,  method  to  be 
advocated. 

Operation  by  the  Ligature. — Gentle,  but  forcible 
stretching  of  the  sphincter  should  be  a  preliminary 
to  either  the  ligature,  cautery  or  crushing  operation. 
This  manceuvre  gives  ready  access  to  the  parts,  and 
saves  the  patient  from  the  painful  pinchings  of 
an  irritated  sphincter.  The  best  position  for  the 
patient  in  all  pile  operations  is  the  Sims'  position 
for  operations  on  the  uterus  or  vagina,  in  which 
he  should  be  placed  after  full  anaesthesia  has  been 
induced.  Some  few  patients,  by  previous  injec- 
tions of  a  four  per  cent,  cocaine  injection  into 
the  bases  of  the  piles,  will  permit  an  operation 
without  general  ansethesia.  A  preliminary  evacua- 
tion of  the  bowels  by  means  of  a  laxative  given 
the  night  before,  and  a  tepid  enema  a  half  hour 
or  so  before  the  operation,  should  not  be  omitted. 
After  full  dilatation  of  the  sphincter,  each  pile  in 
turn  should  be  seized  with  a  volsellum-toothed  for- 
ceps or  tenaculum,  and  separated  from  the 
muscular  and  connective  tissues  by  dissecting  it 
up  with  the  scissors  parallel  to  the  bowel.  The 
incision  is  to  be  started  in  the  sulcus,  commonly 
indicated  by  a  whitish  line,  where  the.  mucous 
membrane  and  skin  meet.  As  the  vessels  run 
parallel  to  and  just  beneath  the  mucous  membrane, 
entering  the  pile  at  its  upper  part,  the  dissection 
can  be  carried  on  without  danger  until  the  tumor 
is  connected  by  a  pedicle  composed  only  of  the 
vessels  and  mucous  membrane.  A  strong,  well- 
waxed  ligature  must  now  be  carried  well  down  to 
the  bottom  of  the  wound,  the  pile  be  firmly  pulled 
out,  and  the  thread  tightly  tied  as  high  up  the 
pedicle  of  the  tumor  as  possible.  The  surgeon 
had  better  begin  with  the  smallest  piles  when  a 
number  are  present,  lest  they  be  overlooked,  and 


94 


THE   CANADA   MEDICAL   RECORD, 


the  most  inferior  ones  should  be  attacked  first,  so 
that  the  flow  of  blood  may  not  obstruct  the 
operator's  view. 

After  each  pile  has  been  tied,  the  bulk  of  it  must 
be  removed  by  the  scissors,  leaving  only  enough 
to  prevent  the  ligature  from  slipping;  the  latter 
must  be  cut  short,  and  when  all  the  haemorrhoids 
have  been  dealt  with,  the  stumps  must  be  carefully 
returned  into  the  bowel  well  within  the  sphincter, 
after  having  been  well  dusted  with  iodoform. 
Any  external  tabs  of  skin  requiring  removal  should 
now  be  snipped  off  in  a  radiating  manner  with 
the  scissors,  bearing  in  mind  that  a  too  free 
removal  of  skin  may  cause  undue  contraction 
of  the  anus. 

Before  recovery  from  anaesthesia,  a  rectal 
suppository  containing  a  couple  of  grains  of  opium 
should  be  introduced  into  the  rectum,  and  a  com- 
press of  hnt  or  cotton  firmly  secured  over  the  anus 
by  a  T  bandage.  This  tends  to  obviate  anal  spasm 
and  consequent  pain. 

Operation  by  Clamp  and  Cautery. — Each  tu- 
mor must  be  separately  dealt  with,  being  firmly 
drawn  out  by  a  volsellum  or  tenaculum,  so  that 
the  clamp  can  be  carefully  applied  to  the  base  of 
the  hxmorrhoid.  After  securing  the  clamp  tight, 
the  operator  should  remove,  with  a  pair  of  curved 
scissors,  all  of  the  tumor  which  projects  above  the 
clamp,  except  about  a  "scant  fourth  of  an  inch  ;" 
if  the  stump  be  cut  too  short,  the  cautery  cannot 
act  effectively  in  sealing  the  vessels.  The  stump, 
after  having  been  wiped  dry,  should  be  slowly  and 
thoroughly  cauterized  with  the  iron  at  a  dull  red 
heat,  destroying  the  stump  down  to  the  surface  of 
the  clamp.  Special  attention  should  be  paid  to 
sealing  the  vessels  at  the  upper  end  of  the  pile, 
wiiere  its  chief  vascular  supply  enters.  Another 
method  is  to  use  either  a  dull  chisel  or  serrated- 
edged  cautery,  which  must  be  made  to  travel  along 
the  upper  surface  of  the  clamp  until  the  protruding 
portion  of  pile  is  removed. 

Whichever  method  has  been  employed,  after  the 
cauterization  has  been  completed,  the  clamp  must 
be  loosened,  turn  by  turn,  and  while  this  is  being 
done,  care  must  be  taken  to  press  it  well  down 
against  the  bowel,  lest  the  stump  slip  out  too  soon; 
if,  during  the  loosening,  any  vessel  bleeds,  it  must 
be  cauterized  anew,  with  or  without  retightening 
the  clamp,  according  to  the  flow  of  blood.  All  the 
piles  having  been  treated,  the  stumps  are  to  be 
gently  returned  well  up  the  bowel  by  the  oiled 
finger,  an  opium  suppository  introduced,  and  an 
anal  pad  and  heavy  T  bandage  applied.  Some  ooz- 
ing ahvays  results  from  the  mucous  membrane 
where  compressed  by  the  clamp,  but  must  be  disre- 
garded. 

The  advantages  of  tlie  cautery  over  the  ligature 
are  said  to  be  immunity  from  tetanus,  pyosmia  and 
hemaemorriiage,  the  less  chance  of  retention  of 
urine  and  the  freedom  from  pain.  All  these 
accidents  have,  however,  l-^appened,  and  while  I 
personally  prefer  this  method  to  the  ligature  for 
prolapsing  indurated  piles,  yet   no    method — not 


even  the  injection  plan — can  be  said  not  to 
occasionally  terminate  fatally.  This  fact  must 
never  be  forgotten.  Upon  the  other  hand,  a  tena- 
culum, a  pair  of  scissor^,  and  ordinary  strong  liga- 
ture silk  are  all  that  are  needed  for  the  tying 
operation.  These  the  general  practitioner  has 
always  at  his  command,  while  a  proper  clamp  and 
cautery — I  prefer  the  Paquelin,  when  obtainable 
— is  only  in  the  posession  of  the  few.  I  think  the 
cautery  is  a  safer  operation  when  done  by  one 
accustomed  to  this  method,  but  I  would  recom- 
mend the  tyro  to  depend  upon  the  ligature. 

In  the  same  way,  Mr.  Pollock's  operation  of 
"  screw  crushing,"  as  modified  by  Allingham,  re- 
quires a  special  instrument,  which  none  but  speci- 
alists, or,  perhaps,  a  few  general  surgeons,  will 
possess,  so  that  I  shall  not  speak  further  of  this 
method  beyond  saying  that  it  has  received  the 
unqualified  sanction  and  preference  of  so  great  an 
authority  as  Mr.  Allingham. 

After-treatment. — This  is  the  same  for  any  of  the 
radical  operations.  The  diet  should  be  light  and 
unstimulating,  such  as  beef  or  mutton  broth,  beef 
tea,  milk,  tea  and  toast,  etc.,  until  after  the  first 
movement  of  the  bowels,  when  a  more  liberal  diet 
may  be  instituted.  Unless  there  is  some  special 
condition  demanding  their  use,  wine,  beer  or 
sjiirits  should  be  strictly  interdicted.  If  retention 
of  urine  occurs,  a  warm  hip  bath  is  indicated,  and 
often  suffices  ;  if  not,  the  catheter  must,  of  course, 
be  used.  The  bowels  had  better  be  opened  on  the 
third  or  fourth  day  by  castor-oil  emulsion,  aided, 
perhaps,  by  an  olive-oil  injection  carefully  thrown 
into  the  bowel  just  before  the  stool,  which  may  be 
thus  rendered  almost  painless,  although  the  patient 
should  be  warned  that  he  may  experience  severe 
pain  and  have  a  little  bleeding.  The  bowels — kept 
quiet,  if  necessary,  by  paregoric — should  be  again 
relieved  in  two  or  three  days,  when — i.e.,  after  the 
lapse  of  a  week — if  the  patient  has  not,  previous  to 
operation,  lost  much  blood,  he  may  be  allowed  to 
exchange  his  bed  for  a  sofa.  At  the  end  of  ten 
days — better  two  weeks — although  the  cut  surfaces 
are  not  usually  entirely  healed,  they  are  in  a  con- 
dition to  allow  of  moderate  exercise  or  a  return  to 
light  work.  An  enema  should  precede  every 
motion  for  at  least  two  weeks  longer,  since  a  cos- 
tive movement  or  hard  straining  at  stool  will 
sometimes,  so  late  as  ten  days  or  more,  induce 
rather  smart  bleeding  from  the  congested  granu- 
lating surfaces.  Should  the  resulting  ulcers  fail  to 
heal,  or  extend  after  any  method  of  operating, 
rest  in  bed  and  stimulating  local  applications,  with 
attention  to  the  action  of  the  bowels  and  general 
health,  must  be  resorted  to. 

When  a  very  extensive  operation  has  been  per- 
formed, it  may  be  well  for  the  surgeon  or  patient 
to  pass  the  well-oiled  forefinger  or  a  small  rectal 
bougie  through  the  anal  orifice  once  or  more  daily 
for  a  few  weeks,  to  prevent  undue  contraction ;  this 
is,  however,  very  rarely  necessary,  unless  the  skin 
aromid  the  anus  has  been  recklessly  cut  away. 

I  think  that  I  have  now  demonstrated  that  there 


I 


THE  CANADA  MEDICAL  RECORD. 


95 


is  no  such  thing  as  '■^  the  best  treatment  "  for  piles, 
but  that  each  variety  and  each  individual  case 
must  be  treated  indifferently  ;  that  many  cases  will 
need  no  operative  treatment  so-called,  and  that 
a  minute  scientific  knowledge  of  this  disease,  as 
of  all  others,  teaches,  theoretically,  what  proves  to 
be  the  best  treatment,  and  explains  why  methods 
empirically  adopted  are  clinically  successes  or 
failures. — Phil.  Polyclinic. 


THE  TREATMENT  OF  GON'ORRHCEA  BY 
IODOFORM. 

Dr.  Alexander  V.  Khrul,  of  Irkutsk,  recom. 
•mends  (Proceedings  of  the  Eastern  Siberian 
[Irkutsk]  Medical  Society,  1885,  p.  34)  the  treat, 
mcnt  of  gonorrhcea  after  the  method  of  Dr.  Watson 
Cheyne  (described  in  the  British  Medical  Journal^ 
188 1),  somewhat  modified,  which  he  has  successful, 
ly  practiced  about  two  years.  An  ointment  made 
of  one  part  of  iodoform  and  ten  parts  of  vaseline 
is  somewhat  liquefied  by  heating,  and  then  aspirated 
(by  suction)  into  a  fine  elastic  catheter,  the  latter 
peing  anointed  externally  with  the  same  mixture? 
and  introduced  into  the  urethra  to  the  depth  desired. 

The  ointment  is  blown  out  of  the  catheter  by 
the  operator's  or  patient's  mouth  applied  to  the  free 
end  of  the  instrument.  The  advantages  claimed 
for  this  plan  by  the  author,  on  the  ground  of 
seventeen  cases,  are  as  follows  : 

1.  It  enables  even  deeper  parts  of  the  urethra 
to  be  subjected  to  the  direct  action  oi  the  iodoform. 

2.  While  covering  the  urethra  walls,the  ointment 
gives  them  sufficient  .protection  against  any  irrita- 
ting influence  of  the  urine. 

3.  The  method  enables  us  to  get  rid  of  internal 
administration  of  balsamic  drugs,  which  are  in- 
jurious, being  apt  to  produce  renal  pain,  albuminu- 
ria and  nephritis. 

4.  On  the  other  hand,  it  enables  one  also  to  get  rid 
of  the  treatment  by  watery  injections,  which  do  not 
allow  any  prolonged  contact  of  the  medicaments 
with   the   diseased   mucous   membrane. 

5.  The  ointment  produces  a  strikingly  rapid 
narcotic  and  disinfectant  action,  the  painful  phen- 
omena of  the  acute  stage  disappearing  within 
twenty-four  hours. 

The  method  is  especially  indicated  in  persons 
with  irritable  urethra  and  kidneys.  The  single 
drawback  is  the  necessity  of  aspiring  and  insufflat- 
ing the  ointment  by  the  mouth,  which  procedure 
may  appear  rather  unattractive,  even  to  not  over- 
fastidious  people.  However,  it  might  be  replaced 
by  the  use  of  an  India-rubber  contrivance. — Len- 
don  Medical  Record- 


The  Canada  Medical  Record. 

A  Monthly  Journal  of  Medicine  and  Surgery- 
EDITORS  : 

FRANCIS  W.  CAMPBELL,   MA.,  M.D.,  L.K.CP.  LOND, 

EfUtor  and  Proprietor. 

E.  A.  KENNEDY,  M.A.,  M.D.,  Managing  ICdllor. 

ASSISTANT  EDITORS: 

CASEY  A.  WOOD,  CM.,  MD. 
GEOIIGE  E,  AKliSTKONG,  CM.,  M.D. 

SUUSCmi'TIO.S    TWO    DOLLARS    I'EIt    A.NNHM. 

All  communications  and  Rxchanqe.s  must  be  addressed  to 
the  EdUort,VrawerZbG,  Post  Ufice,  Montreal. 


MONTREAL,  JANUARY,  1887. 


SUDDEN  CHANGES  OF  CLIMATE. 

Mr.  E.  V.  Robins,  in  the  Popular  Science 
Monthly  for  December,  says  : — 

"  If  a  blizzard  of  unusual  severity  were  coming 
from  the  northwest  that  would  send  the  ther- 
mometer down  50°  or  70°  in  three  hours,  we 
should  expect  a  great  increase  of  pneumonia  and 
other  respiratory  diseases,  resulting  in  many 
deaths.  Now,  instead  of  three  hours,  suppose  the 
mercury  were  to  drop  threescore  degrees  in  three 
minutes — or,  take  another  step  in  fancy,  and  sup- 
pose this  great  change  to  take  place  in  three 
seconds— 'x\\?i'i\so\M  likely  be  the  effect  on  health? 
And  yet  we  bring  about,  artificially,  changes  to 
ourselves  quite  as  sudden  and  as  severe  as  this. 

We  make  an  artificial  climate  in  our  houses.  We 
live  in-doors  in  an  atmosphere  heated  by  stoves, 
furnaces,  or  steam  pipes,  to  70  °  or  80  °  ,  and  we 
pass  from  our   parlor  or  hall,  so  heated,  into  the 
open  air.     At   a  step,    literally   in  a   breath,    the 
temperature  of  the  air  has,   for  us,  dropped  50 
or  70  °  .     We  may  put  on  an  extra  coat  or  shawl 
and  shield  the  outside  of  the  body  and  chest,  but 
we  cannot  shield   the  delicate  linings  and  mem- 
branes of  the  air-passages,  the  bronchial  tubes,  the 
lung-cells.     Naked  they  receive  the  full  force  of 
the  change — the  last  breath  at  70°  ,  the  next  at 
freezing  or  zero — and  all  unprepaacd.     We  have 
been  sitting,  perhaps,  for  hours  in  a  tropical  atmos- 
phere ;  nay,  worse,  in  an  atmosphere  deprived  by 
hot  iron  surfaces  of  its  ozone  and  natural  refreshing 
and  bracing  qualities.     Our  lungs  are  all  relaxed, 
debilitated,    unstrung,    and  in  this  condition  the 
cold  air  strikes   them   perhaps  60  °  below  what 
they  are  graduated   to   and  prepared  for.     Is  it 
strange  if  pneumonia  and  bronchitis  are  at  hand? 
If  we  are  at  the  West  Indies,  or  even  in  Florida, 
and  wish  to  come  north  in  winter,  we  try  to  make 
the  change  gradual.     But  in  our  houses  w'e  keep 
up  a  tropical  climate,  or  worse,  for  you  have  not 
the  freshness  of  air  that  prevails  in  an  open  tropi- 
cal atmosphere,   and  we  stepat  once~into  an  at- 
mosiihere  as   much   colder  as    40  °  difference   of 
latitude  will   make  it.     It  is  in  effect  going  from 
Cuba  to    Iceland,  or  at  least  to   New  York,  at  a 


96 


THE   CANADA    MEDICAL    RECORD. 


step,  and  we  make  the  journey  perhaps  a  dozen 
times  a  day.  And  often,  while  we  are  still  shut  up 
in  our  domiciliary  Cuban  climate,  Iceland  comes 
down  upon  us  from  an  open  window.  Especially 
is  this  likely  to  occur  in  school-houses,  where  chil- 
dren will  instinctively  seek  to  get  a  breath  of  fresh 
air  that  has  not  had  all  its  natural  refreshing 
qualities  quite  cooked  out  of  it  by  hot  stoves, 
furnaces,  or  steam-pipes.  And  all  these  sudden 
changes  and  shocks  of  cold  come  upon  us  while 
the  wliole  system  has  its  vitality  and  powers  of 
resistance  gauged  down  to  the  low  necessities  of  a 
tropical  climate." 

There  is,  of  course,  a  great  deal  of  truth  in  the 
above  remarks,  and  those  of  us  who  reside  in  the 
northern  part  of  the  continent  are,  perhaps,  a  little 
better  fitted  to  realize  the  fact,  than  are  those  who 
live  where  intense  cold  is   not  the  rule  in  winter. 
Yet  nature  is  wonderfully  alive  to   the  necessity 
which  exists   to  train  up    those    thus    situated   to 
withstand  the  sudden  transitions  to  which  they  are 
subjected.     Theoretically     speaking,   we    should 
have  a  series  of  apartments,  each   of  a  gradually 
lower  temperature,  through  which  we  should  pass 
with  a  brief  sojourn  in  each,  before  passing  into 
the  outer  atmosphere.     This  is  the  rule  in  Turkish 
baths.    Of  course,  in  our  daily  life,  such  a  practice 
is  quite  impossible,  and  that  we  do  not  suffer  by 
jjassing  from  a  room  at  a  temperature  of  70  to  a 
tenii3erature  of  20  below   zero  is  simply   because 
nature  has  trained  our  apparently  delicate  internal 
organization  to  it.     Still  even  with  us,  there  comes 
a   time   when    our  organization    is   so  weakened, 
either  by  failing  health  or  advancing  age,  that  Pneu- 
monia, Pleurisy  or  Bronchitis  is  a  common  result  of 
this  sudden  transition  of  temperature.     Can  any- 
thing be  done  to  prevent  it  ?     We  think  there  can  : 
Aged  and  weak  persons  should  not  go  out  during 
intensely  cold  weather,  and  any  who  may  be  com- 
pelled to  do  so  should  be  taught  to  breathe  through 
their  nostrils,  and  to  keep  the  mouth  shut.  This,  we 
believe,  is  the   route  which  nature  intended  air 
should  pass  on    its    way  to  our   lungs.     But   to 
many  this  is  a  practice  difficiult  of  accomplishment. 
.Such    persons    should    wear   a  respirator,     and 
in  this  way  warm  the  air  they  breathe.     If  this  was 
done  we  are  satisfied  that    many  a  life  would    be 
saved,  wliich  is  now  lost  during  our  severe  winter 
weather. 


PERSONAL. 

Dr.  F.  W.Campbcll,  Surgeon  of  "  B."  Co.  Infan- 
try School  Corps,  took  rank  as  a  Surgeon  Major  in 


the  Canadian  Militia  in  October  last,  after  twenty 
years  service  as  a  Surgeon. 

DrJ.  Leslie  Folcy,(M.D.  Bishops  College,i88o) 
has  recently  successfully  passed  the  examination 
for  the  fellow  ship  of  the  Massachusetts  Medical 
Society.  He  is  in  practice  in  Boston.  We  hear 
he  was  lately  offered  the  position  of  Assistant 
Physician  of  the  Utica  Insane  Hospital  at  an  ex- 
cellent salary  and  perquisites.  His  prospects  in 
Boston,  however,  are  so  good  that  he  declined. 

Dr.  Howard,  of  St.  Johns,  Que.,  who  has  been  so 
seriously  ill  since  August,  1885,  is,  we  are  glad  to 
say,  so  far  improved  as  now  to  be  able  to  get  out 
occasionally.  We  but  echo  the  wish  of  his  many 
friends  when  we  express  the  hope  that  before 
many  months,  his  improvement  may  be  still  more 
marked. 

Dr.  Blackmer  (M.  D.  Bishops,  1883)  of  St, 
Louis,  Mo.,  was  in  Montreal  this  month  on  his 
wedding  trip. 

Dr.  J.  M.  Mackay  (M.D.  Bishops  College,  1879) 
has  been  appointed  Inspector  of  Anatomy  for  the 
City  of  Quebec. 

Dr.  Kannon  (M.D.  Bishops  College,  1879)  has 
removed  from  Montreal  to  Los  Angelos,  Califor- 
nia. He  was  doing  well  in  Montreal,  but  he 
made  the  transfer  on  acount  of  his  wife's  health. 
We  regret  to  hear  that  hardly  had  he  arrived  at 
Los  Angelos  than  the  house  in  which  he  was  stay- 
ing took  fire,  and  that  the  Doctor  lost  most  of  his 
goods,  including  his  Diploma  from  Bishops  Col- 
lege, and  the  License  of  the  College  of  Physicians 
and  Surgeons  of  Quebec. 

Dr.   Gillard,   (M.D.  Bishops  College,  1885)  of 
Jamaica,  is  at  present  in  Montreal  on  six  months         i 
sick  leave.  Dr.  Gillard  is  employed  in  the  Colonial         ' 
Service. 

Dr.  Blackader,  Instructor  in  diseases  of  children 
in  McGill  University,  Faculty  of  Medicine,  has 
returned  from  a  three  months' sojourn  on  the  Con- 
tinent in  search  of  the  latest  medical  knowledge.  : 
We  are  glad  to  find  Dr.  Blackader  looking  much 
improved  from  his  trip. 

Dr.  Roddick,  Professor  of  Clinical  Surgery, 
McGill  University,  has  gone  to  Florida  on  a  trip 
for  the  benefit  of  his  health. 


THE  CANADA  MEDICAL  RECORD. 


Vol.  XV. 


MONTREAL,  FEBRUARY,  1887. 


No.  5. 


OOlsTTElsTTS. 


ORIGINAL  COMMUNICATIONS. 

Soino  of  tin'  presonl.  aspot-is  t^f  Snrg«ry..97 
A  Cliiii»';il  Lccturi!    ilolivered  at    tlio 
Moiit.n-;iI  (Joiienil  llospiml  ICO 

SOCIETY  PROCEEDINGS. 

Medico-t'hiiiiiyifnl    S"ci.'iy   of    Mont- 
real  "!.... .* lO'J 

PROGRESS  OF.SCIENCE. 

Ophtlinloiia  Noonatorum 105 

BisiuuUi  Subnitrate  in  Uatid    perapi- 

ralioii  of  the  Kect inc 

SpaamoiUc  Asthma— Us  Troatnient KK! 

Kissures  of  the  Toiipuo , I(i7 

The  Dietary  of  Blights  Disease 108 

Maiiageiueiit  of  simple  constipation.. .  110 


Hiol  iu  lh<' 'i'i-c'!ilm.-iil  ol  Kjiilopsy   112 

('hoIiiKn!.;iio  pills 113 

Vim  of  Kliu-k  Haw  in  habitiiiil  aboralion 

atul  other  uterine  troubles 113 

On    sonio   Forms  of    alhuminuiia  not 

(Inngeroiis  U*  I-ifo 114 

I.t  tho  •' Kneo-lvii'k  "  a  reflex  ael'.' 114 

Man.igeminit  of  melain-liolia    115 

l^ia^^nosis  of  infaiilile  ili.^oascs 115 

Hysteria  in  a  now  lA^hx. 116 

The  nijiht  sweats  of  phthisis  truuted  by 

seoalo  eornntum 116 

Treatment  of  chronit:  eonstipjition  in 

Children IIG 

Puerperal  Kelamp'^ia  treated  with  Pilo- 
carpine   117 

Uu'es  for  opening  the  abdomen '   117 

A  Domestie  Device  fornipple shields  .  H« 


Ix>eal  remedy  for  neuralgia 118 

lioweie  Treatment  of  ehronic  (Jonor- 
rliea 118 

EDITORIAL. 

Annual  of  the  Me. Heal  sfiencos  118 

College  of  Physleiaiis  and  Sur^eoiu'cf 

Ontiirio 119 

Appropriation    for    the    Int<TnHtional 

Medical  Congress. 119 

Pay  of  American  army  and  naval  medi- 
cal orticers 119 

Laetated  Food 119 

Gleaninj^A 120 

Personal 120 

Obituarv...   120 

I>r.  Joseph  Morley  Drake 120 


^mdmai  BQinmunlcaUmii. 


SOME  OF  THE  PRESENT  ASPECTS  OF 
SURGERY. 

By  Wm.  n.  Kingston,  M.D.,  D.C.L.,  L.R.C.S.IO., 

Surgeon  to  the  Hotel  Diaii  ;  Professor  of  Clinical 

Surgery. 

Read  before  the  MedUo-Chirurgieal  Society , 

Much  of  what  I  am  about  to  read  to  you  has 
been  hurriedly  written.  Your  secretary  called  upon 
me  three  evenings  ago,  and  invited  me  in  the  name 
of  the  Society  to  read  a  paper  before  you  to- 
night. Here  it  is,  with  all  the  evidences  of  haste 
clinging  to  it : 

The  aspects  of  a  science  or  of  an  art  are  as  the 
aspects  of  a  country  ;  not  being  always  objective 
are  not  always  the  same — for  the  subject,  seeing, 
has  views  of  his  own,  habits  of  vision  as  it  were, 
and  these,  unconsciously  to  himself,  perhaps, 
change  and  colour  the  prospective.  I  am  as  one, 
and  only  one  of  those  observers,  and  the  field  of 
observation — chiefly  ultra  mare — is  the  scene  of 
former  and  more  lengthened  residence. 

During  my  recent  visit  to  Europe,  after  an  in- 
terval of  nineteen  years,  I  perceived,  or  fancied  I 
perceived  among  individuals  in  the  higher  walks 
of  the  profession,  whether  met  with  in  society  or 
at  their  own  homes,  a  greater  seriousness — a 
greater  earnestness  than  on  former  occasions. 
Or  was  it  that  those  intervening  years  had 
changed  the  mode  of  vision  in  the  observer  ? 

The  friction  of  mind  against  mind  is  seemingly 
incessant.  The  struggle  for  position  is  unremit- 
ting— rendered  the  more  necessary  by  the  increased 
and  steadily  increasing  cost  of  living,  and  almost 


pari  passu,  the  steadily  increasing  number  of 
votaries  to  the  healing  art.  'I'he  large  incomes 
enjoyed — not  always  enjoyed,  but  alw.iys  slaved 
for — by  a  limited  ift\i,  have  caused  recruits  innu 
inerable,  each  one  hoping  to  achieve  distinction, 
as  in  the  time  of  Napoleon  the  hiunblest  soldier 
was  animated  with  a  hope  of  one  day  ex- 
changing his  musket  for  the  baton  of  the  marshal. 

Although  great  courtesy  characterizes  the 
relationship  of  members  of  the  profession  with  one 
another,  there  are  few  who  are  not  keenly  alive 
to  the  necessity  of  continued  effort  for  supremacy, 
as  well  as  for  its  recognition  ;  and  self-assertion, 
though  clothed  with  becoming  modesty,  is  not 
always  absent  from  the  highest  and  most  conser- 
vative ranks  of  the  profession. 

But — and  most  markedly  in  Great  Britain — 
plain, honest  thought  finds  plain,  honest  expression 
at  all  the  meetings  of  societies  I  attended.  Vague 
statements  are  unheeded;  and  if  imagination  is 
suspected  as  a  possible  source  of  slated  fact,  a 
clapping  of  hands  is  an  indication  o^  that  fact  hav- 
ing been  duly  noted.  The  most  imaginative  could 
not  devise  a  readier  method  of  expression  than  the 
clapping,  graduated  on  a  crescendo  scale,  which 
marks  distrust  or  disapproval;  and  tediousness 
or  irrelevancy  receives  a  quietus  in  the  same  way. 

The  vast  strides  in  the  study  of  minute  and 
morbid  anatomy,  and  in  special  and  general 
pathology,  have  opened  up  newer,  and,  it  is 
laid,  more  profitable  fields  of  professional  labour. 
The  growth  and  multiplication  of  specialties  are 
prodigious.  The  three  divisions  of  physician,  sur- 
geon and  accoucheur  ;  the  subdivision  of  eye  and 
ear  surgery,  and  afterwards  the  further  separation 


98 


THE   CANADA   MEDICAL   RECORD. 


of  the  two  latter,  are  no  longer  adequate  to  express 
the  numerous  subsections  of  professional  work. 
On  former  visits  I  usually  spent  an  hour  or  two 
a  day  with  Sichel,  Desmarres,  or  von-Grjefe  over  the 
eye  ;  with  Wilde  or  Toynbee  in  studying  the  ear ; 
while  a  Stokes,  a  Graves,  a  Trousseau,  or  a  Schoen- 
lein  was,  in  our  then  benighted  condition,  deemed 
fit  to  teach  the  practice  of  medicine  in  general ;  and 
a  Syme,  a  Velpeau,  or  a  Langenbeck,  was 
supposed  to  be  quite  abreast  of  general  surgery. 
Now,  all  is  changed,  and  perched  on  every  barley- 
corn of  vantage  ground,  the  specialist  works  in  a 
narrower — a  more  restricted  sphere,  seeing  clearer, 
no  doubt,  what  he  does  see,  but  with  less  acquain- 
tance, it  is  said,  with  the  ailments  of  other  organs 
with  which  his  own  may  be  intimately  connected. 
Yet  the  labors  of  the  specialist — each  in  his  own 
department — have  greatly  advanced  the  general 
stock  of  knowledge.  The  all-around  man  is 
becoming  a  rara  avis ;  yet  when  a  Jonathan 
Hutchison  appears,  going  to  and  from  the  meet- 
ings of  the  British  Medical  Association,  he  is 
greeted  by  physician  and  surgeon  alike  as  one  who, 
in  his  day,  has  touched  many  things  pertaining 
to  both  medicine  and  surgery,  yet  of  whom  it  may 
be  said,  nee  tetiget  quod  non  ornavii.  It  is  men 
such  as  he  who  show  us  how  the  various  branches 
of  our  art  are  mutually  dependent,  and  how  they 
correct,  reform  and  reclaim  each  other. 

The  newer  and  more  inviting  fields  of  special 
work  are,  in  Great  Britain,  drawing  into  their  ranks, 
at  a  rapid  rate,  men  who  will  be  competitors  in 
those  ranks.  There  must  soon  be  a  limit  to 
subdivision.  The  story  told,  a  few  years  ago,  of  a 
lady  in  London  who  had  given  her  lungs  to  one 
physician ;  her  liver  to  a  second ;  her  heart  to  a 
third  ;  her  womb  to  a  fourth,  and  so  on,  would  now 
be  strange  in  the  atmosphere  of  refined  life,  were  she 
so  incautious  and  so  ill  informed  as  to  confide  the 
whole  of  any  organ  to  a  single  individual. 

Now  and  then,  as  you  are  aware,  efforts  are  made 
in  the  direction  of  synthetizing  diseases.  Thus 
Erasmus  Wilson,  in  his  old  age — and  it  was  a 
richer  legacy  than  that  represented  by  his  Cleo- 
patra's needle, — reduced,  for  therapeutic  purposes, 
diseases  of  the  skin  to  fo'ur  clearly  and  easily 
understood  heads.  The  whole  was  contained  in 
a  few  duodecimo  pages.  Eczema  was  grouped 
naturally  under  one  of  them,  and  I  much  doubt  if 
any  of  the  octavo  volumes,  on  that  disease  alone, 
have  contained  more  matter  for  the  practising  physi- 
cian   than  the  few   lines   in  question.       No  one 


is  still  doing  more  to  harmonize  medicine  and  sur- 
gery than  Sir  Jas.  Paget,  who  draws  from  patho- 
logical anatomy  and  from  clinical  pathology, 
whether  for  the  use  of  flie  experimentalist,  the 
chemist  or  the  microscopist. 

Great  advances  have  been  made  in  the  diagnosis 
of  diseases  of  the  different  cavities  of  the  body;  but 
in  the  exploration  of  mucous  inlets,  as  the  nose, 
larynx,  trachea,  urethra,  bladder  or  vagina,  I  failed 
to  notice  any  advantages  not  within  the  />ortee  of 
practitioners  twenty  years  ago. 

The  principles  of  treatment  are  not  now 
much  better  understood,  although  diagnosis  may 
have  outstripped  its  former  self  by  many  a  stride. 

With  the  greatly  increased  facilities  for  the  in- 
vestigation of  disease  ;  with  the  improvements  in 
the  methods  of  diagnosis  ;  and  with  the  application 
of  direct  methods  of  treatment,  initiation  is  some- 
times shrouded  in  well-intentioned  mystery.  For 
instance, in  a  specular  examination  ofone  of  the  mu- 
cous inlets,  there  was  an  arrangement  of  mirrors 
which  reflected  the  electric  Wght/our  times  before 
it  reached  the  mucous  membrane.  The  green  baized 
drapery  completed  the  illusion  ;  and  the  fee  was 
larger,  possibly,  than  if  the  examination  had  been 
gone  through  with  direct  light,  or  with  light  once 
reflected. 

The  separation  of  medicine,  as  a  whole,  from  sur-' 
gery,  as  a  wnole,  seemed  destined  to  be  complete 
and  irreparable.  But  it  is  not  so.  Handmaids  of 
each  other  they  must  ever  remain ;  again,  a  ten- 
dency is  noticeable  of  an  approehement,  and  this 
time  by  the  invasion  by  the  surgeon  of  tlie  domain 
of  medicine. 

The  lines  which  separate  specialties  are,  as  I 
have  said,  narrow,  short,  yet  well  defined.  They 
are  steadily  becoming  narrower,  shorter,  and  still 
more  defined  as  between  specialties,  and  especially 
surgical  specialties.  That  tlie  public  is  a  gainer 
is  much  doubted.  But  while  the  lines  which  con- 
fine specialism  within  steadily  narrowing  limits 
are  becoming  more  defined,  the  lines  which  separ- 
ate medicine,  as  a  whole,  from  surgery,  as  a  whole, 
— even  in  those  departments  in  which,  till  re- 
cently, the  physician  tolerated  not  the  aid  or  inter- 
vention of  the  surgeon, — the  latter  has  dared  to 
enter,  and  with  advantage,  the  domain  of  the 
physician. 

Not  many  years  ago,  for  instance,  in  all  affec- 
tions of  the  chest  or  abdomen  requiring  manual 
interference,  the  surgeon  was  sent  for,  and  the 
operation  was  performed  at  the  request,  and  under 


THE  CANADA  MEDICAL  RECORD. 


99 


the  guidance  and  direction  of  the  physician  whose 
diagnosis  was  followed,  and  who  had  called  in  the 
surgeon  to  do  that  which  required  a  cooler  nerve 
or  a  more  dexterous  hand  than  lliat  possessed  by 
himself.  How  is  it  now  ?  The  surgeon's  know- 
ledge of  internal  derangements  within  the  skull, 
chest  or  abdomen  requires  to  be  so  precise  that 
skill  in  operating  must  wait  upon,  and  be  pre- 
ceded by  great  accuracy  in  diagnosis. 

The  surgeon  who  trephines  the  skuli,  cuts 
through  its  membranes,  and  removes  a  tumor  from 
the  brain  ;  or  who  sends  a  bistoury  through  its 
substance  to  an  abscess,  docs  thai  wliich  requires 
no  extraordinary  manual  skill  or  dexterity — a 
butcher,  or  a  butcher's  boy  could  do  it  as  well. 
But  the  exact,  the  precise  localizing  of  disease 
within  the  brain,  by  the  correct  interpretation  of 
disturbance  of  function  at  a  distance,  is  one  of  the 
greatest  triumphs  of  modern  surgery,  and  is  a  step 
towards  its  recognition  as  a  science  as  well  as  an  art. 

The  domain  of  the  surgeon  is,  therefore,  steadily 
extending,and  fractures,  dislocations  and  excisions 
of  tumours  no  longer  limit  the  field  of  his  labours. 

It  would  be  inconsistent  with  the  time  at  my 
disposal  to  traverse  the  field  of  practical  surgery, 
to  point  out  what  might  be  considered  encroach- 
ments upon  the  territory  of  the  physician.  I  shall 
only  allude  to  those  instances,  where,  till  recently, 
medicine,  and  medicine  alone,  was  relied  upon  for 
relief: 

In  chest  affections  requiring  surgical  interference, 
diagnosis  must  be  clear  and  precise.  In  empyema, 
for  instance,  not  alone  must  the  quantity  and  situa- 
tion, but  even  the  quality  of  tlie  fluid  be  made  out 
before  proceeding  to  operation.  In  bronchiectasis 
of  the  lung,  where  the  difficulty  of  diagnosis  is  ad- 
mittedly great,  it  must  be  precise  before  resorting 
to  any  operative  procedure.  Here,  again,  the  sur- 
geon, although  he  may  receive  aid  in  determining 
the  exact  site  and  nature  of  the  disease,  must  rely 
upon  his  own  diagnosis,  chiefly,  if  not  entirely. 

In  local  peritonitis  what  could  be  more  daring, 
more  surprising,  yet  more  satisfactory  than  Mr. 
Lawson  Tait's  thrusting  a  bistoury  into  the  groin 
of  a  woman  labouring  under  all  the  symptoms  of 
puerperal  fever,  where  he  suspected  pus  by  the 
symptoms  alone,  but  where,  as  he  told  me,  there 
Were  no  outward  signs  of  its  presence  ;  no  swelling, 
and  no  local  tenderness.  From  a  condition,  almost 
of  collapse,  recovery  took  place.  The  operation 
Was  not,  t'is  true,  a  diflScult  one.  Anyone  could 
have  performed  it ;  but  the  diagnosis  was  prophetic. 


The  case  of  Dr.  Leslie  Phillips,  operated  upon 
by  John  W.  Taylor,  F.  R.  C.  S.,  is  of  like  charac- 
ter, and  now  that  attention  has  been  directed  to 
the  subject,  and  that  surgery  has  taught  a  means  of 
escape,  deaths  from  supposed  puerperal  fever 
will,  it  is  hoped,  be  less  frequent  than  formerly. 
Here,  as  you  will  see,  surgery  comes  to  the  relief  of 
the  obstetric  physician  in  cases  which  are  pecu- 
liarly within  the  province  of  the  latter. 

In  diseases  of  the  abdominal  organs  how  much 
has  lately  been  done  by  surgery.  Hepatitis,  with 
all  its  train  of  sufferings,  was  claimed  by  medicine 
as  its  own  ;  but  surgery  of  the  liver  has  sud- 
denly leaped  into  importance  lately.  A  painful, 
inflamed,  and  enlarged  liver  is  now  relieved  by 
Harley  and  others,  and  the  patient  cured  by  the 
insertion  into  it,  at  its  upper  and  convex  part,  of  a 
long  trocar,  and  by  the  drawing  directly  therefrom 
as  large  a  quantity  of  blood  as  was  considered  pru- 
dent to  be  taken  from  the  arm  in  the  days  of  vene- 
section. Operation  for  draining  hepatic  abscesses 
or  removing  hepatic  cysts  ;  cholecystotomy  for 
crushing  or  taking  calculi  from  the  gall  bladder  ; 
laparatomy  for  purulent  or  persistent  peritonitis  ; 
abdominal  sections  for  internal  hemorrhage,  etc.,  are 
all  of  recent  dale,  and  open  a  field,  not  of  brilliant 
operative  procedures,  but  of  more  brilliant  diag- 
nosis, and  what  is  of  greater  moment,  of  far  more 
beneficent  results.  ^ 

The  considerable  degree  of  immunity  from  dan- 
ger which  has  attended  abdominal  sections,  has  led 
to  the  spaying  of  females — married  and  unmarried 
— for  sometimes  real — sometimes,  it  is  believed,  un. 
real  sufferings.  This  operation  has  been  performed 
for  objective  disturbances,  and  for  disturbances 
purely  subjective  :  Prolapsus  of  the  ovary,  a  com- 
mon affection ;  atrophy  of  the  ovary,  not  easily 
diagnosed  ;  cedematous  ovary  ;  a  pultaceous  con- 
dition of  the  ovary ;  cirrhotic  ovary ;  hydrosal 
pinx ;  in  pyosalpinx  pur  et  simple,  Often  guessed  at 
by  raised  temperature  alone  ;  in  pyosalpinx  result- 
ing from  gonorrhoea ;  in  that  condition  of  neurosis 
whose  shapes  are  endless,  and  whose  outward 
hysterical  manifestations  are  innumerable ;  in 
localized  peritonitis  where  the  intestines,  omen- 
tum, etc.,  are  glued  together,  etc.,  etc.,  etc.;  in  in- 
flammatory conditions  after  confinement,  especially 
in  the  acute  and  subacute  stage  ;  in  deformity,  where 
the  birth  of  a  living  child  might  be  reasonably  ex- 
pected to  prove  fatal  to  the  mother ;  in  uterine 
myomata  where  the  size  of  the  growth  is  inconve- 
nient ;  in  bleeding  myomata ;  in  (who  would  believe 


loO 


THE   CANADA   MEDICAL   RECoRO. 


it?)  all  cases  of  uterine  niyoniata  inpatients  under 
forty  years  of  age  ;  in  retroflexed  and  anteflexed 
uterus  ;  in  epilepsy  ;  in  hystero  epilepsy  ;  in  every 
case  of  insanity  in  the  female.  !  I 

Here,  as  you  will  perceive,  I  have  said  nothing 
of  those  considerable  tumours  of  the  ovary  or 
tubes — cystic,  fibrocystic  or  malignant,  which,  all 
agree,  may  demand  removal. 

Is  it  to  be  wondered  at  that  this  operation 
should  be  resorted  to  with  a  frequency  which  is 
alarming  ?  Ophorectomy  is  to-day  epedemic  in 
many  places  on  the  other  and  on  this  side  of  the 
Atlantic.  Occasionally  an  authority,  such  as 
Thomas  More  Madden,  in  Europe,  writes  that  the 
operation  of  laparotomy  is  performed  "  too  fre- 
quently "  and  in  unsuitable  cases  ;  and  Emmet,  on 
this  side,  stems  tlic  tide  somewhat  by  saying  that 
for  a  year  he  had  seen  but  one  case  of  disease  of 
the  tubes,  where  the  operation  might  be  justifi- 
able, that  the  patient  refused  to.  be  operated 
upon,  and  got  well  in  a  few  months.  Yet  every 
one  knows  Emmet's  unsurpassed  field  of  clinical 
observation.  In  one  hospital  in  Liverpool,  says 
Dr.  Carter,  no  less  than  one  hundred  and  eleven 
women  had  been  deprived  of  one  or  both  ovaries 
during  the  year  1S85,  said  to  be  about  one-third  of 
all  the  patients  admitted.  Tliis  frequency  contin- 
ued in  1886,  and  led  to  a  commission  of  enquiry. 
Canada  has  many  ophorectomisls  and  salpingoto- 
mists.  The  Upper  Canada  Lancet  has  denounced 
the  epidemic,  and  at  our  own  Medico-Ciiirurgical 
society  ovaries  are  sometimes  fished  up  from  the 
depths  of  the  pocket, — sometimes  the  vest  pocket 
—and  sometimes  it  has  happened  that  so  able  a 
pathologist  as  Professor  William  Osier  has,  after 
close  inspection,  declared  he  found  nothing  abnor- 
mal in  them. 

The  fashion,  doubtless,  will  soon  change  ;  diag- 
nosis of  affections  of  the  appendages  will,  in  the 
meantime,  have  been  much  advanced ,  and  the 
question  of  operation  will  have  been  settled  in  ac- 
cordance with  those  general  principles,which  should 
guide  all  prudent  and  honorable  men  in  its  per- 
formance or  rejection. 

This  question  has  a  moral  and  a  social  as  well 
as  a  medical  aspect ;  but  I  do  not  arrogate  to  my- 
self any  preparedness  not  possessed  by  others. 
I  may  say,  however,  I  have  more  than  once  pre- 
vented the  operation,  and  I  have  been  aftei  wards 
thanked  for  it,  and  another  then  unborn  generation 
has  been  advantaged  by  it.  I  admit  there  are  cases 
where  a  diseased  condition  of  the  ovaries  or  tubes 


demands  surgical  interference  ;  but  those  are  not 
cases  where  every  objective  sign  is  absent,  and 
where  the  symptoms  detailed  by  a  hysterical 
woman  are  the  only  guide.' 


A  CLINICAL  LECTURE 

Delivered  at  the  Montreal  General  Hospital, 
Nov.  20,  1886. 

By  Francis  Wavland  Campbell,  M.A.,  M.D.,  L.R.C.P., 

London, 

Dean  and  Professor  of  Practice  of  Medicine  in  the  Medicaj: 

Faculty,  University  of  Bishops'  College. 

ANEMIA. 

The  term  "  Anemia  "  is  often  very  loosely  ap- 
plied ;  generally  speaking  it  refers  to  three  classes 
of  cases,  viz. :  (i)  Where  the  blood  is  deficient  in 
quantity;  (2)  where  it  presents  certain  abnor- 
mal qualities  ;  (3)  where,  owing  to  a  weak  heart,  the 
arteries  are  not  properly  filled.  Very  often  in 
cases  we  find  a  combination  of  the  whole  three. 
The  principal  alteration  in  the  quality  of  the  blood 
depends  upon  a  deficiency  or  diminution  in  the 
number  of  the  red  corpuscles.  In  such  cases 
the  salts  are  in  excess,  as  well  as  the  proportion  of 
water,  and  the  serum,  as  a  result,  is  of  a  low 
specific  gravity.  Tlie  fibrin  is  generally  in 
excess,  and  there  is  a  tendency  for  the  blood  to 
coagulate  in  the  veins.  Chlorosis  is  a  form  of 
anemia — commonly  known  as  green  sickness, 
from  a  greenish  tint  of  the  skin^ — met  with  in  young 
girls  who  are  sufferers  from  some  menstrual  derange- 
ment. The  causes  which  produce  this  disease  are 
numerous,  but  among  the  principal  are  the  follow- 
ing :  Excessive  loss  of  blood  at  one  time,  or  j  e- 
peated  small  losses,  as,  for  instance,  losses  from 
epistaxis  or  nose  bleeding,  or  from  ha-morrhoid  or 
piles  ;  constant  sedentary  employment,  especially 
if  this  employment  is  carried  on  under  unfav- 
orable hygienic  conditions,  as,  for  instance,  in 
a  confined  atmosphere,  and  where  the  sunlight 
is  deficient,  mal-assimilation  of  food,  and  where 
animal  food  is  eaten  rarely.  Anemia  is  also 
met  with  in  women,  who  are  nursing  strong 
and  vigorous  children,  and  who  prolong  lactation 
beyond  the  time,  which  is  usual  to  devote  to  this 
function.  The  disease  is  met  with  more  frequent- 
ly in  women  than  in  men,  and  between  the  ages 
of  fifteen  and  twenty-five  years.  The  reason  of 
this  is  the  great  demands  made  about  the  periods 
of  puberty,  upon  the  developing  power  of  the  in- 
dividual.    Anemia  gives   rise    to    a    gicat   many 


THE   CANADA    MDUICAL   IIKCOHU. 


101 


iphcnomuna,  especially  rferr  ahlc    to  the   ik'i  vous 
.system,    mental    depression,    iiiitahility,   want   of 
(.energy,  a  feeling  of  lassitude  and  inilolence.    Mns. 
■  ciilar    e.vertion,  is  distasteful,  and,   therefore,   it  is 
wvilli  difi'iiulty  that  the  patient  can  be  induced  to 
take    out-of-door    exercise.      Digestion    is    often 
;  painful,  and  when  not,  during  the  digestive  act,  the 
;physicial   and    mental   powers   are  markedly   de- 
pressed.    Palpitation  of  the  heart  is  very  common 
.as  is    pulsation   of  the   jugular    veins,  the    latter 
producing  a  decided  venous  hum.     There  is  gener. 
ally  also  heard   functional  systolic  mmmurs  at  the 
.base  of  the  heart,  which  are  believed  to  be  pro. 
•  duced  within  the  aorta  and  the  pulmonary  artery, 
J'he  fact  that  they  disappear  under  the  treatment 
.ado|Hed  for  the  anemic  condition,  as  well  as  the  ab- 
sence ofany  sign  [jointing  to  organic  lesion,  denotes 
their  luiK  lional  character;  breathlessness,   espe- 
icially  on  the  least  exertion,  headache,  dizanessand 
jioise  in  the  ears  are  common  symptoms.      Neural- 
gia is  apt  to  occur  in  various  situations,  esjpecially 
over  the  cardiac  region  and  in  intercostal  muscles  ; 
spinal  irritation,  and  sometimes  ovarian  irritation 
are  often  met  with.    The  various  orgajjs  of  the  body 
are  deficient  in  functional  power,  in  proportion  to 
the  lessened  amount  of  blood  which  goes  to  them 
compared  to  what  they  receive  in  health.    Anemic 
patients  are  pale,  often  have  a  waxy  look  with  a  clear 
.and  transparent  skin  ;  or  if  the  patient  is  chlorotic, 
ithen  there  is  a  greenish   tint    to  the    skin.     The 
mucus  membrane  is  pale,  especially  that  of  the  Jips, 
gums,   and  the  conjunctiva  of  the  lower  •eyelid_ 
The  sclerotic  are  clear  and  bluish, usually  the  tissues 
are  flabby  and  wanting  in  tone.     The  ankles  are 
o.''ten  swollen  and  cedematous,  and  after  standing 
some  time  the  legs  are  apt  to  be  greatly  swollen- 
In  the  morning  the  eyelids  are  puffy,  the  extremi- 
ties are  cold,  and  the  patient  is  afraid  of  the  slight, 
est  cold  ;  leucorrhrea  is  often  present.     The  pulse 
is  small,  feeble  and  compressible,  sometimes  it  can 
with  difficulty  be  felt.     The  urine  is  pale,  exces- 
sive in  quantity,  and  of  low  specific  gravity,    and 
very  faintly  acid.  Treatment. — -The  first  thing  to  be 
done  is,  if  possible,  to  find  out  the  cause  and  have 
it  removed  ;  haemorrhages  must  be  arrested  or  res- 
trained, the  food   must  be    abundant  and  varied, 
and  must  have  a  due  proportion  of  animal  diet. 
If  the  patient  is  nursing  this  must  at  once  be  dis- 
continued, and   it   may  be  advisable    to    caution 
against    pregnancy,  for,  strange  as   it    may  seem, 
anemic  women  are  very  apt  to  conceive.  Digestion 
and  assimilation  must  be  improved  by  the  adiiun- 


istration  of  those  remedies  which  assist  these  fimc- 
tions,  as  Pepsin  and  Muriatic  Acid,  given  in  com- 
bination with  some  of  the  vegetable  tinctures, 
(ireat  attention  shcjuld  be  (laid  to  the  hygiene  of 
the  individual ;  fresh  air,  plently  of  sunlight,  out- 
door exercise,  avoiilance  of  crowded  and  hot 
rooms,  and  early  hours  of  retiring,  and  at  least 
8  hours  sleej)  must  be  insisted  on  ;  change  of 
scene,  especially  to  the  sea-side  with  sea 
bathing,  followed  by  rapid  friction,  will  do 
much  good.  Particular  attention  must  be  paid 
to  the  bowels,  from  which  there  should  be 
a  daily  evacuation,  and  the  best  ajjcrient  to  use 
is  aloes,  given  in  the  form  of  the  well-known,  Aloes 
and  Myrrh  pill ;  the  great  remedy  in  this  disease  is 
iron.  In  chlorosis,  the  Mist.  Ferri  Co.,  or  GrifTith's 
mixture,  which  you  have  seen  me  so  often  prescribe 
in  the  out-door  clinic  to  weak,  delicate  girls,  suffer- 
ing from  amemorrhiea,  is  the  Kxv^Ay  par  excellence. 
In  ordinary  anemia  the  Pill  Ferri  Sach.  Carb., 
the  Ammonia-Citrate  of  iron,  and  Ferrum  Redac-' 
turn  are  very  useful,  and  have  all  done  good  ser- 
vice. They  are' all  preparations  which  are  readily 
assimilable.  The  most  commonly  employed  irorj 
preparation  is  the  tincture  of  steel,  better  known 
medically  as  the  "  Tincture  of  the  Muriate  of 
Iron,"  It  is  an  invaluable  remedy,  and  it  is  the  only 
one  I  have  prescribed  for  this  patient.  All  these 
preparations  should  be  taken  after  meals,  so  as  to 
be  assimilated  along  with  the  food.  How  they  act 
we  do  not  positively  know  ;  but  the  fact  that  iron 
is  a  constituent  of  the  red  corpuscles  of  the  blood 
affords  a  partial  explanation.  No  matter  in  what 
way  they  act,  nothing  is  more  certain  than  the 
value  of  iron  in  this  disease.  It  is  a  wise  precau- 
tion to  change  from  time  to  time  the  preparation  of 
iron  which  is  being  taken.  Wine,  especially  Bur- 
gundy, is  useful,  it  promotes  assimilation  and  dim- 
inishes tissue  waste.  Extract  of  malt  is  also  a 
useful  remedy.  Cod  liver  oil  is  recommended,  but 
my  exi>erience  is  not  favorable.  It  is  very  apt  to 
upset  the  stomach,  already  performing  its  work 
badly.  The  patient  should  be  encouraged  to  look 
for  a  cure  ;  but  it  is  well  to  deal  honestly  and  say 
that  it  will  take  several  months  to  effect  it,  and 
that  a  steady  perseverance  iq  the  treatment  is  an 
absolute  necessity. 

ACUTE    LARYNGITIS. 

The  patient  now  before  you  is,  as  you  perceive,  a 
strong,  healthy  man,   who  g^a^eg  \^\  his  bed  ia 


102 


THE   CANADA    MEDICAL   RECORD. 


placed  near  a  door,  where  there  is  a  very  cold 
draught,  and  that  he  woke  up  the  other  morning 
with  a  sensation  of  rawness  and  tickling,  which  he 
referred  to  the  larynx,  and  a  sense  ofcliillness  and 
general  malaise  or  soreness  of  the  muscles.  This 
was  followed  by  cough  of  a  coarse,  harsh  character, 
and  destitute  of  expectoration.  Then  the  cough 
got  somewhat  loose,  and  now  the  expectoration  is 
considerable,  and  of  the  character  of  mucopus. 
There  is  often  some  aphonia,  and  there  was  and  still 
is  in  this  case.  This  peculiarity  of  the  voice  is 
due  to  swelling  of  the  mucus  membrane,  and  varia' 
tion  in  the  tension  of  the  vocal  cords.  The  disease  is 
an  acute  catarrhal  infl:ammation  of  the  mucus  mem- 
brane of  the  larynx,  and  if  moderately  mild  passes 
through  its  various  stages  in  a  week ;  more  serious 
cases  may  take  a  month  or  more. 

Trcahnent. — In  severe  cases  confinement  to  bed 
and  to  a  room  of  a  uniform  temperature  ;  in  mild 
cases  confinement  in  the  house  and  possibly  to  a 
room  of  uniform  temperature.  It  is  well  to  moist- 
en the  air  by  discharging  steam  into  it ;  tincture  of 
aconite  and  vinum  antimonialis  will  often  loosen  the 
cough,  and  hasten  the  production  of  secretion  from 
the  membrane.  A  solution  of  morphia  sprayed  over 
the  throat  often  relieves  cough.  A  good  combina- 
tion for  the  same  purpose  is  tartar  emetic,  cam- 
phorated tincture  of  opium,  and  syrup  of 
lactucarium.  A  mustard  poultice  for  a  few  min- 
utes to  the  throat  followed  by  the  wet  compress. 
Bromide  of  potash  is  a  good  addition  to  any 
mixture.  I'ersons  are  very  apt  to  become  subject 
to  it ;  such  persons  should  sponge  the  body  every 
morning  with  cold  water,  wear  flannels,  protect  the 
feet  from  dampness,  and  keep  up  the  general 
health.  It  is  said  that  an  impending  attack  may 
be  abated  by  the  administration  of  fifteen  grains  of 
quinine,  and  a  quarter  to  half  a  grain  of  morphia. 
Persons  subject  to  this  disease,  and  who  have  the 
means,  should  live  in  a  dry,  equable  climate. 

MEDICO-CHIRURGICAL  SOCIETY  OF 
MONTREAL. 

Stated  Meeting,  December  iil/t,  1886. 

J.  C.  Cameron,  M.D.,  President,  in  the  Chair. 

Aneurism  0/ the  Innominate  Artery. — Dr.  W. 
G.  Johnston  exhibited  a  specimen  of  aneurism  of 
the  innominate  artery,  which  had  eroded  the  ster- 


num and  first  and  second  ribs  on  right  side.  The 
arch  of  the  aorta  was  unaffected.  The  right  caro- 
tid and  right  subclavian  were  given  off  from  the 
sac.  Tlie  left  carotid  and  left  subclavian  pressed 
upon  and  pushed  over  towards  the  left.  The 
superior  vena  cava  was  obliterated  through  pres- 
sure at  a  point  two  inches  above  its  origin.  Azygos 
vein  enlarged  to  the  size  of  the  ring  finger,  and 
communicated  by  a  large  branch  with  the  superior 
intercostal  vein.  Superficial  anastanioses  of 
epigastric  and  hypogastric  veins  were  prominent 
Hemorrhoidal  veins  normal. 

Dr.  Ross  said  that  the  patient  had  been  under 
his  observation  for  eighteen  months,  and  was  never 
recognized  as  a  case  of  aneurism  of  the  innominate 
artery,  but  the  symptoms  pointed  more  to  the  arch 
of  the  aorta.  The  earliest  symptoms  were  pain  at 
the  back  of  neck  and  shoulder  of  a  neuralgic 
nature,  accompanied  with  cough.  These  were 
relieved  by  potassium  iodide.  The  patient  got 
better  of  his  first  attack,  but  was  frequently  laid  up 
in  hospital.  Enlargement  of  the  superficial  veins 
of  the  abdomen  and  thorax  was  early  evident,  but 
lately  the  superficial  veins  were  tortuous  and  as 
large  as  a  man's  finger.  The  patient  also  exhibited 
signs  of  intra-thoracic  pressure — such  as  paralysis 
of  the  right  vocal  cord,  rattle  in  the  larynx,  and 
signs  of  pressure  on  the  trachea. 

Dr.  R.  L.  MacDonnell  had  had  the  case  under 
observation  for  the  last  fourteen  months,  both  in 
his  wards  in  the  Montreal  General  Hospital,  as 
well  as  during  the  past  summer,  when  the  patient 
was  earning  his  living  as  a  night  watchman.  There 
were  two  points  of  clinical  interest  in  the  case.  In 
the  first  place,  the  results  of  the  use  of  the  sphyg- 
mograph  were  deceptive.  The  tracings  obtained 
showed  very  marked  interference  with  the  blood 
current  through  the  left  radial,  hence  he  had  as- 
sumed that  the  aneurism  was  situated  on  the  arch 
at  a  point  beyond  the  giving  off  of  the  innominate 
artery,  the  fact  being  that  the  great  dilatation  of 
the  innominate  artery  caused  not  an  impediment 
through  that  channel,  but  by  its  bulk  had  pressed 
upon  the  subclavian  and  disturbed  the  flow  of 
blood  to  the  left  upper  extremity.  In  the  second 
place,  the  relief  afforded  by  the  iodide  of  potas- 
sium had  been  most  effectual.  Whenever  the  drug 
had  been  discontinued,  or  whenever  the  patient 
had  been  unable  to  obtain  it,  the  pain  and  dyspnoea 
had  increased.  This  effect  had  several  times  been 
noted,  and  particularly  by  the  patient  himself. 

Dr.  "WiLKiNS  referred  to  a  case   in  his  practice 


THE   CANADA    MEDICAL   RECORD. 


103 


where  there  was  obliteration  of  the  superior  vena 
cava  from  clot,  which  produced  no  varicosity. 

Dr.  Ross  said  one  of  the  early  symptoms  of  the 
(Case  was  a  suffused  appearance  of  the  face,  but  the 
•varicosity  did  not  progressively  increase ;  it  was 
:sudden  and  at  the  last. 

Typhoid  coinplicated  with  Diphtheria. — Dr. 
Johnston  exhibited  for  Dr.  Nealson  specimens 
from  a  case  of  typhoid  fever  complicated  with 
diphtheria.  There  was  a  well  defined  membrane 
covering  the  fauces,  and  extending  through  the 
larynx  to  the  smaller  divisions  of  the  bronchial 
tubes.  The  spleen  was  enlarged,  and  there  were 
typhoid  lesions  in  the  intestines. 

Dr.  Kknnedv  stated  that  the  patient  had  con- 
sulted him  about  a  week  prior  to  his  being  sent  to 
hospital.  The  symptoms  present  were  somewhat 
anomalous.  There  was  acute  bronchitis  with  con- 
gestion of  the  base  of  both  lungs.  On  the  second 
vday  of  attendance  a  rash  made  its  appearance  over 
the  face  and  back,  and  as  there  were  two  children 
sick  with  measles  in  the  next  room  it  was  looked 
,upon  as  being  a  severe  case  of  measles.  On  the 
following  day  the  patient  exhibited  typhoid  symp- 
toms, which  increased  in  severity  during  subsequent 
days.  Typhoid  fe\er  was  clearly  apparent,  and 
the  patient  was  sent  to  the  hospital.  The  peculiar- 
ity of  the  case  appears  in  the  probable  co-existence 
of  measles  with  typhoid  fever.  The  severity  of  the 
subsequent  symptoms  and  rapid  termination  seems 
to  strengthen  the  possibility  of  this  combination. 

Congenital  Absence  of  the  Petrous  portion  of 
the  Temporal  Bone. — Dr.  R.  L.  MacDonnell  ex- 
hibited the  skull  of  an  idiot,  which  had  been  dis- 
sected at  McGill  College.  There  was  on  both 
sides  deficient  development  of  the  petrous  portion 
of  the  temporal  bone.  The  base  of  the  skull,  as 
seen  from  within,  was  flat,  the  petrous  bone  not 
forming  the  normal  ridge  between  the  middle  and 
posterior  fossK.  The  organs  of  hearing  had  never 
reached  development,  there  being  in  reality  but  a 
rudimentary  tympanic  cavity.  The  foramina 
through  which  the  various  nerves  passed  were 
small.  No  previous  history  of  the  case  had  been 
obtained.  The  subject  presented  several  other 
abnormalities,  i.  The  right  common  carotid 
divided  into  its  external  and  internal  division,  oppo- 
site the  lower  border  of  the  thyroid  cartilage.  2. 
The  left  common  carotid  did  not  divide  at  all,  but 
was  continued  upwards  as  the  internal  'carotid  ; 
the  superior  thyroid  and  lingual  arteries  were  given 
off  this  common  trunk,    and  the  facial  from  tJie 


lingual.  3.  The  hypoglossal  nerve  was  given  off 
from  the  pneumogastric.  4.  There  was  deficient 
development  of  the  teeth.  The  bicuspids  were 
represented  by  small  round  pegs.  The  molars  were 
ill  formed,  small,  and  rounded  like  milk  teeth. 

Dr.  WiLKiNS,  ist  Vice-President,  then  took  the 
chair,  and 

Dr.  Cameron  read  a  paper  on  "  Aseptic  Mid- 
V  if  cry." 

Dr.  Cameron  alluded  to  the  absorbing  power 
being  specially  active  in  the  puerperal  state,  owing 
to  the  denuded  placental  site,  and  the  many 
lacerations  and  abrasions  present  after  labor. 

The  absorbable  septic  agents  may  be  con- 
veniently divided  into  three  classes  : 

1.  Specific  microbes,  which  multiply  rapidly 
and  invade  the  whole  body,  even  when  absorbed  in 
small  quantities. 

2.  Ptomaines  or  fennents,  active  inanimate 
septic  matters,  frequently  the  product  of  microbes 
acting  upon  the  tissues,  giving  rise  to  the  condi- 
tion called  by  some  saprcemia. 

3.  Pyogenic  cocci,  which  penetrate  rapidly  and 
in  large  numbers,  and  which  may  or  may  not 
produce  metastases.  They  have  the  power  of  set- 
ting up  suppuration  in  the  tissues  with  which 
they  come  in  contact.  The  most  important  of 
them  is  the  Streptococcus  Pyogenes,  the  cause  of  or- 
dinary acute  abscess.  From  cultivation  experiments 
it  seems  highly  probable  that,  under  favorable 
circumstances,  this  coccus  may  rival  the  anthrax 
bacillus  in  virulence  and  ability  to  spread  through- 
out the  body. 

The  true  relation  existing  between  micro-or- 
ganism and  septicaemia  is  not  yet  settled.  Some 
regard  micro-organisms  as  the  cause,  while  others 
consider  them  as  the  result  of  the  septic  state. 

Whatever  difference  of  opinion  may  exist  the- 
oretically ia  to  the  cause  of  purerperal  septicaemia, 
practically  it  seems  pretty  well  agreed  that  the 
infectious  matter,  whether  animate  or  inanimat'-, 
comes  directly  or  indirectly  from  without,  and  is  ab- 
sorbed through  some  lesion  in  the  parturient  canal. 
The  rational  treatment  of  the  puerperal  period  Hcs, 
therefore,  in  the  direction  oi  asepsis  or  antisepsis, 
the  exclusion  or  the  destruction  of  germs. 

The  aseptic  or  dry  method  aims  to  exclude 
germs,  and  is  theoretically  preferable  ;  but,  practi- 
cally, it  requires  great  care,  and  the  lochia  some- 
times become  offensive  in  sprte  of  every  precau- 
tion. 

The  antiseptic  or  moist  method  aims  to  destroy 


104 


THE   CANADA    MEDICAL    RECORD. 


the  germs  by  frequent  antiseptic  douches  or  to 
wash  them  and  their  products  away.  But  constant 
douching  is  hable  to  certain  risks,  notably  the 
absorption  of  the  antiseptic  or  the  production  of 
pelvic  inflnnimation. 

The  metliod  now  in  use  in  the  University 
Maternity,  and  which,  with  some  slight  modifica- 
tions, he  adopts  in  private  practice,  is  as  follows  : 

1.  Strict  precautions  are  taken  to  scrub  and 
disinfect  the  hands  thoroughly  before  each  vaginal 
examination. 

2.  Whenever  possible,  a  preliminary  vaginal 
douche  (sublimate)  is  given  at  the  beginning  of  the 
second  stage  of  labor. 

3.  Great  pains  are  taken  to  secure  and  maintain 
firm  uterine  contraction  after  the  expulsion  of  the 
placenta ;  frictions  to  the  fundus  are  kept  up  for  an 
hour  before  the  binder  is  applied. 

4.  After  the  birth  of  the  child  the  vulva  is  kept 
covered  with  a  pad  of  sublimated  jute,  and  is 
carefully  washed  with  a  sublimate  solution  every 
time  the  pad  is  changed.  Vaginal  or  uterine 
douches  are  not  employed,  except  in  operative 
cases,  or  where  the  hand  has  been  introduced 
within  the  vagina  or  uterus  after  the  expulsion  of 
the  placenta. 

5.  A  few  hours  after  delivery,  the  vulva  and 
anterior  portion  of  the  vagina  are  thoroughly 
douched  out  with  a  strong  sublimate  solution,  the 
parts  carefully  inspected,  stitches  applied  if  neces- 
sary, and  about  a  drachm  of  boro-iodoform  insuf- 
flated into  the  vulva  and  ostium  vagina  ;  a  thick  pad 
of  sublimated  jute  is  applied,  and  whenever  it  is 
changed  the  external  parts  are  washed  with  a  sub- 
limate solution.  No  further  dressing  or  douching 
is  usually  required,  the  uterus  generally  involutes 
rapidly,  and  the  lochia  soon  fade.  If  the  lochia 
become  offensive,  an  antiseptic  vaginal  douche  is 
given,  boro-iodoform  again  applied  to  the  vulva, 
and  the  dry  dressings  continued.  This  plan  works 
admirably ;  the  patients  are  more  comfortable, 
elevations  of  temperature  rare,  involution  more 
rapid  and  complete,  and  convalescence  more 
satisfactory. 

When  temperature  and  pulse  rise  rapidly  from 
the  third  to  sixth  day,  and  other  causes  can  be 
excluded,  sepsis  may  be  generally  inferred.  In 
such  cases  the  septic  condition  is  most  frequently 
due  to  the  presence  of  decomposing  debris  in  the 
uterine  cavity ;  loose  shreds  and  clots  are  not 
usually  as  dangerous  as  bits  of  placenta  or  mem- 
brane which  remain  adherent  to  the  uterine  wall, 


and  are,  therefore,  in  more  intimate  relations  with 
the  maternal  circulation.  A  simple  uterine  douche 
is  generally  sufficient  to  sweep  away  loo.se  debris, 
but  is  unable  to  dislodge  those  portions  which 
adhere  to  the  uterine  wall.  When  a  uterine 
douche  fails  to  bring  down  the  temperature  in  a 
few  hours,  it  i ;  good  practice  to  follow  the  German 
method,  viz.,  pass  a  blunt  curette  iuto  tire  uterine 
cavity  and  scrape  away  the  adherent  decouiposing 
material.  He  first  saw  this  method  last  July  in 
Carl  BraiMi's  wards  in  Vienna  ;  it  was  then  quite  a 
novelty,  having  been  in  use  only  a  few  weeks,  but 
has  now  become  a  recognized  treatment.  Since  his 
return  he  has  had  occasion  to  use  the  curette  in  sev- 
eral cases.  In  all  of  them  he  scraped  away  shreds  of 
membranes  or  decomposing  debris  firmly  adherent 
to  the  uterine  w.ill,  which  repeated  douches 
had  failed  to  dislodge. 

The  most  important  points  in  the  antiseptic 
treatment  may  be  briefly  summarized  as  follows  : 

1.  Great  care  in  the  disinfection  of  hands  and 
clothing. 

2.  A  preliminary  vaginal  douche  (sublimate) 
when  possible. 

3.  Careful  management  of  the  third  stage  of  labor, 
j  and  securing  fnm  contraction  of  the  uterus. 

4.  The  dry  method  of  dressing. 

5.  A  vaginal  douche,  if  there  is  rise  of  tempera- 
ture or  offensive  discharge  :  if  that  fails,  a  uterine 
douche  ;  if  that  fails,  immediate  curetting  of  the 
uterine  cavity. 

6.  If,  later  on,  there  is  evidence  of  peritonitis 
and  the  presence  of  pus  in  the  peritoneal  cavity, 
abdominal  section  with  thorough  cleansing  and 
draining  offer  the  best  chance  of  recovery. 

Discussion. — Dr.  Kennedy  agreed  with  Dr. 
Cameron  in  his  conclusions.  He  rarely  allowed  a 
patient  to  have  a  douche ;  always  believes  in  using 
it  in  person,  as  he  foimd  nurses,  as  a  rule,  unre^ 
liable.  He  could  tell  by  the  temperature  chart  in 
the  hospital  which  nurse  had  charge  of  a  ward.  He 
did  not  believe  in  the  use  of  a  douche,  unless  there 
had  been  operative  procedures. 

Dr.  Roddick  said  he  was  always  interested  in 
antisejisis,  and  had  long  believed  antisepsis  to  be 
as  important  in  midwifery  as  in  surgery ;  but  from 
his  experience,  as  well  as  from  the  facts  in  the 
paper,  he  now  regarded  it  of  even  more  import- 
ance in  the  former.  In  1877  he  had  been  asked 
to  give  some  rules  for  the  guidance  of  a  friend,  then 
superintendent  of  the  Hamilton  General  Hospital, 


THE   CANADA    MEDICAL   RECORD. 


105 


and  had  laid  stress  on  the  use  of  antiseptic  injec- 
tions previous  to  delivery,  as  before  operations  in 
surgery.  The  results  were  good  in  Hamilton, 
though  only  tried  for  a  very  short  time.  He 
tliought  the  excellent  results  obtained  in  the  Queen 
(-liarlotte  Hospital  were  largely  due  to  the  previous 
washing  out  of  the  vagina,  as  tlie  discharge  before 
labor  was  often  septic. 

Dr.  Ai.LOWAv  thought  no  subject  was  of  more 
importance  than  aseptic  midwifery.  Owing  to  its 
acceptance  the  mortality  had  notably  decreased 
during  the  past  five  years.  It  is  rare  now  to  hear 
of  septic  cases,  much  less  of  death.  For  the  last 
five  years  he  had  been  an  antiseptisist,  and  had 
not  witnessed  a  single  death  durina;  that  period, 
though,  through  nurse  or  midwife  examining  pa- 
tients, he  has  seen  many  cases  of  septicemia.  He 
cited,  as  an  example,  where  one  midwife  had 
lighted  up  several  septic  cases.  Dr.  Roddick's 
importation  of  Listerism  had  induced  him  long  ago 
to  apply  it  to  midwifery  cases.  Dr.  Cooper  of 
New  York  reports  40,000  cases  in  Vienna,  with  re- 
sults similar  to  those  stated  by  Dr.  Cameron.  He 
(Dr.  Cooper)  insists  on  using  corrosive  sublimate 
whenever  there  is  any  abrasion  of  the  vagina. 

Dr.  Trenholme  said  he  had  never  had  a  case 
of  septicaemia  in  his  practice,  though  he  never 
uses  a  tube,  and  believes  this  result  due  to  his 
great  care  in  removing  the  membranes  and  pla- 
centa entire. 

Dr.  Shepherd  called  attention  to  the  results,  as 
stated  by  Dr.  Cameron,  of  removing  by  the  curette 
any  adhering  portions  of  the  placenta  as  soon  as 
septic  symptoms  appear. 

Dr.  Cameron,  in  replying,  stated  that  the  use 
of  the  jute  pad  and  iodoform  to  the  vulva  after  de- 
livery was  analogous  to  the  mode  of  stopping  a 
test  tube  in  germ  culture.  There  is  always  danger 
of  carrying  in  air  with  the  douche,  and  for  that 
reason  prefers  the  dry  dressings. 

3^i(-oj^t/eU  of  Stknu. 

OPHTHALMIA  NEONATORUM. 

Its  Treatment. — Dr.  J.  E.  Weeks,  of  New 
York,  one  of  the  resident  staff  of  the  Ophthalmic 
and  Aural  Institute,  writes,  in  the  Medical  Record, 
on  ophtholmia  neonatorum,  that  the  plan  of  treat- 
ing this  affection  he  has  found  most  rational  is  as 
follows,  for  the  careful  carrying  out  of  which  a 
trained  nurse  or  a  careful  attendant  is  essential : 


If  only  one  eye  is  attacked,  the  well  eye  must 
be  carefully  guarded  against  the  possibility  of  in- 
fection from  the  diseased  eye.  'I'his  is  done  by 
cleansing  both  eyes  frequently  with  absorbent  cot- 
ton or  clean  sjjonges,  and  clean,  cool  water,  weak 
solutions  of  sublimate,  boracic  acid,  etc.  Sealing 
the  eye  in  infants  is  very  unsatisfactory ;  it  may  be 
done  with  benefit  in  adults.  Constant  cold  appli- 
cations to  the  lids  .should  be  made.  I  find  the  fol- 
owing  method  most  efficient  :  Pieces  of  linen, 
twelve  or  eighteen  in  number,  are  folded  into  three 
layers,  so  as  to  form  squares  of  an  inch  and  a 
half  These  squares  are  dampened  and  spread  on 
a  cake  of  ice.  The  nurse  in  attendance  changes 
the  pieces  of  linen  to  and  from  the  eye  sufficiently 
often  to  have  a  cold  piece  ahuays  resting  on  the 
lids.  These  applications  are  kept  up  const ontiy 
until  the  swelling  of  the  lids  subsides,  and  until  the 
discharge  has  almost  entirely  ceased,  usually  from 
three  to  seven  days.  The  plan  of  making  the 
cold  applications  at  intervals  of  two  or  more  hour? 
is  certainly  not  advisable  in  these  cases,  as  the 
temperature  of  the  lids  rises  as  soon  as  the  cold  is 
removed,  and  the  development  of  any  living  germ 
in  the  tissue  of  die  conjunctiva  is  resumed.  I  have 
witnessed  the  increase  of  inflammatory  action  in 
cases  of  this  kind  when  the  intermittent  plan  was 
followed.  The  secretion  is  removed  from  the  con- 
juuctii'a  by  careful  washing  with  cold  or  cool 
Water,  a  clean  sponge  or  absorbent  cotton,  usually 
every  twenty  or  thirty  minutes — more  or  less  fre- 
quently according  as  the  secretion  is  more  or  less 
profuse. 

In  these  conditions  applications  of  a  one  to  two 
per  cent,  solution  of  nitrate  of  silver  are  made  to 
the  surface  of  the  conjunctiva  every  morning  and 
evening,  care  being  taken  not  to  make  the  solution 
sufficiently  strong  to  cause  an  increase  in  the  in- 
flammation of  the  lids  when  it  is  applied.  The 
applications  are  made  in  the  following  manner  : 
The  lids  are  everted,  and  the  solution  of  silver  is 
brushed  upon  the  conjunctiva  freely  with  a  soft 
camel's-hair  brush.  After  the  silver  has  remained 
in  contact  with  the  conjunctiva  from  fifteen  to  thir- 
ty seconds,  it  is  washed  off  with  a  very  weak  solu- 
tion of  sodium  chloride  or  simple  water. 

The  above-mentioned  applications  may  be  made 
in  all  stages  of  the  disease,  without  regard  to  the 
condition  of  the  cornea.  If  corneal  ulcers  exist, 
one  or  two  drops  of  a  one  per-cent  solution  of  the 
sulphate  of  atropine  should  be  instilled  between 
the  lids  two  or  three  times  a  day.  I  find  that  the 
gonococci  are  present  so  long  as  the  purulent  dis- 
charge continues. 

If  the  above  plan  of  treatment  be  carefully  car- 
ried out,  I  am  confident  that  no  eye  need  be  lost 
by  any  form  of  gonorrheal  ophthalmia,  if  the  treat- 
ment is  commenced  before  the  cornea  becomes 
involved,  and  that  corneal  complications  will  be 
very  rare.  In  nearly  every  case  the  progress  of 
the  disease  will  be  arrested  from  the  moment  that 
treatment  is  begun.  Canthotomy,  Critcher's  oper- 
ation of  a  perpendicular  incision  through  the  mid- 


106 


TDE   CANADA   MEDICAL   EECORD. 


dle  of  the  upper  lid,  or  scarification,  I  deem  harm- 
ful and  entirely  unnecessary. 

BISMUTH  SUBNITRATE  IN  FCETID  PERS- 
PIRATIOxN  OF  THE  FEET. 
Vieusse  recommends  the  subnitrate  of  bismuth 
in  the  treatment  of  fcetid  perspiration  of  the  feet, 
and  concludes  as  follows  : — (i)  Profuse  perspira- 
tion of  the  feet,  whether  accompanied  by  pain  or 
fcetidity,  is  easily  cured  by  the  application  with 
slight  friction  of  subnitrate  of  bismuth  upon  the 
diseased  parts.  (2)  In  opposition  to  the  opinion 
generally  held,  according  to  which  the  suppression 
of  exaggerated  perspiration  may  produce  numerous 
accidents  of  metastasis,  observation  shows  that  the 
cure  of  this  affection  has  not  been  followed  by 
unfavorable  results,  and  that  if  these  are  observed 
they  should  be  attributed  to  other  methods  of 
treatment  hitherto  employed.  (3)  In  the  cure  of 
this  disease,  subnitrate  of  bismuth  appears  to 
exercise  a  purely  local  action,  rendering  the  super- 
ficial cuticular  structures  firmer  and  more  resistant. 
The  remedy,  perhaps,  exerts  an  action  also  upon 
the  sudoriparous  glands  and  sebaceous  follicles, 
changing  the  quality  and  quantity  of  their  products, 
and,  possibly,  as  a  result  of  the  changes  produced 
in  the  part  with  which  it  comes  in  relation,  modifies 
more  or  less  profoundly  the  capillary  circulation. 
(4)  In  certain  cases  the  remedy  suppresses  oniy 
temporarily  the  profuse  perspiration  of  the  feet, 
but  causes  the  foetid  odor,  as  well  as  the  pain, 
which  is  the  consequence  of  the  exaggerated 
secretion,  to  disappear  permanently.  Jiivista 
Internazionale  de  Medecina  e  Chinirgia. 


SPASMODIC    ASTHMA— ITS    TREAT- 
MENT. 

This  young  lady  is  troubled  with  cough  and 
shortness  of  breath,  spells  of  which  come  on  sud- 
denly during  the  night.  She  has  suffered  from 
this  affection  for  four  years,  and  the  attacks  show 
a  tendency  to  recur  on  Saturday  nights.  She  is 
very  liable  to  catch  cold,  and  she  is  then  more  apt 
to  suffer  with  the  shortness  of  breath.  I  learn  that 
several  members  of  this  young  lady's  family  are 
affected  in  the  same  way.  She  is  suffering,  as  you 
would  infer  from  this  history,  with  spasmodic 
asthma.  When  the  spasm  is  not  present,  nothing 
abnormal  is  heard  on  auscultation.  If,  as  often 
happens,  emphysema  or  bronchitis  coexists  with 
the  spasmodic  tendency,  the  signs  due  to  these 
conditions  will  be  found.  During  the  existence  of 
an  attack  there  would  be  found  wheezing  and 
whistling  sounds. 

I  shall  make  this  case  the  basis  of  a  few  remarks 
on  the  treatment  of  spasmodic  asthma.  The  man 
who  has  studied  asthma  more  thoroughly  than 
perhaps  any  other  is  Hyde  .Salter,  whose  work  on 
asthma  contains  all  that  is  known  about  this  disease. 
It  is  like  Anstie's  work  on  neuralgia — a  complete 
text-book  on  the  subject.  Salter  says  that  every 
case  of  asthma  has  a  climate  which  will  cure  it, 


provided  we  can  find  that  climate.  We  have  no> 
means  of  judging  beforehand  what  climate  is  going 
to  aire  any  particular  case,  but  in  the  majority  of 
instances,  the  dusty,  dirty,  smoky  air  of  the  city- 
is  better  for  asthmatics  tlian  the  pure  air  of  the: 
country.  If  we  can  find  the  appropriate  climate 
the  patient  will  be  free  from  his  asthma.  It  might 
also  be  said  that  in  th«  majority  of  such  cases  as 
this,  of  hereditary,  spasmodic  asthma,  unless  we 
can  find  the  appropriate  climate,  the  patient  can- 
not be  cured. 

Apart  from  the  consideration  of  climate,  tke 
treatment  of  asthma  divides  itself  into  two  parts^ 
which  are  essentially  distinct:  first,  the  treatment 
of  the  pajoxysm  ;  and  second,  the  treatment  to  pre- 
vent the  recurrence.  In  the  treatment  of  asthma,, 
always  use  single  remedies,  for  asthma  is  peculi- 
arly a  disease  which  is  helped  by  single  remedies  ; , 
that  is  to  say'  you  will  find  certain  cases  that  will' 
obtain  relief  only  from  tobacco  ;  and,  again,  cases 
will  be  found  that  are  relieved  by  lobelia,  and  by 
nothing  else.  It  would  be  folly  to  give  aperscrip- 
tion  containing  both  these  drugs  when  only  one 
is  going  to  be  of  service. 

In  the  treatment  of  the  paroxysm,  almost  any- 
thing will  succeed  in  some  cases,  while  there  are 
others  in  which  nothing  affords  relief  It  would 
take  more  than  the  time  which  we  have  at  our 
disposal  to  enumerate  all  the  drugs  that  have  been 
successfully  employed  to  relieve  a  paro.xysm  of  asth- 
ma. Tobacco  is  one  of  the  very  best,  and,  in  the 
present  case,  the  attacks  have  been  relieved  by 
smoking  a  cigarette.  There  is,  of  course,  a  great 
likelihood  that  a  patient  using  tobacco  for  this  pur- 
pose will  acquire  a  fondness  for  the  weed ;  but  a 
person  who  uses  tobacco  to  stop  an  asthmatic  attack 
must  not  use  it  at.  other  times,  or  it  will  lose  its 
effect.  There  is  one  exception  to  this  rule,  and 
that  is,  that  in  some  rare  cases  habitual  smoking 
prevents  the  recurrence  of  the  attack,  and  as  long 
as  the  patient  smokes  two  or  three  cigars  a  day,  he 
will  be  free  from  the  asthma,  but  as  soon  as  the 
tobacco  is  stopped,  the  paroxysms  recur.  Some- 
times a  few  whiffs  of  the  cigar  will  stop  the  attack ; 
but,  as  a  rule,  smoking  must  be  continued  until  poi- 
sonous effects  begin  to  be  manifest,  in  the  depressed 
circulation,  the  cold  sweat,  and  the  nausea,  perhaps 
with  vomiting.  In  most  cases  this  is  a  harmless 
remedy,  but  where  there  is  feebleness  of  the  heart, 
tobacco  must  be  avoided. 

Lobelia  clo.sely  resembles  tobacco  in  its  action, 
and  my  remarks  with  reference  to  the  latter  drug 
would  equally  apply  to  lobelia.  This,  however, 
helps  some  cases  in  which  tobacco  fails,  and  fails 
in  some  cases  that  tobacco  relieves.  A  common 
remedy  is  the  smoking  of  stramonium  leaves. 
These  may  be  made  into  cigarettes,  either 
with  or  without  tobacco,  and  have  been  found  of 
service.  In  the  same  way  the  leaves  of  hyoscya- 
mus,  and  belladonna  have  been  found  of  value. 
Probably  the  remedy  most  frequently  used  is  salt- 
petre ])aper.  A  saturated  solution  of  the  potassi- 
um nitrate  is  prepared,  and  in  this  is  steeped  blot- 


THE   CANADA   MEDICAL   RECORD. 


107 


ting  paper  ;  the  paper  is  then  dried  and  cut  into 
strips.  These  strips  when  h'ghted  burn  slowly, 
and  the  patient  inhales  the  smoke.  Sometimes  a 
minute  proi)ortion  of  arsenic  is  added  to  the  solu- 
tion. Thi.s  is  particularly  recommended  by  Trous- 
seau. Stramonium,  hyoscyamus  and  belladonna 
are  also  added  at  times.  Dr.  F.  E.  Stewart  has 
recommended  cigarettes  of  cocoa  leaves  and  to- 
bacco, which  probably  would  be  useful.  The  fact 
that  smoking  so  many  different  substances  gives 
relief  has  led  some  observers,  and  among  them 
Cicrmain  See,  to  ascertain  whether  there  is  not 
something  in  the  smoke  itself  to  which  the  benefi- 
cial action  is  due.  As  a  result  of  these  investigations 
we  have  a  comparatively  new  remedy,  pyridine. 
This  is  used  in  quantities  of  a  drachm,  vaporized, 
on  a  hot  plate,  in  a  close  room.  This  is  one  of  the 
most  efficient  remedies  we  have  in  a  paro.xysm  of 
asthma.  An  emetic  is  often  efficient.  Tartar  emetic 
is  of  service  for  this  purpose.  The  inhalation  of 
ether  or  of  ethyl  bromide  is  sometimes  employed. 
Amyl  nitrite  is  one  of  the  most  elegant  preparations 
which  we  have  for  controlling  the  asthmatic  attack. 
The  use  of  nitro-glycerin,  in  the  dose  of  the  hun- 
dredth part  of  a  drop,  has  been  recommended.  Moral 
and  mental  influences  have  often  been  successful 
in  checking  the  attack.  I  have  read  of  a  patient 
suffering  from  an  attack  of  asthma,  which  did  not 
respond  to  any  treatment,  who,  being  alarmed  by 
a  sudden  cry  of  fire,  jumped  out  of  bed  and  rushed 
down  stairs ;  the  asthma  instantly  and  entirely 
disappeared. 

One  of  the  most  efficient  remedies  for  the  relief 
of  the  attack  is  chloral  hydrate,  in  doses  of  twenty 
or  thirty  grains.  This  is  contraindicated  when  the 
heart  is  weak.  Hypodermic  injections  of  morphia 
are  of  value,  especially  when  the  morphia  is  com- 
bined with  atropia.  I,  however,  do  not  recom- 
mend this  for  constant  use  ;  for  the  danger  of  the 
morphia  habit  is  infinitely  greater  than  the  danger 
of  the  asthma.  In  some  cases  stimulants  are  em- 
ployed, brandy  occasionally  being  given  in  lethal 
doses.  I  mention- this  plan  of  treatment  only  to 
condemn  it. 

It  is  better  for  the  patient  to  have  his  asthma 
than  to  run  the  risk  of  a  more  serious  condition. 

For  the  purpose  of  preventing  the  return  of  the 
paroxysm,  a  great  many  drugs  have  been  recom- 
mended. Arsenic,  continued  for  many  months,  in 
doses  just  short  of  those  which  produce  the 
characteristic  poisonous  effects,  has,  perhaps, 
been  extolled  more  highly  than  any  single  remedy. 
Ammonium  bromide  is  favorably  mentioned. 
The  bromides  are  eliminated  by  the  bronchial 
mucous  membrane,  and  are  supposed  to  exert  a 
local  ansesthetic  effect.  The  bromide  of  potassium 
has  also  been  employed  for  the  same  reason. 
Cimicifuga  is  another  remedy  which  deserves  far 
more  attention  than  it  has  received.  Like  many 
other  of  our  indigenous  plants,  it  has  been  neglect- 
ed for  the  old  standard  drugs  brought  over  by  our 
forefathers,  for  the  simple  reason  that  the  latter 
are  better   known. 


A  very  good  remedy,  in  some  cases,  is  quinine. 
When  the  paroxysm  returns  with  such  jjeriodicity 
that  we  are  able  to  say  when  an  attack  is  to  be 
cxi^ected,  this  drug  will  often  prevent  its  recurrence. 
If  the  paroxysm  be  ex])ected  at  one  o'clock  in  the 
morning,  a  full  dose  of  quinine  should  be  adminis- 
tered at  nine  o'clock  the  preceding  evening,  so 
that  its  effects  will  be  manifest  at  the  time  of  the 
expected  attack.  While  quinine  prevents  the 
paroxysm,  I  have  never  been  able  to  satisfy  my- 
self that  the  continuous  prevention  of  the  attacks, 
even  for  months  at  a  time,  had  much  effect  in  re- 
moving the  tendency  to  the  disease. 

Another  remedy  which  has  been  introduced 
within  the  past  few  years  is grindelia  robusta.  For 
the  past  three  weeks,  this  lady  has  been  taking 
the  fiuid  extract  of  grindelia  robusta  in  half-drachm 
doses.  She  states  that  during  this  time  she  has 
been  better,  and  has  had  but  two  slight  attacks. 

Tliere  is  one  more  point  to  which  I  desire  to 
allude  in  connection  with  this  subject,  and  that  is 
that  it  has  recently  been  found  that  in  a  certain 
number  of  cases  of  spasmodic  asthma,  there  is 
liypertrophy  of  the  Schneiderian  mucous  mem- 
brane, and  that  this  is  the  starting  point  of  the 
asthmatic  attacks.  This  patient  has  been  examined 
by  Dr.  Barton,  who  has  found  hypertrophy  of  the 
nasal  mucous  membrane,  which  he  is  removing 
with  the  galvano-cautery.  By  removing  this  dis- 
eased tissue  we  do  away  with  one  of  the  possible 
causes  of  the  asthma.  This  is  a  comparatively 
recent  advance,  and,  I  think,  a  very  important  one, 
in  the  treatment  of  this  affection.  If  the  paroxysms 
continue  after  the  removal  of  the  hypertrophied 
patches  in  the  nose,  we  should  conclude  that  in 
all  probability  there  is  hypertrophied  mucous  mem- 
brane in  the  trachea  and  bronchi.  Can  we  reach 
this  ?  We  cannot  reach  it  with  the  cautery  as  we 
can  in  the  case  of  the  nasal  mucous  membrane, 
but  by  the  use  of  iodine  and  carbolic  acid  by  inhala- 
tion persisted  in  for  months,  I  think  that  this 
condition  of  the  tracheal  and  bronchial  mucous 
membrane  can  be  removed.  Under  the  use  of  these 
agents  I  have  seen  hypertrophies  in  the  throat  dis- 
appear almost  as  quickly  as  they  would  have  done 
under  the  use  of  caustics. 

In  the  present  case,  we  shall  continue  the  treat- 
ment with  the  grindelia  robusta  as  long  as  it  has  a 
good  effect.  It  is  good  practice  when  you  have  a 
remedy  which  appears  to  be  benefical,  to  con- 
tinue it  until  its  good  effects  cease  before  changing 
to  another.  For  the  treatment  of  the  paroxysm, 
she  will  continue  the  use  of  tobacco  until  she  be- 
gins to  like  it,  when  we  shal.l  resort  to  saltpetre 
paper. 


FISSURES  OF  THE  TONGUE. 

In  some  people,  especially  where  gastric  disturb- 
ances are  present,  the  tongue  suddenly  becomes 
fissured  all  over,  without,  however,  becoming  coat- 
ed, changing  its  color,  or  losing  its  moiiture.  Prof. 
Schwimmer  (^Wiener.  Med.  IVoch.  lo,  1886)  had 
the  opportunity  to  experiment  on  some  cases  at 


108 


THE  CANADA   MEDICAL  RECORD. 


his  clinic.  Although  he  tried  chromic  acid,  which 
had  been  recommended  by  Vidal,  and  though  he 
applied  iodoform,  which  Dr.  Unna,  a  dermatologist 
of  Hamburg,  had  greatly  praised,  in  none  of  his 
cases  the  tongues  evinced  any  improvement.  If 
anything,  they  became  worse,  especially  under 
iodoform.  As  the  patients  were  greatly  annoyed 
by  this  morbid  state  of  their  tongues.  Prof  S.  tried 
a  series  of  remedies  in  the  hope  to  bring  about 
some  alteration,  but  utterly  in  vain  ;  even  Kaposi's 
treatment  with  nitrate  silver  was  useless.  Some 
improvement  was  noticed  after  the  applications  of 
soda  solutions ;  and  the  lactic  acid,  first  employed 
by  Schiff,  gave  the  patients  decided  relief,  and  the 
latter  in  one  case  almost  established  a  cure.  Fi- 
nally S.  used  papayotin,  and  the  result  was  sur- 
prising. In  every  case  an  amelioration  was  at 
once  noticed,  and  within  a  few  weeks  a  perfect 
cure  was  obtained.  S.  applies  the  papayotin  as 
follows  : 

IJ.     Papayotin,  .05  to  i.o  (8-16  gr.) 

Aq.  destill.. 
Glycerin,         aa        5,0  (Sow). 

This  solution  is  applied  with  a  camel's  hair 
brush  from  2  to  6  times  every  day,  after  the  parts 
have  been  previously  well  dried.  The  effect  is  not 
a  rnacerating  one,  as  one  would  think  from  the 
action  of  the  drug  on  digestion,  but  it  acts  on  the 
parts  deprived  of  their  epithelium,  and  causes  a 
renewal  of  the  latter. 

In  25  cases,  many  of  which  were  of  many 
years'  duration,  a  complete  and  permanent  cure 
was  established  in  all  with  the  exception  of  one, 
where  a  syphilitic  dyscrasia  existed,  but  where 
specific  treatment  brought  about  no  result  either  ; 
but  even  in  this  case  a  great  amelioration  was 
obtained. 


THE  DIETARY  OF  BRIGHT'S  DISEASE. 

By    J.    MiLNER    FoTHERGILL,    M.   D.,  EDIN.,  HoN.    M.  D- 

Rush,  III. 


The  importance  of  the  dietary  in  Bright's  disease 
is  all  the  greater  in  that  medicines  exercise  com- 
paratively little  influence  upon  its  progress. 

The  form  of  Bright's  disease  here  treated  is  the 
chronic  one,  v/here  the  kidneys  are  "  granular,  " 
"  contracted,  "  "  gouty  "  or  "  cirrhotic.  "  This  is  a 
slow  development  of  connective  tissue  (a  paren- 
chymatous inflammation)  throughout  the  structure 
of  these  organs,  which  contracting — as  is  its  nature 
— destroys  the  secreting  and  tubular  portions. 
Some  portions  are  destroyed  as  regards  function, 
while  others  remain  normal  and  uninjured.  At 
last  the  destruction  is  so  extensive  that  the  kidneys 
become  quite  inadequate  to  carry  out  their  duty, 
and  the  organism  perishes. 

The  opinion  of  the  profession  (as  regards  its 
members  iinder  fifty  years  of  age)  is  that  the  main 
cause  of  this  chronic  inflammation  is  the  output  of 
urates  by  the  kidneys.  Mammalian  kidneys  have 
the  soluble  urea  as  their  form  of  nitrogenized  waste, 
while  urates  belong  to  animals  with  a  three-cham- 


bered heart  and  a  solid  urine.  When,  then,  the 
mammalian  liver  forms  this  primitive  urine  the 
kidneys  become  injured  by  casting  it  out.  Long 
ago  Dr.  George  Johnson,  F.  R.  S.,  the  respected 
professor  of  the  Practice  of  Physic  at  King's  Col- 
lege, and  a  recognized  authority  on  Kidney  disease, 
wrote  :  "  Rcuai  degeneration  is  a  conseqitenee  of 
the  long-continued  elimination  of  the  products  of 
faulty  digestion  through  the  kidneys.  " 

Recognizing,  as  we  do,  that  under  certain  cir- 
cumstances (often  mental  strain)  the  liver  falls 
back  upon  this  primitive  urinary  stuff,  it  is  obvious 
that  the  rational  plan  of  meeting  the  difficulty  is 
to  reduce  the  albuminoid  elements  of  our  food  to 
the  needs  of  the  organism  rather  than  the  cravings 
of  the  palate.  That  bite  of  solid  meat  so  accepta- 
ble to  the  Anglo-Saxon  has  led  him  to  cultivate 
flocks  and  herds  to  a  point  of  excellence  unattai- 
ned  by  other  races.  The  beef  and  mutton  in  other 
countries  will  not  furnish  solid  joints  ;  it  has  to  be 
hashed  and  stewed  and  made  into  ragouts  in  order  to 
be  palatable.  Even  a  leg  of  mutton  stuffed  with 
onions  is  but  indifferently  good.  A  "  Wiener 
Schnitzel "  is  a  veal  cutlet  and  the  continental 
equivalent  of  our  steak  and  chop- — not  forgetting 
Fillet  de  Bo;uf.  The  "  plain  roast  and  boiled,  " 
the  pride  of  the  Anglo-Saxon  housewife  and  cook, 
are  largely  responsible  for  the  prevalence  of  this 
form  of  Bright's  disease  amidst  Anglo-Saxon  peo- 
ple. 

This  statement  is  not  rashly  hazarded  as  a  spe- 
cious and  ready  generalization.  It  is  the  outcome 
of  careful  thought  on  the  matter. 

In  England  at  least  the  impression  exists  that 
simple  fare — "  plain  roast  and  boiled,  "  is  innocu- 
ous. It  is  a  murderous  fallacy  !  It  is  just  the 
abundance  of  meat — sapid,  palatable,  readily  pre- 
pared, stimulating — that  is  the  bane  of  so  many 
men.  It  would  not  be  too  sweeping  a  generaliza- 
tion to  say  that  the  lady  who  dines  at  home  is 
comparatively  free  from  Bright's  disease  while,  the 
business  man  who  takes  his  midday  meal  at  a 
restaurant,  and  dines  at  home  in  the  evening,  is 
the  victim  of  Bright's  disease  par  excellence. 
As  he  looks  down  the  menu  for  his  lunch  his 
eye  lights  upon  dish  after  dish,  in  the  composi- 
tion of  which  lean  meat  forms  the  integral 
factor. 

This  fact  cannot  be  impressed  too  distinctly  on 
the  mind.  To  traverse  the  statement  by  pointing 
to  the  fact  that  many  men  notoriously  consume 
large  and  unusual  quantities  of  such  animal  food 
with  apparent  impunity,  is  merely  to  state  that 
the  human  liver  is  in  many  instances  equal  to  con- 
verting into  urea  the  whole  surplusage,  or  lu.xus 
consumption  of  albuminoid  matter.  It  leaves 
unaffected  the  fact  that  when  the  liver  is  unequal 
to  such  complete  conversion,  and  reverts  to  the 
formation  of  urates,  it  becomes  a  wise  and  prudent 
measure  to  reduce  the  albuminoid  elements  in  the 
dietary  to  the  wants  of  the  body. 

There  is  a  strong  impression  abroad  among 
medical  men,  who  have  paid  great  attention  to  the 


THE   CANADA  MEDICAL   RECORD. 


109 


subject,  that  the  lean  of  the  larger  animals  has  a 
strongdr  tendency  in  the  metabolism  of  albu- 
minoids to  form  urates  than  any  other  forms  of  al- 
bummoids.  This  impression  must  just  be  taken  for 
wliat  it  is  worth.  It  is  sufl'icientiy  a  matter  of  faith 
with  the  writer  to  inspire  conduct,  as  his  butcher 
realizes  to  his  cost ;  while  the  fishmonger  and  the 
greengrocer  benefit  by  it. 

The  entries  and  made  dishes  of  French  cookery 
arc  far  less  pernicious  than  "the  roast  beef  of  old 
England,  "  and  its  congeners.  They  consist  to 
some  extent  of  lean  meat,  true  ;  but  they  also  con- 
tain notable  quantities  of  oil  and  vegetal)les. 

The  man  who  is  held  to  be  the  subject  of  chron- 
ic Bright's  disease  should  banish  the  solid  joint 
from  his  table  ;  except,  may  be,  on  Christtnas  Day. 
The  steak  and  chop  should  be  indulged  in  rarely, 
and,  when  eaten,  not  be  devoid  of  fat.  The  veal, 
or  rabbit,  or  beefsteak  pie  should  not  be  without  a 
due  proportion  of  fat. 

The  same  may  be  said  of  the  meat  pudding,  the 
hash,  or  the  Irish  stew,  and  the  currey.  He  should 
have  one  vegetable  course  at  dinner,  and,  what  is 
more,  ought  religiously  to  partake  of  it. 

White  meats,  as  chicken,  are  less  objectionable 
than  brown  meats  ;  but,  after  all,  it  is  but  a  matter 
of  comparison.  One  patient  obeyed  his  instruc- 
tions to  the  letter,  but  grossly  violated  them  in  the 

spirit.  He  was  a  blue-blooded  Patrician,  inheri- 
ting an  insufficient  liver — illustrating  the  truth  of 
the  adage,  "  the  fathers  have  eaten  sour  grapes 
and  the  children's  teeth  are  set  on  edge  " — whose 
urine  was  laden  with  lithates.  Meat  being  forbid- 
den, but  fowls  permitted  ;  he  explained  that  he 
"  had  passed  the  joint  but  laid  into  the  turkey,  "  as 
a  gastronomic  rule.  A  sharp  attack  of  articular 
gout  opened  his  eyes  for  him. 

Of  what,  then,  should  the  dietary  of  the  man  with 
chronic  Bright's  disease  consist  ? 

Breakfast  :  Oatmeal  or  hominy  porridge,  homi- 
ny fritters,  followed  by  a  litde  fish  with  plenty  of 
butter  to  it ;  or  a  slice  of  fat  bacon,  or  pork.  Fat, 
fish  and  farinaceous  matters.  Hominy  and  fat 
pork  for  the  less  affluent. 

Lunch  or  supper :  Mashed  potatoes  well  but- 
tered. Other  vegetables  well  buttered.  A  milk 
pudding  made  without  an  egg.  Biscuits  of  various 
kinds,  and  butter,  with  a  nip  of  rich  cheese. 

Dinner  :  Soup  containing  plenty  of  vegetable 
matter,  broken  biscuit,  or  sago  or  vermicelli. 
Cream,  in  lien  of  so  much  strong  stock,  should  hirk 
in  the  soup  tureen  ,  especially  in  white  soup.  This 
should  be  followed  by  fish  in  some  form  ;  a  course 
of  vegetables,  as  stewed  celery,  chopped  carrots,  a 
boiled  onion,  leeks,  nicely  prepared  potatoes,  as 
"  browned  potatoes  "  a  la  Marion  Harland,  aspara- 
gus, or  "  scolloped  tomatoes ''  and  corn  or  "  boiled 
corn.  "  Then  should  follow  apple-bread  pudding. 
Maud's  pudding,  bread  and  raisin  pudding  ;  and, 
if  the  digestion  can  be  trusted,  roly-poly  pudding, 
sweet  pudding  and  fruit  pies.  Stewed  fruit 
with  creeled  rice,  rice  milk,  or  other  milk  pudding 
is  good,  or  better  still,  cream.     Then  comes  the 


biscuit,  or  crackers  and  butter.     Dessert,  with  its 
many  fruits  should  never  be  omitted. 

The  reader  who  prefers  something  tasty  and  pi- 
quant will  exclaim  this  is  too  much  in  "  the  baby- 
food,  "  or  the  "  nursery  hne  "  for  him,  and  asks 
for  some  game,  or  some  toasted  cheese.  Well  I 
in  strict  moderation  let  it  be— as  the  tasting  of  for- 
bidden fruit. 

Where  something  more  sapid  is  fancied  let  it  be 
anchovy  toast,  herrings  skinned,  cut  into  inch 
lengths  and  fried  on  toast,sardines  on  toast;  [lossibly, 
a  little  caviare,  herring  roes  and  millets,  or  mush- 
rooms. Certainly  Pate  de  Foie  Gras — all  jjrejudi- 
ces  to  the  contrary  notwithstanding. 

There  is  a  great  deal  of  toothsome  eating  in  a 
dietary  suitable  for  a  man  with  Bright's  disease, 
all  the  same. 

Eggs,  ordinary  cheese,  and  fish  roes,  are  all 
highly  albuminous,  it  must  be  remembered. 

Fowls,  chicken,  game  are  meats  less  objection- 
able than  joints;  but  again  it  is  a  matter  of  com- 
parison. 

From  what  has  been  stated  above,  it  is  clear 
that  "  hotel  dietary  "  is  as  unsuitable  for  the  person 
with  Bright's  disease  as  it  is  to  the  dyspejjtic. 
Travel  is  not  prudent  for  either.  They  had  better 
keep  to  a  private  house  with  cookery  adapted  to 
their  special  wants. 

Then  as  to  drink.  The  interest  in  the  matter 
centres  round  alochol.  Other  than  alcoholic  be- 
verages are  beyond  contention ;  except,  perhaps, 
milk,  which  contains  a  notable  proportion  of  albu- 
men in  the  form  of  caseine.  If  it  be  taken  as  a 
beverage,  or  as  a  food  adjunct  its  composition  must 
be  borne  in  mind,  and  the  other  foods  be  sparing 
in  albumen. 

Probably  light  wines  are  practically  innocuous, 
that  is  in  moderate  quantities  ;  as  is  cider.  Possi- 
bly the  same  may  be  said  of  the  light  lager  beers, 
as  Pilsener ;  but  ales  brewed  on  the  English  plan 
exercise  a  malign  influence  upon  the  liver.  This 
applies  to  porter  and  stout.  Then  as  to  spirits  and 
waters,  aerated  or  other !  Opinions  may  differ. 
There  is  much  less  Bright's  disease  in  Scotland, 
where  oatmeal  porridge  and  whiskey  go  together, 
than  in  England,  with  its  beef  and  beer.  The  rea- 
der  can  draw  the  influence. 

There  is  no  valid  proof  that  alcohol  in  modera- 
tion tends  to  add  further  to  the  morbid  process, 
which,  bit  by  bit,  is  slowly  and  insidiously  working 
the  ruin  of  the  kidneys.  On  the  other  hand,  beef- 
tea  often  does  much  mischief.  The  meat  extrac- 
tives it  contains,  ihoush  not  food,  are  at  the  head 
of  the  descending  series,  ending  in  uric  acid  and 
urea,  and  add  to  the  work  of  the  kidneys. 

One  exquisite  beverage,  palatable  and  nutritive, 
is  made  with  some  malt  extract  and  aerated  w-ater. 
Unfortunately,  in  order  to  prevent  fermentation,  a 
malt  extract  has  to  be  reduced  to  the  consistency 
of  treacle.  This  viscidity  renders  it  most  trouble- 
some to  handle.  The  readiest  plan  is  to  get  the 
cook  every  morning,  or  second  morning,  to  dilute 
a   certain  amount  of  malt  extract  with  an  equal 


110 


TbE  CANADA  MEDICAL  RECORD. 


quantity  of  warm  water,  and  beat  it  to  a  syrup. 
Fill  a  tumbleone-third  full  with  the  malt  syrup, 
fill  with  aerated  water.  This  is  a  glorious  malt 
liquor  for  a  teetotaller — or  any  other  man. — Jour- 
nal of  RecoHstrudivcs. 


MANAGEiVrENT  OF  SIMPLE  CONSTIPA- 
TION. 

Sir  Andrew  Clark  thus  writes  in  the  Lancet, 
January  i : 

The  untoward  consequences  of  constipation  are 
always  considerable  and  sometimes  serious;  but 
greater  than  they — greater  than  the  anaemia,  the 
blood-poisoning,  the  headache,  the  nervousness, 
and  the  heart  disorder,  which  arise  out  of  ftecal 
retention — are  the  untoward  consequences  of 
ingnorant  and  unskillful  domestic  management. 

For  two  days  a  patient  has  had  no  relief  to  the 
bowels.  He  has  been  travelling,  or  he  has  chan- 
ged his  diet,  or  his  accustomed  routine  has  been  in 
some  other  way  interrupted.  The  subject  is  seri- 
ously considered  ;  in  the  light  of  an  excited  self- 
consciousness  impending  dangers  are  seen,  and 
forthwith  he  determines  to  take  "  a  dose.  "  But 
the  taking  of  doses  is  an  inconvenient  and  a  disa- 
greeable procedure,  and  so  it  is  settled  that  the 
dose  shall  be  a  good  one—such  a  one  as  will  speed- 
ily and  effectually  overcome  the  constipation  and 
relieve  the  patient  of  his  trouble.  The  dose  is  taken, 
the  bowels  (small,  perhaps,  as  well  as  large) 
are  emptied  of  their  contents,  the  object  of  treat- 
ment has  been  achieved,  and  all  for  a  time  seems 
well.  But  the  next  day  arrives,  and  there  is  no 
fresh  movement  of  the  bowels ;  even  a  second  day 
passes,  and  they  are  still  inactive.  The  patient  is 
more  uncomfortable  than  he  was  before  he  took 
his  "  dose.  "  What  is  to  be  done?  Matters  can- 
not continue  as  they  are.  Plainly  the  medicine 
first  employed  has  confined  the  bowels,  and  so 
another  must  be  taken  which  shall  be  free  from 
this  disadvantage.  The  other  is  taken  ;  again  the 
bowels  are  freely  moved,  and  a  liquid,  light-colored 
mucoid,  and  feculent  discharge  attests  the  success 
of  the  new  endeavor.  But  the  bowels  fail  to  resume 
their  periodical  discharges ;  the  patient  becomes 
worse  than  ever;  again  he  flies  to  artificial  help 
or  relief  ;  again  he  is  disappointed  in  recalling  na- 
ture to  her  own  ways  ;  and  at  last  the  bowels,  rob- 
bed of  their  normal  conditions  of  action,  and  ex- 
hausted by  frequent  irritation  refuse  to  act  at  all, 
except  under  the  spur  of  strong  aperients  frequent- 
ly repeated.  With  few  exceptions,  no  person  has 
passed  through  this  experience  and  fallen  under 
the  tyranny  of  aperients  without  finding  his  life 
invaded  by  a  pack  of  petty  miseries  which  lower 
his  health,  vex  his  temper,  and  cripple  his  work. 
Now,  for  the  most  part,  all  these  troublesome  con- 
sequences of  constipation  may  be  avoided  by  at- 
tending to  the  conditions  of  healthy  defecation.  The 
chief  of  them  requiring  consideration  at  this  time, 
and  assuming  the  integrity  of  the  nervo-muscular 
apparatus  of  the  bowels,  are  plenty  of  solid  and 
liquid,  digestible  food,  a  fair  amount  of  refuse  mat- 


ters in  the  colon,  regard  to  the'promptings  of  nature, 
daily  solicitation  at  an  appointed  time,  the  co-ope- 
ration of  expectation  and  will,  and  contentment 
with  a  moderate  discharge.  I  propose  to  discuss 
briefly  each  of  these  conditions. 

t.  Plenty  of  solid  and  fluid  digestible  food. 
People  leading  a  sedentary  or  a  society  life  become 
disposed  to  eat  too  fine  foods,  and  to  drink  too 
little  liquid.  Among  the  results  of  such  habits  are 
a  general  want  of  nervo-muscular  vigor,  a  defi- 
ciency of  intestinal  secretion,  and  an  insufficient 
amount  of  refuse  matter  in  the  bowels  to  secure 
daily  relief  To  correct  this  without  the  help  of 
drugs,  coarse  and  irritating  foods  are  taken.  For 
a  day  or  .two,  perhaps,  they  succeed  ;  but  after  a 
time  they  provoke  catarrhal  irritation,  and  either 
incre  a se  the  constipation  or  bring  about  lienteric 
diarrhrea.  As  a  rule,  it  is  a  practical  error  to 
treat  constipation  by  means  of  hard,  indigestible, 
and  irritating  articles  of  food. 

2.  A  moderately  full  colon  is  essential  to  the 
sufficient  periodical  discharge  from  the  bowels.  It 
is  true  that  the  ordinary  peristaltic  action  of  the 
bowels  is  automatic,  and  substantially  independent 
of  external  stimulation  ;  but  it  is,  I  think,  equally 
true  that  for  the  stronger  peristaltic  action  which, 
accompanied  by  inhibition  of  the  associated  lum- 
bar centre  and  relaxation  of  the  anal  sphincter, 
issues  in  normal  defecation,  an  external  stimulus,the 
of  an  adequate  amount  of  retained  faeces,  is  neces- 
sary. If  by  an  aperient,  or  by  any  other  means, 
the  colon  is  more  or  less  completely  emptied  of  its 
contents,  defecation  will  be  suspended  until  the 
colon  becomes  again  more  or  less  full ;  it  cannot 
act  independently  of  the  appointed  conditions  of 
action ;  it  cannot  make  bricks  without  straw. 

3.  Regard  to  the  promptings  of  nature.  When 
the  lower  part  of  the  sigmoid  flexure  is  full,  sensory 
impulses  are  sent  to  the  .nervous  centres,  and 
these  are  responded  to  by  discharges  which  not 
only  excite  vigorous  peristalsis  in  the  upper  part 
of  the  colon  and  solicit  cooperation  of  the  will,  but 
tend  to  inhibit  the  lumbar  centre  and  to  bring 
about  relaxation  of  the  anal  sphincter.  The  con- 
ditions of  defecation  are  present,  and  it  needs  only 
a  patient  effort  of  wiU  and  concurrent  expectation 
to  originate  and  complete  the  operation.  But 
when  attention  to  these  promptings  of  nature  is 
denied  they  cease  for  the  time  ;  and  although  they 
recur  and  suffice  for  action,  the  denial,  if  often 
repeated,  blunts  the  sensibilities  of  the  parts  con- 
cerned, deprives  us  of  the  normal  intimations  of 
the  need  for  relief,  and  brings  about  a  form  of 
constipation  difficult  to  cure. 

4.  Daily  solicitation  of  nature  at  an  appointed 
time.  It  has  been  found  that  for  the  great  majority 
of  people  the  most  favorable,  and  also  the  most 
convenient,  time  for  procuring  relief  to  the  bowels 
is  after  breakfast ;  and  it  is  one  of  the  greatest 
helps  to  sufficiency  and  regularity  of  action  that 
the  daily  solicitation  of  nature  should  be  practiced 
at  that  time.  In  order  that  both  solicitation  and 
action  should  become  developed  into  a  habit,  it  is 


THE   CANADA   MEDICAL   RECORD. 


Ill 


necessary  tiiat  nature  should  not  be  listened  to  at 
any  other  than  the  aj)pointed  time.  And  in  this 
prccej)t  there  is  no  contradiction  of  the  statement 
made  in  the  previous  paragraph  ;  for  it  is  not  the 
tenijjorary  and  excejuional  denial  of  nature  with 
the  view  of  establishing^  a  regular  habit  of  defeca- 
tion— it  is  the  repeated  denial  of  nature  with  no- 
such  object  in  view  which  blunts  the  reflex  sensi- 
bilities of  the  parts  concerned,  and  Ixings  about  an 
obstinate  constipation. 

5.  The  co-operation  of  expectation  and  will. 
Many  persons  seek  relief  to  the  bowels  without 
taking  any  pains  to  secure  success.  With  some 
persons,  indeed,  such  pains  arc  unnecessary.  A 
certain  automatism  has  been  established ;  and  it 
needs  only  lime,  place,  and  |)osition  to  set  it  in 
successful  motion.  Eut  in  [icrsons  whose  defeca- 
tion is  difficult,  direct  attention,  expectation,  and 
effort  are  essential,  and  when  patiently  practiced 
seldom  fail.  The  practice  of  slight  alternate  con- 
traction and  relaxation  of  the  anal  sphincter  some- 
times provokes  exceptionally  active  peristalsis  of 
the  lower  colon  ;  and  so,  with  concurrent  effort, 
secures  relief  which  could  not  otherwise  be 
obtained. 

6.  Contentment  with  a  moderate  discharge. 
Ignorance  of  the  average  amount  of  freces  re- 
quired for  the  daily  healthy  relief  of  the  bowels  is 
one  of  the  main  causes  of  constipation,  the  un- 
necessary use  of  aperients,  and  the  evils  that  arise 
from  both.  For  a  man  of  average  weight,  consum- 
ing an  average  amount  of  food,  the  average  amount 
of  feeces  ready  for  discharge  in  twenty-four  hours 
is  about  five  ounces.  This  should  be  formed, 
sufficiently  jerated  to  float,  and  coherent.  Accord- 
ing as  the  cylinder  is  moist  or  dry  it  will  measure 
from  four  to  six  inches  in  length.  Now,  many 
people  expect  to  have  a  much  more  abundant  dis- 
charge, and  are  dissatisfied  or  anxious  if  they  do 
not  get  it.  They  complain  of  their  insufficient  re- 
lief, and  take  aperients  to  make  it  larger.  For  a 
day  or  two  larger  discharges  are  procured,  but 
then,  when  the  reserves  of  faeces  are  removed  and 
the  colon  is  empty,  and  the  conditions  of  defecation 
no  longer  exist,  more  or  less  complete  inaction  of 
the  bowels  ensues,  constipation  (as  it  is  here  erron- 
eously called)  becomes  confirmed,  new  and  strong- 
er aperients  are  had  recourse  to,  and  at  last  the 
patient  falls  into  a  pitiable  condition  of  physical 
suffering  and  moral  wretchedness.  And  from  this 
condition  there  is  no  escape  through  the  complete 
suspension  of  aperients,  the  renewal  of  obedience 
to  physiological  laws,  and  a  courageous  patience 
in  vi^aiting  upon  nature. 

I  will  conclude  these  imperfect  remarks  by 
putting  down  as  briefly  as  possible  the  instructions 
which  I  ask  my  pupils  to  give  to  their  patients  for 
the  management  of  simple  constipation  : 

1.  On  first  waking  in  the  morning,  and  also  on 
going  to  bed  at  night,  sip  slowly  from  a  quarter  to 
a  half  pint  of  water,  cold  or  hot. 

2.  On  rising,  take  a  cold  or  tepid  sponge  bath, 
followed  by  a  brisk  general  toweling. 


3.  Clothe  warmly  and  loosely  ;  see  that  there  is 
no  constriction  about  the  waist. 

4.  'lake  three  sinijile  but  liberal  meals  daily; 
and,  if  desired,  audit  docs  not  disagree,  take  also 
a  slice  of  bread  and  butter  and  a  cup  of  tea  in  the 
afternoon.  When  tea  is  used  it  should  not  be  hot 
or  strong,  or  infused  over  five  minutes.  Avoid 
pickles,  spices,  curries,  salted  or  otherwise  preser- 
ved provisions,  pies,  pastry,  cheese,  jams,  dried 
fruits,  nuts,  all  coarse,  hard,  and  indigestible  foods 
taken  with  a  view  of  moving  the  bowels,  strong  tea, 
and  much  hot  liquid  of  any  kind,  with  meals. 

5.  Walk  at  least  half  an  hour  twice  daily. 

6.  Avoid  sitting  and  working  long  in  such  a  posi- 
tion as  will  compress  or  constrict  the  bowels. 

7.  Solicit  the  action  of  the  bowels  every  day 
after  breakfast,  and  be  patient  in  soliciting.  If 
you  fail  in  procuring  relief  one  day,  wait  until  the 
following  day,  when  you  will  renew  the  solicitation 
at  the  a])pointed  time.  And  if  you  fail  the  second 
day,  you  may,  continuing  the  daily  solicitation, 
wait  until  the  fourth  day,  when  assistance  should 
be  taken.  The  simplest  and  best  will  be  a  small 
enema  of  equal  parts  to  olive  oil  and  water.  The 
action  of  this  injection  will  be  greatly  helped  by 
taking  it  with  the  hips  raised,  and  by  previously 
anointing  the  anus  and  the  lower  part  of  the  rec- 
tum with  vaseline  or  with  oil. 

8.  If  by  the  use  of  all  these  means  you  fail  in 
establishing  the  habit  of  daily  or  of  alternate  daily 
action  of  the  bowels,  it  may  be  necessary  to  take 
artificial  help.  And  your  object  in  doing  this  is 
not  to  produce  a  very  copious  dejection ;  your 
object  is  to  coax  or  persuade  the  bowels  to  act 
after  the  manner  of  nature  by  the  production  of  a 
moderate  more  or  less  solid  formed  discharge. 
Before  having  recourse  to  drugs,  you  may  try,  on 
waking  in  the  morning,  massage  of  the  abdomen, 
practiced  from  right  to  left  along  the  course  of  the 
colon  ;  and  you  may  take  at  the  two  greater  meals 
of  the  day  a  dessert-spoonful  or  more  of  the  best 
Lucca  oil.  It  is  rather  a  pleasant  addition  to 
potatoes  or  to  green  vegetables. 

g.  If  the  use  of  drugs  is  unavoidable,  try  the 
aloin  pill.  Take  one  half  hour  before  the  last 
meal  of  the  day,  or  just  so  much  of  one  as  will 
suffice  to  move  the  bowels  in  a  natural  way  the 
next  day  after  breakfast.  If  it  should  produce  a 
very  copious  motion,  or  several  small  motions,  the 
pill  is  not  acting  aright ;  only  a  fourth,  or  even 
less,  should  be  taken  for  a  dose.  When  the  right 
dose  has  been  found  it  may  be  taken  daily  or  on 
alternate  days,  until  the  habit  of  daily  defecation 
is  established.  Then  the  dose  of  the  pill  should 
be  slowly  diminished,  and  eventually  artificial  lielp 
should  be  withdrawn. 

The  aloin  pill  is  thus  composed . 
R.     Alointe, 

Extr.  nucis  vom.,  J  gr. 

Pulv.  sulph.,  J  gr. 

Pulv.  niyrrha;  ^  gr. 

Saponis,  ^  gi. 

Fiatpil.  i. 


112 


THE   CANADA   MEDICAL   RECORD. 


If  the  feces  are  dry  and  hard,  and  if  there  is 
no  special  7i'eakness  of  the  heart  half  a  grain  of  ipe- 
cacuanha may  be  added  to  each  pill.  Should  the 
action  of  the  pill  be  preceded  by  griping  and  the 
character  of  the  action  be  unequal,  half  a  grain  of 
fresh  extract  of  belladonna  will  probably  remove 
these  disadvantages.  If  the  aloin  pill  gripes,  pro- 
vokes the  discharges  of  much  mucus,  or  otherwise 
disagrees,  substitute  the  fluid  extract  of  cascara 
sagrada,  and  take  from  five  to  twenty  drops  in  an 
ounce  of  water,  either  on  retiring  to  bed  or  before 
dinner.  And  when  neither  aloin  nor  cascara 
agrees,  you  may  succeed  by  taking  before  the 
mid-day  meal  two  or  three  grains  each  of  dried 
carbonate  of  soda  and  powdered  rhubarb. 

The  exact  agent  employed  for  the  relief  of  con- 
stipation is  of  much  less  importance  than  its  mode 
of  operation.  If,  whatever  the  agent  may  be,  it 
succeeds  in  producing  after  the  manner  of  nature 
one  moderate  formed  stool,  it  maybe,  if  necessary, 
continued  indefinitely  without  fear  of  injurious 
effects.  But,  treated  upon  physiological  conside- 
ration, I  have  the  belief  that  in  the  great  majority 
of  cases  simple  constipation  may  be  successfully 
overcome  without  recourse  to  aparients. 


DIET  IN  THE  TREATMENT  OF 
EPILEPSY. 
By  A.E.  Bridges,  London,  B.  A.,  .-indB.  Sc  ;  of  Paris, 
M.D.,  Edin. 

Epilepsy,  like  hydrophobia,  a  disorder  of  the 
nervous  system  without  pathognomonic  microsco- 
pic lesion,  has  for  many  years  possessed  a  fascina- 
tion for  the  scientific  pathologist,  who,  according 
to  his  individual  experience  and  irrespective  of  that 
of  his  brethren,  has  sought  to  classify  the  disease, 
bestowing  on  each  class  a  formidable  scientific 
name. 

Ignoring  such  classifications,  I  shall,  for  the 
purposes  of  chemical  observation,  and  more  espe- 
cially for  that  of  treatment,  divide  epilepsy  into 
the   following  four  great  classes  : 

I  St.  Simple  epilepsy — rare  in  women. 

2d.  Mixed  epilepsy  (hystero-epilepsy) — rare  in 
men. 

3d.  Epileptiform  seizures — result  of  course  from 
brain  lesion,  injury  to  head,  tumor  of  cerebrum, 
etc. 

4th.  Reflex  epilepsy — common  in  children,  less 
frequent  in  woman,  rare  in  men. 

My  observations  as  regards  the  effect  of  diet  in 
epilepsy  will  refer  almost  exclusively  to  class  i,  the 
most  hopeless,  and,  therefore,  from  a  medical 
standpoint,  the  most  interesting  form  of  the  di- 
sease. They  will,  however,  apply  in  a  sense,  res- 
tricted according  to  the  peculiarities  of  each  case 
to  the  other  classes  which  1  have  enumerated. 

The  frequent  occurrence  of  the  convulsive  seiz- 
ures which  occur  in  the  course  of  epilepsy  is  due, 
there  is  every  reason  to  suppose,  to  an  explosion 
of  what  we  are  compelled  to  call,  for  want  of  a 
better  term,  nerve  force. 

Now,  we  know  that  of  the  four  main  elements 


of  which  the  human  body  is  composed,  carbon, 
hydrogen,  oxygen  and  phosphorus,  nitrogen  is  the 
one  which  has  the  fewest  and  weakest  chemical 
affinities,  and  we  also  knoiv  that  exactly,  by  rea- 
son of  this  chemical  peculiarity,  nitrogen  is  a 
necessary  element  in  all  the  most  powerful  explo- 
sives. We  have,  therefore,  just  reason  to  con- 
clude that  it  plays  a  very  important  part  in  those 
nerve  explosions  of  which  we  have  spoken.  It  is 
then  quite  as  reasonable  to  limit  in  epilepsy  the 
amount  of  nitrogen  supplied  by  the  medium  of 
our  food  stuffs,  as  it  is  to  limit  the  supply  of  ar- 
ticles containing  sugar  and  starch  in  diabetes 
mellitus.  Not  only,  however,  may  we  limit  the 
actual  amount  of  nitrogen  taken,  we  may  give 
it  in  that  form  in  which  it  is  apparently  digest- 
ed and  broken  up  in  the  easiest  manner.  It  is 
a  fairly  well-attested  scientific  fact,  and  one  that  ac- 
cords with  personal  experience  that  the  nitrogenous 
compounds  which  we  use  as  foods,  and  which  are 
supplied  from  the  vegetable  kingdom,  are  more 
easily  broken  up  and  assimilated  by  the  economy 
than  those  derived  from  the  animal  kingdom. 
The  reason  of  this  difference  is  one  not  very  easily 
explained.  The  best  explanation,  perhaps,  that 
can  be  offered  is  that  in  regard  to  the  digestibility 
of  foods  in  general,  it  may  be  said  that  the  more 
concentrated  a  food  is  the  more  difficult  is  it  of 
assimilation.  Eggs  and  cheese,  two  substances 
exceptionally  rich  in  nitrogen,  are  familiar  proofs 
of  this.  The  same,  to  a  lesser  extent,  may  be 
said  of  meat.  I  am  well  aware  that  peas  and 
beans  contain  a  larger  percentage  of  nitrogen  than 
meat ;  but,  on  the  other  hand,  those  substances 
are  mixed  with  a  far  larger  proportion  of  car- 
bon, and,  furthermore,  as  compared  with  meat, 
do  not  enter  nearly  so  largely  into  ordinary 
vegetarian  diet  as  does  the  latter  in  the  menu  of 
a  mixed  feeder — furthermore,  more  water  is  used 
in  their  cooking,  and  is  absorbed  by  them  and 
eaten  with  them  than  is  the  case  with  meat,  and  they 
are,  therefore,  contrary  to  what  we  might  expect  at 
first  sight,  really  more  dilute  foods  than  are  the 
various  fleshy  articles  of  diet.  The  same  applies, 
but  with  greater  force,  to  the  cereals. 

My  argument  may,  however,  seem  to  tell 
against  myself,  for  it  might  be  said  :  well,  since 
animal  albuminoids  are  less  digestible  than  veget- 
able ones,  it  follows  that  less  of  the  first  will  be 
taken  up,  with  the  result  of  a  decreased  supply  of 
nitrogen  to  the  body  at  large.  The  conclusion, 
however,  is  incorrect.  The  result  of  the  deficient 
digestion  of  any  albuminoid  is,  partly  at  least,  that 
imperfectly  prepared  peptones  are  liable  to  be  ab- 
sorbed into  the  system,  and  it  is  mainly  with  the 
further  conversion  of  these  that  the  liver  has 
trouble. 

I  appeal  from  theory  to  practice.  Take  a  case 
of  feeble  digestion,  due  to  general  atony,  and  not 
to  any  special  digestive  derangement,  and  give  to 
that  individual  a  meal  of  meat  and  bread,  and  he 
will  very  shortly  afterwards  develop  the  well 
known  symptoms  of  atonic  dyspepsia.    Give  to  the 


THE   CANADA    MEDICAL   RECORD. 


same  man  a  dish  of  Revalenta,  of  crushed-wheat 
meal,  or  of  oatmeal  porridge  with  bread,  and  let 
such  meal  contain  exactly  the  same  amount  of  ni- 
trogen as  in  the  one  composed  mainly  of  meat, 
and  he  will,  as  a  rule,  suffer  little,  if  at  all.  This 
is  the  real  secret  of  the  enormous  sale  in  this 
country  of  Revalenta  Arahica.  1  have  at  present 
many  dyspeiitics  under  my  care,  who  take  that 
form  of  diet  without  the  least  inconvenience,  and 
to  whom  tiie  painless  digestion  of  meat  is  appa- 
rently iniposssible. 

Among  substances,  however,  that  are  derived 
from  animals,  and  which  contain  nitrogen,  milk  is 
the  only  one  that  is  an  exception  to  the  above 
rule,  and  this  simply  because  the  nitrogen  it  con- 
tains is  in  a  very  dilute  form. 

We,  therefore,  come  to  this  conclusion :  In  epi- 
lepsy we  have  a  disease  in  which  it  is  very  ne- 
cessary to  regulate  exactly  the  amount  of  nitrogen. 
It  is  also  desirable  that  all  the  organs  of  the  body, 
and,  therefore,  the  stomach  and  liver,  should  be 
kept  in  as  healthy  a  state  as  is  possible.  Veget- 
able nitrogenous  compounds  and  milk  and  its 
preparations  (^buttermilk,  skim-milk,  koumiss,  etc.) 
enable  us  to  obtain  both  ends,  and  we,  therefore, 
in  our  treatment  of  epilepsy,  should  entirely,  or 
almost  so,  discard  the  use  cf  flesh  foods. 

Even  meat  soups  are  objectionable.  Though 
apparently  very  dilute  they  really  are  highly  con- 
centrated foods,  the  water  with  which  the  meat 
juice  is  mixed  being  absorbed  with  great  rapidity 
by  the  stomach.  The  result  is  that  in  a  few  min- 
utes after  swallowing,  a  thickish  meat  jelly  only  is 
left. 

Basing  my  deductions  in  the  foregoing  premises, 
I  have  for  some  time  past  bten  in  the  habit  of 
treating  all  cases  of  epilepsy  by  the  vegetarian 
system,  though  I  hasten  to  explain  that  I  am  no 
vegetarian  myself,  nor  do  I  recommend,  as  is  gen- 
erally done  by  gentlemen  of  that  persuasion,  that 
particular  style  of  feeding  as  a  sovereign  preventa- 
tive and  sure  remedy  for  all  the  ills  of  life. 

It  will  scarcely  be  necessary  to  give  any  exact 
dietary  which,  of  course,  varies  with  the  means  of 
my  patient  and  with  his  surroundings.  Epileptics 
are  of  all  people  most  anxious  to  be  rid  of  their 
complaint,  and  will  better  follow  out,  at  least  that 
is  my  experience,  more  than  any  other  class  of 
patients,  the  rules  laid  down  for  their  guidance. 

All  I  can  say  is,  that  the  greatest  possible 
benefit  is  often  to  be  derived,  especially  in  those 
still  retaining  fair  stamina,  from  keeping  the  sup- 
ply of  nitrogen  down  below  that  laid  down  as  ne- 
cessary for  maintenance  of  health  in  the  ordinary 
physiological  hand  books.  This  is  especially  true 
of  those  who  take  little  exercise. 

With  regard  to  the  use  of  drugs.  In  a  majority 
of  cases  I  use  none,  unless,  in  spite  of  dietetic 
treatment  and  hygienic  surroundings,  the  disease 
progresses  rapidly.  I  avoid  the  bromides.  The 
apparent  benefit  derived  from  them  is  more  than 
overbalanced  by  their  disastrous  permanent  effect 
on  the  nervous  system. 


Iodide  of  potassium,  lo  to  20  grains,  at  bed- 
time, is  my  favorite  prescription,  even  in  cases 
where  I  do  not  suspect  syphilis. 

Delladonna  and  digitalis  I  also  find  in  certain 
cases  to  be  very  useful  and  free  from  most  of  the 
drawbacks  which  attach  to  the  bromides. 

Stomachics — bismuth,  with  rhubarb  and  soda 
— are  often,  especially  at  the  onset  of  the  disease, 
of  great  service. 

Of  twenty-three  cases  belonging  to  class  i, 
which  I  treated  on  what  I  call  a  vegetarian  and 
milk  system,  nineteen  were  markedly  benefited. 
Seven  of  the  nineteen  were  apparently  cured,  and 
eight  were  able  to  resume  occupation  which 
they  had,  by  reason  of  the  frequency  of  the  fits, 
been  compelled  to  abandon.  The  other  four  of 
those  who  derived  benefit  had  a  considerable  di- 
minution in  the  numlier  of  fits. 

Of  I  iS  cases  belonging  to  classes  2,  3  and  4, 
about  half  received  decided  benefit,  but,  unless 
I  give  my  full  statistics,  which,  I  fear^  would  be 
too  great  a  call  on  your  space,  I  cannot,  in 
cases  where  the  causation  the  epilepsy  variess  so 
widely  as  it  does  in  such  a  grou]),  draw  any 
convincing  deductions  worthy  the  attention  of 
your  readers. — Journal  of  Reconstructions. 

CHOLAGOG U E  PI  LLS. 
Excellent  cholagogue  pills  to  use  in  case  of  hab- 
itual costiveness  are  the  following  : 

Podophyll.  resin grs.  ij  to  iij. 

Extract.  Belladonaj gfS- j  to  jss. 

Extract,  nucis  vom grs.  iv  to  ij. 

Ext.  colocynth.  co 

Pulv.  rhei aagrs.  xii  to  3j. 

Make  into  pills.  Patient  is  to  take  one  pill  at 
night  and  one  in  the  morning,  every  time  he  re- 
mains a  day  without  a  full  and  satisfactory  opera- 
tion. 


USE  OF  BLACK  HAW  IX  HABITUAL 

ABORAI'ION  AND  OLHER  UI  ERLME 
TROUBLES. 

In  1878  my  attention  was  called  to  the  haw  in 
a  paper  published  in  New  Remedies,  page  105, 
April,  1S7S.  I  first  employed  it  in  the  case  of 
a  lady  who  had  aborted  three  times.  It  was  used 
from  the  third  to  the  fifth  month  with  her  with 
good  effect,  and  she  went  to  full  term,  and  since 
has  borne  two  children  without  any  inconve- 
nience. 

Besides  this  case  I  have  employed  the  haw  in 
sixteen  cases  of  threatening  abortion  that  I  have 
notes  of,  besides  seven  others  of  which  I  have  no 
record.  Six  of  these  patients  had  aborted  from 
two  to  four  times.  In  five  of  them  the  child  was 
carried  to  full  term.  In  one  abortion  occurred, 
but  I  do  not  think  the  drug  was  kept  up  long 
enough  to  have  the  desired  effect. 

Three  of  the  sixteen  had  aborted  once,  and  they 
all  went  to  full  term,  and  did  well. 

Of  the  remaining  three  cases  noted  of  primipa- 
rse  two  aborted,  and  I  feel  sure  that  too  much  time 


114 


THE   CANADA   MEDICAL   RECORD. 


had  been  lost  hifote  they  let  it  be  known,  and  the 
membranes  were  broken. 

In  half  of  these  cases  I  did  not  have  the  fluid 
extract  of  the  haw,  and  to  make  a  decoction  of 
the  bark  of  the  root,  which  I  think  is  best.  In 
giving  the  fluid  extract  I  gave  from  thirty  to  sixty 
drops,  from  two  to  four  hours  apart,  till  all  pains 
ceased. 

In  congestive,  as  well  as  obstructive  dysmenor- 
rhea, I  find  it  very  beneficial,  increasing  the  flow 
in  the  obstructive  form,  that  is,  obstruction  from 
clots  and  shreds  plugging  up  the  canal. 

In  after-pains  it  has  acted  well  with  me,  causing 
the  patient  to  rest  well. 

By  its  quieting  effect  on  the  contracted  uterus 
at  the  menstrual  epoch,  black  haw  allows  the  flow 
to  go  on  without  causing  the  patient  to  suffer  as 
much  as  she  would  without  it ;  and,  if  given  in  suffi- 
cient quantities,  I  believe  it  will  prevent  abortion  in 
almost  every  case  where  the  placenta  is  not  detach- 
ed or  the  membranes  broken.  It  has  never,  in  my 
hands,  affected  the  stomach  enough  to  produce 
nausa. — Dr.  C.  Bevill,  Therapeutic  Gazette. 


ON  SOME  FORMS  OF  ALBUMINURIA 
NOT  DANGEROUS  TO  LIFE. 

The  gravity  of  albuminuria,  as  a  sympton,  has 
been  differently  estimated  at  different  times,  but 
gradually  it  has  come,  in  recent  years,  to  be 
known  that  albumen  often  appears  in  the  urine, 
even  in  considerable  quantity  and  very  persist- 
ently in  persons  free  from  important  organic 
malady.  Indeed,  it  may  be  maintained  that  some 
patients  with  persistent  albuminuria  are  yet  eligi- 
ble for  life  insurance  at  little,  if  at  all,  above  or- 
dinary rates. 

It  is,  therefore,  important  to  know  the  charac- 
teristic features  of  these  non-dangerous  albuminu- 
rias. 

Dr.  Grainger  Stewart,  in  the  January  issue  of 
The  American  Journal  of  the  Medical  Scietices, 
studies  the  following  varieties  :  ist,  paroxysmal 
albuminuria;  2d,  dietetic  albuminuria  ;  3d,  albumi- 
nuria from  muscular  exertion  ;  and  4th,  simple  per- 
sistent albuminuria ;  and  illustrates  each  with  re- 
ports of  cases  which  are  markedly  characteristic. 

The  diagnostic  features  of  paroxysmal  albuminu- 
ria arc  the  sudden  and  copious  occurrence  of  al- 
bumen in  the  urine  with  numerous  casts,  the 
process  lasting  only  a  short  time,  and  recurring  at 
intervals  with  or  without  a  perceptible  exciting 
cause.  The  exciting  cause,  according  to  Dr. 
Stewart,  is  irritation  of  the  kidneys  from  blood- 
changes.  The  treatment  should  be  directed,  on  the 
one  hand,  to  the  avoidance  or  diminution  of  renal 
irritation  ;  and,  on  the  other,  to  the  regulation  of 
the  hepatic  function,  and  of  the  chemical  processes 
in  the  body.  Happily,  the  attacks  are  usually  of 
brief  duration,  and  he  has  never  known  them  prove 
permanently  injurious. 

Dietetic  albinniiniria  is  a  variety  which  has  long 
been  more  or  less  distinctly  recognized.  Some])eo- 
ple  suffer  from  it  whenever  they  indulge  in  certain 


articles  of  diet.  In  some  cases  one  kind  of  food, 
in  others  many  require  to  be  proscribed ;  cheese, 
pastry,  and  eggs  are  "among  the  more  common 
offenders.  Of  this  group  our  present  knowledge 
does  not  suffice  to  afford  a  satisfactory  explana- 
tion. 

Those  cases  of  albuminuria  folloiving  upon 
muscular  exertion  Dr.  Stewart  is  disposed  to  at- 
tribute to  a  general  change  in  vascular  activity. 
The  principal  indications  for  their  treatment  are 
met  by  rest,  judicious  diet,  and  attention  to  the 
general  health.  Those  remedies  which  act  upon 
the  muscular    fibres    of  the    vessel  deserve  trial. 

The  features  of  5/;////^  persistent  albuminuria 
are  the  constant  presence  of  albumen,  usually  m 
small  quantity,  unattended  by  tube-casts,  diminu- 
tion of  urea,  by  increased  muscular  tension,  car- 
diac hypertrophy,  or  other  consequence  of  renal 
malady,  persisting  for  a  period  of  months  or  years, 
and  little  influenced  by  diet  or  e-xercise. 

Dr.  Stewart  concludes  his  study  with  a  consid- 
eration of  the  prognosis  of  these  groups. 


IS  THE 


KNEE-KICK' 
ACT? 


A  REFLEX 


Dr.  Warren  P.  Lombard,  in  a  paper  in  the 
January  number  of  The  Americati  Journal  of  the 
Medical  Sciences,  endeavors  to  determine  whether 
the  time  between  the  moment  of  the  blow  on  the 
ligamentum  patellae,  and  the  beginning  of  the  fol- 
lowing contractor  of  the  quadriceps  muscle,  is  long 
enough  to  permit  the  phenomenon  to  be  a  reflex  act. 
The  result  was  the  discovery  that  this  period  was 
about  only  one-fourth  as  long  as  that  required  for 
a  skin  reflex  from  the  knee,  and  very  little  longer 
than  that  seen  when  the  quadriceps  muscle  is  in- 
cited to  action  by  direct  electrical  stimulation. 

His  experiments  lead  him  to  the  belief  that  the 
contraction  of  the  quadriceps  muscle  following  a 
blow  on  the  ligamentum  patellae  comes  much  too 
soon  to  be  the  result  of  a  reflex  stimulation.  It  is 
probable  that  the  stimulation  is  due  to  a  sudden 
stretching  of  the  muscle  fibres,  and  that  the  sti- 
mulus has  the  same  character  as  when  the  mus- 
cle receives  a  direct  blow.  Before  this  conclusion 
can  be  accepted,  however,  the  undoubted  influence 
of  the  spinal  cord  upon  the  production  of  the 
phenomena  must  be  explained.  The  current 
explanation  that  the  irritability  of  the  muscle  to 
finer  mechanical  stimuli  is  dependent  on  "muscle 
tonus  "  will  not  be  altogether  satisfactory  until 
the  existence  of  "  muscle  tonus  "  is  proved. 

It  seems  probable  that,  in  addition  to  the  first 
impulse  which  comes  to  the  quadriceps  when  the 
ligamentum  patella;  is  struck,  occasionnally  a 
second  impulse,  of  reflex  nature,  originating  either 
in  the  nerve  ends  of  the  skin  or  of  the  tendon  and 
muscle,  may  come  to  it  and  increase  the  height 
of  the  contraction.  Under  normal  conditions, 
however,  this  would  .seem  to  play  a  very  subor- 
dinate part. 


THE  CANADA   MEDICAL  RECORD. 


115 


MANAGEMENT  OF  MELANCHOLIA. 

Dr.  C.  H.  Hughes  sums  up  the  strictly  medical 
management  of  melancholia,  in  the  absence  of  all 
apprecialile  gross  functional  or  organic  conditions, 
as  follows  : 

ist.  I'ranquilization  of  physical  agitation. 

2d.  Restoration  of  the  lost  cerebral  tonicity. 

3d.  The  substitution  of  new,  diverting  and 
agreeable  physical  impressions. 

4th.  The  removal  of  the  moral  causes  of  the 
melancholia  or  tlie  removal  of  the  patient  from 
their  influences. 

5th.  The  removal  of  all  physical  causes  so  far  as 
they  are  descernible  and  practicable. 

'I'he  first  and  third  indications  are  temporary 
symjitomalic  expedients,  but  they  are  essential  aids 
to  the  fulfilment  of  the  second  requirement.  To 
accomplish  the  first,  nightly  doses  of  alcohol, 
chloral  hydrate,  urethran  or  opium  to  induce  sleep, 
and  ether  lotions  to  the  head  suggest  themselves, 
and  occasionally  ether  or  chloroform  inhalations. 
Cephalic  galvanizations  before  bed-time  may  sup- 
plant the  necessity  for  hypnotics,  and  will  always 
be  found  an  invaluable  adjuvant  treatment.  To 
fulfil  the  second  indication  everything  that  builds 
up — generous  diet,  malt  extracts,  liquors  and 
wine  (sparingly),  with  pepsin,  ingluvin  and  pan- 
creatine, the  compound  hypophosphites,  muriate 
of  ammonia,  iron,  arsenic,  strychnia,  phosjihorus, 
valerian,  camphor,  and  zinc.  The  patient  will 
refuse  and  resist  food,  but  it  must  be  urged 
upon  him  in  concentrated  liquid  form  if  he  will  not 
take  solids,  and  its  digestion  and  assimilation 
must  be  assured  by  chemical  aids  ;  but  solids  are 
the  best.  The  ozone  formed  by  the  static  machine 
quickens  the  blood  changes,  makes  a  demand  for 
iron,  and  accelerates  the  formation  of  hemoglobin, 
of  which  pure  air  and  iron  are  the  pabula.  For 
this  purpose,  static  electricity  and  mild  static 
electro-massage  give  valuable  aid,  especially  where 
the  patient  is  fleshy  and  cannot  be  induced  to 
walk  out  or  ride  on  horseback.  Violent  and  oft- 
repeated  massage,  mechanical  or  manual,  and  oft- 
repeated  Turkish  baths,  are  positively  hurtful  to 
these  patients  by  the  e.\cessive  weariness  Ihey 
occasion,  if  not  compensated  by  adequate  restora- 
tive nutrition.  The  interrupted  current  and  tiie 
static  shock  fix  and  divert  the  attention  of  the 
patient,  and  have  in  my  hands  sometimes  awaken- 
ed a  new  interest  in  the  medical  aspects  of  this 
cure. 

The  daily  surcharging  of  the  patient  with  the 
positive  current  does  good,  and  the  study  of  the 
marvelous  phenomena  of  electricity  sometimes 
supplants  for  a  time  the  self-introspection  of  the 
patient,  pending  our  reconstructive  measures, 
and  the  silent  electric  saturant  has  also  power  to 
reawaken  dormant  nutritives  and  formative  force 
energies  in  the  depressed  organism  of  melancholia. 
The  free  use  of  aromatic  flowers  and  jilants,  and 
attractive  and  novel  paintings,  statuary  and  articles 
ot  vertu,  birds   and  enlivening  music,   humorous 


illustrated  literature,  plays,  panoramas,  and  panto- 
mimes are  valuable  auxiliaries.  The  exhilarant  in- 
fluence of  aromatic  flowers  and  plants  has  been  attri- 
buted to  their  capacity  to  generate  ozone. 

The  third  indication  is  promoted  by  the 
judicious  and  temporary  use  of  the  exhilarant 
stimulants,  opium,  codia,  cannabis  indica,  caffein, 
thein,  quinine,  camphor,  the  valeriates  of  ammonia, 
iron,  etc.,  Hoffman's  anodyne,  chloroform,  the 
etherials,  the  alcoholics,  and  coca  extract  and 
cocaine.  I  deem  it  advisable  to  use  all  of  these 
stimulants  si)aringly,  and  the  latter,  especially, 
with  extreme  caution.  The  extract  of  wine  of  coca, 
especially  the  old  "  Vin  I^Lariani,"  arc  safe  and  more 
preferable  than  cocaine.  No  mental  im|iression  that 
will  agreeably  divert  the  mind  should  be  ignored 
in  melancholia.— -77/1-  Alienist  and  Neurologist. 


DIAGNOSIS  OF  INFANTILE  DISEASES. 

In  a  recent  number  of  L' Union  Afalica/c  <iu 
Canada,  Dr.  Bradley  gives  the  following  sum- 
mary of  points  on  the  diagnosis  of  disease  in  in- 
fants ; 

1.  Congestion  of  the  cheeks,  excepting  in  cases 
of  cachexia  and  chronic  disease,  indicates  an  in- 
flammation or  a  febrile  condition. 

2.  Congestion  of  the  face,  ears,  and  forehead 
of  short  duration,  strabismus,  with  febrile  reaction, 
oscillation  of  the  iris,  irregularity  of  the  pupil,  with 
falling  of  the  upper  lids,  indicates  a  cerebral 
affection. 

3.  A  marked  degree  of  emaciation,  which  pro- 
gresses gradually,  indicates  some  subacute  or 
chronic  affection  of  a  grave  affection. 

4.  Bulbar  hypertrophy  of  the  fingers  and  curving 
of  the  nails  are  signs  of  interference  in  the  normal 
functions  of  the  circulatory  apparatus. 

5.  Hypertrophy  of  the  spongy  portion  of  the 
bones  indicates  rachitis. 

6.  'I'he  presence  between  the  eyelids  of  a  thick 
and  inirnlent  secretion  from  the  ^Ieibomian  glands 
may  indicate  great  prostration  of  the  general 
powers. 

7.  Passive  congestion  of  the  conjunctival  vessels 
indicates  approaching  death. 

8.  Long-continued  lividity,  as  well  as  lividity 
produced  by  emotion  and  excitement,  the  respira- 
tion continuing  normal,  are  indices  of  a  fault  in  the 
formation  of  the  heart  or  the  great  vessels. 

9.  A  temporary  lividity  indicates  the  existence 
of  a  grave  acute  disease,  especially  of  the  respira- 
tory organs. 

10.  The  absence  of  tears  in  children  four  months 
old  or  more  suggests  a  form  of  disease  which  will 
usually  be  fatal. 

11.  Piercing  and  acute  cries  indicate  a  severe 
cerebro-spiiial  trouble. 

12.  Irregular  muscular  movements,  which  are 
partly  under  control  of  the  will  when  the  patient 
is  awake,  indicate  the  existence  of  chorea. 

13.  Contraction  of  the  eye-brows,  together  with 
a  turning  of  the  he.ad  and 'eyes  to  avoid  the  light,  is 
a  sign  of  cephalalgia. 


116 


THE   CANADA   MEDICAL   RECORD. 


14.  When  the  child  holds  his  hand  upon  his 
head,  or  strives  to  rest  the  head  upon  the  bosom  of 
his  mother  or  nurse,  he  may  be  suffering  from  ear 
disease. 

15.  When  the  fingers  are  carried  to  the  mouth, 
and  there  is,  besides,  great  agitation  present,  there 
is  probably  some  abnormal  condition  of  tlie 
larynx. 

■  16.  When  the  child  turns  his  head  constantly 
from  one  side  to  the  other  there  is  a  suggestion  of 
some  obstruction  of  the  larynx. 

17.  A  hoarse  and  indistinct  voice  is  suggestive 
of  laryngitis. 

18.  A  feeble  and  plaintive  voice  indicates  trou- 
ble in  the  abdominal  organs. 

ig.  A  slow  and  intermittent  res[iiralion,  accom- 
panied with  sighs,  suggests  the  presence  of  cere- 
bral disease. 

20.  If  the  respiration  be  intermittent,  but  acce- 
lerated, there  is  ca|iillary  bronchitis. 

21.  If  it  be  superlicial  and  accelerated,  there  is 
some  inflammatory  trouble  of  the  larynx  and 
trachea. 

22.  A  strong  and  sonorous  cough  suggests 
spasmodic  croup. 

23.  A  hoarse  and  rough  cough  is  an  indication  of 
true  croup. 

24.  ^Vhen  the  cough  is  clear  and  distinct,  bron- 
chitis is  suggested. 

25.  When  the  cough  is  suppressed  and  painful, 
it  points  toward  imeumonia  and  pleurisy. 

26.  A  convulsive  cough  indicates  whooping- 
cough. 

27.  A  dry  and  painless  cough  is  sometimes  noti- 
ced in  the  courseof  typhoid  and  intermittent  fever, 
in  difficult  dentition,  or  where  worms  are  present. 
• — London  Alcdical  Record. 


HYSTERIA  IN  A  NEW  LIGHT. 

According  to  The  Lancet.,  September  4,  1S86, 
(^Med.  Record)  the  views  of  Mr.  de  Berdt  Hovell  on 
the  subject  of  hysteria  are  to  be  carefully  received 
as  those  of  a  shrewd  practitioner  of  long  practice 
and  large  experience.  He  strongly  protests  against 
the  whole  hypotiiesis  of  hysteria.  He  thinks 
the  theory  that  localizes  the  disease  in  the  uterus 
is  the  mere  survival  of  medical  demonology,  which 
located  ill-humor  in  the  spleen,  blue  devils  in  the 
liver,  and  the  soul  in  the  pineal  gland.  He  claims 
for  hysterical  patients  more  fairness  of  treatment 
and  more  discrimination.  He  attributes  many  of 
the  cases  to  shocks,  physical  or  moral,  leading  to 
deficient  or  depressed  nerve-power,  with  all  that 
this  implies  in  the  way  of  pain,  irritability,  inabili- 
ty for  locomotion,  etc.  Mr.  Hovell  admits  that 
the  cases  are  difficult  to  cure ;  but  he  maintaius 
that  if  we  are  to  deal  with  them  effectually  we  must 
"  set  aside  all  considerations  of  the  organs  of  re- 
production, which  most  probably  are  not  concern 
ed,  and  transfer  our  attention  to  the  moral  nature.  " 
Mr.  Hovell  gives  several  cases  in  which  there  was 
a  distinct  history  of  shock  or  exhaustive  work,  to 
explain  the  break  down  in  the  nervous  system.  We 


live  in  days  when  the  nervous  system  is  getting  its 
full  share  of  attention  from  ])athologists  and  phy- 
sicians, and  when  evaii  gynecologists  are  finding 
out  that  the  uterus,  and  even  its  api>endages,  which 
are  now  blamed  by  some  for  everything,  are  not 
such  culprits  as  has  been  supposed.  Mr.  Hovell 
will  admit  that  the  cases  of  so-called  hysteria  do 
occur  chiefly,  though  by  no  means  exclusively,  in 
women.  In  their  organization  there  is  something 
specially  favoring  the  occurrence  of  this  state  or 
disease.  It  may  not  be  in  the  special  organs  of 
the  female  as  much  as  in  the  special  organization 
of  the  nervous  system.  Mr.  Hovell  deserves  cre- 
dit for  insisting  on  this  jjoint,  and  he  may  well  be 
satisfied  to  know  that  the  drift  of  opinion  among 
physicians  is  toward  the  acceptance  of  his  views. 
Women  are  more  finely  strung  than  men.  They 
are  more  liable  to  paia  or  pains  of  all  sorts  from 
mere  functional  causes.  Such  a  constitution  is 
perplexing  to  the  physician  ;  but  it  has  to  be  con- 
sidered, and  not  treated  as  a  sort  of  crime,  as  has 
too  often  been  the  case. 


THE  NIGHT-SWE.\TS  OF  PHTHISIS 
TREATED  BY  SEC ALE  CORNUTUM, 
Mingot  reports  in  the  Journal  de  Mi-decine  de 
Paris  (  Thcr.  Gaz.)  as  to  the  unexpectedly  favor- 
able results  obtained  with  secale  cornutum  in  the 
night-sweats  of  phthisical  subjects.  He  observed 
inTenneson's  c'inics  at  Paris  that  15J  to  31  grains 
of  ergot  given  in  powder  form,  or,  better,  2  fl.  dr. 
ofergotinine  injected  hypodermically  half  an  hour 
previous  to  the  expected  appearance  of  the  sweat, 
could  suppress  the  latter  for  a  week  or  even  longer. 
No  other  of  the  numerous  remedies  recommended 
against  night-sweats  was,  save  atropine,  found  to 
have  so  great  an  effect  as  ergot  or  ergotinine.  To 
be  sure,  the  tubercular  process  is  in  no  way  influ- 
enced by  the  exhibition  of  this  remedy,  but  it  is 
gratifying  to  be  able  to  stay  one  of  the  most  annoy- 
ing, and  at  the  same  time  weakening,  factors  of 
the  disease. 


TREATMENT  OF  CHRONIC  CONSTIPA- 
TION IN  CHILDREN. 
Dr.  W.  B.  Cheadle,  at  the  close  of  a  clinical 
lecture  on  this  subject,  points  out  the  disastrous 
results  of  mistaken  treatment,  and  shows  the 
necessity  of  a  more  rational  procedure.  "  Look, 
at  the  evil  effect  of  strong  purgations — how  they 
enervate  and  wear  out  the  tone  of  the  bowel.  No 
occasional  purge  of  rhubarb  or  scammony  is 
efficient  to  cure.  Look,  again,  at  the  evil  effect  of 
frequent  enemata.  Enemata  are  only  to  be  used 
on  an  emergency,  Tiiey,  equally  with  strong  purges, 
impair  tone  and  do  diiectharm  by  actual  dilation. 
In  confirmed  cases  of  constipated  habit,  treatment 
must  not  be  intermittent,  but  continuous  ;  the  daily 
administration  of  appropriate  remedies  steadily, 
for  a  considerable  period,  is  absolutely  essential. 
Intermittent  treatment  is  abortive,  ineffectual,  and 
aggravates  the   evil.     What,    then,  is    the  proper 


tnn   CANADA   MEDICAL  RECoRiJ. 


117 


treatment  for  these  cases?  First,  he  sure  that 
there  is  no  malformation,  no  intussusception,  no 
sore  about  tlic  anus,  rendering  defecation  ])ainnil. 
Then  use  saline  laxatives.  Their  mode  of  action 
is  by  increasing  the  flow  of  secretion  rather  than 
1))'  stimulating  peristalsis.  Thus  tone  returns  when 
distention  is  relieved  by  the  easy  evacuation  of 
Ihiid  stools.  Further  aids  to  this  are  strychnia, 
nux  vomica,  iron  and  belladonna.  'J'hey  act  by 
increasing  muscular  tone  and  nutrition,  not  by 
stimulating  peristalsis  directly.  In  the  case  of 
little  children  up  to  two  years  old  simple  carbonate 
of  magnesia  in  milk  is  sufficient  (■;  to  lo  or  20 
gr.)  ;  this  is  better  than  the  piece  of  soap  in  the 
rectum,  or  the  repeated  castor  oil  or  manna  so 
constantly  advised.  In  older  children  the  sul- 
phates of  magnesia  and  soda,  with  the  tonics  named 
above,  and  daily  massage  with  castor  oil  or  cod- 
liver  oil,  are  most  useful.  In  older  children  still,  a 
I)ill  of  aloes  or  euonymin,  with  suli)hate  or  iron 
and  nu.x  vomica,  may  be  given  as  an  alternative 
to  the  salts  and  strychnia,  but  no  freipient  rhu- 
barb, or  scammony,  or  podophyllin,  or  jalap  (these 
are  for  the  relief  of  temporary  difficulty  only)  ;  in 
mild  cases,  perhaps,  or  if  the  liver  is  not  acting,  a 
dose  of  calomel,  grey  powder,  and  soda,  or  senna. 
Regimen  is  an  imi)ortant  element  in  the  treatment, 
if  the  child-  should  have  chronic  constipation  ; 
abundant  water,  pure,  not  hard  ;  "  salutaris  water" 
is  excellent.  In  little  children  add  a  good  infants' 
food  to  milk ,  fruits,  fruit  jellies,  treacle,  cooked 
green  vegetables  of  the  softer  and  more  delicate 
kinds.  Some  variety  in  food  is  useful  ;  a  good 
mixture  is  better  than  a  monotonous  diet.  It  is, 
I  think,  extremely  doubtful  if  coarse  food  is  useful 
in  the  long  run.  It  causes  atony  and  weariness  of 
muscle  eventually  by  over-stimulation.  And  you 
must  insist  on  regular  evacuations.  Take  care 
that  the  stools  are  not  dry  and  liard,  or  the  child 
will  resist  action  and  increase  constipation.  Other 
useful  adjuncts  are — abundance  of  fresh  air, 
which  aids  in  improving  nutrition  ;  and  exercise, 
which  aids  the  passage  of  the  contents  of  the 
intestine  down  the  tube,  and  improves  general 
health  and  muscular  tone." — Lancet,  Dec.  11, 
1886. 


PUERPERAL  ECLAMPSIA  TREATED 
WITH  PILOCARPINE. 

Dr.  T.  Coke  Squance  thus  writes  in  the  Lan- 
cet: 

Early  on  the  morning  of  September  8  I  was 
called  to  attend  Mrs.  L — ,  aged  twenty-two,  in 
her  first  confinement,  her  ordinary  medical  at- 
tendant being  from  home.  I  was  informed  that 
the  "jwins  were  slow,"  that  she  had  been  very 
sick,  and  comjilained  of  severe  ''  pain  in  the 
head."  On  examination,  I  found  the  os  well 
dilated,  head  presenting,  and  membranes  (which 
were  very  tough)  unruptured.  I  ruptured  the 
membranes  and  applied  a  binder,  but  after  wait- 
ing for  some  time  the  pains  became  very  feeble, 
and  the  patient  showed  such  signs  of  exhaustion 


that  I  proceeded  to  deliver  her  with  the  forceps, 
subsequently  removing  the  j)lacenta,  which  was 
l)artially  adherent.  'I'lierc  was  no  hemorrhage 
worth  speaking  of,  and  half  an  hour  after  the 
patient  expressed  herself  as  "  feeling  well."  Her 
l)ulsc  when  I  left  her  was  72.  Later  on,  I  receiv- 
ed a  message  to  the  effect  that  she  was  "  going 
from  one  fit  to  another."  On  my  arrival  I  found 
her  quite  unconscious,  face  flushed,  pupils  widely 
dilated,  skin  harsh  and  dry,  abdomen  tympanitic, 
bladder  empty,  feet  oedematous,  pulse  120  and 
full,  and  temperature  100°.  Her  friends  inform- 
ed me  that  she  had  had  about  a  dozen  exceeding- 
ly severe  fits,  during  some  of  which  they  thought 
she  was  dead.  During  the  "  fits  "  she  had  passed 
f;eces  and  urine.  As  an  attack  was  evidently 
just  commencing,  I  gave  her  a  hypodermic  injec- 
tion of  pilocarpine  (j.^^  grain).  The  head  was 
then  being  turned  from  side  to  side,  the  eyelids 
and  eyeballs  were  moving  rapidly,  the  mouth  was 
drawn  up  towards  the  right  ear,  and  the  head 
turned  towards  the  right  shoulder,  the  counte- 
nance being  of  a  livid  hue.  The  fingers  and 
thumbs  were  then  flexed  on  the  hands,  the  latter 
being  strongly  flexed  on  the  arms,  which  were 
also  somewhat  flexed  ;  the  trunk  and  legs  became 
rigid.  The  left  leg  was  raised  from  the  bed,  and 
remained  extended  for  fifteen  seconds.  There 
was  a  peculiar  hissing  sound  on  respiration,  with 
convulsive  movements  of  the  larynx,  the  face  be- 
coming blue-black  in  color,  and  the  patient 
seemingly  on  the  verge  of  suffocation.  'I'he  ri- 
gidity, which  lasted  for  fifteen  seconds,  was  fol- 
lowed by  clonic  convulsions,  the  face  was  fright- 
fully distorted,  and  large  quantities  of  frothy  foam, 
slightly  tinged  with  blood,  came  from  the  mouth, 
Resjiiralion  became  restored  and  the  convulsion 
ceased,  with  the  exception  of  a  little  twitching,  at 
the  end  of  three  minutes,  by  which  time  the  pa- 
tient was  in  a  profuse  perspiration.  The  atten- 
dant told  me  that  this  attack  was  barely  half  the  du- 
ration of  the  i>revious  ones.  Tliere  was  no  further 
seizure  until  shortly  before  I  saw  her  the  next 
morning,  when  there  was  a  slight  attack.  I  re- 
jK'ated  the  pilocarpine  then  and  once  subsequently, 
and  no  further  seizures  occurred.  She  remained 
unconscious  for  three  days,  during  which  time 
urine  was  passed  in  large  quantities.  There  was 
an  abundant  secretion  of  milk.  When  I  termi- 
nated my  attendance  at  the  end  of  a  week,  her 
own  medical  attendant  having  returned  home, 
she  was  making  most  favorable  progress.  In  ad- 
dition to  the  pilocarpine,  I  ordered  her  a  mixture 
containing  chloral  hydrate  and  bromide  of  po- 
tassium, and  pessaries  of  eucalyptus,  and  per- 
chloride  of  mercury  per  vaginam. 


RULES  FOR  OPENING  THE  ABDOMEN. 
Dr.  T,  Gaillard  Thomas  (^Medical  IVniis,  Dec.  11, 
1886)    gives    the    following  rules  for  explorative 
incision  of  the  abdomen: 

I  St.  Every  explorative  incision  should  be  made 
under  the  strictest  antiseptic  precautions.     As  to 


118 


•THE  CANADA   MEDICAL  RECORD. 


strict  cleanliness,  all  are  agreed  ;  if  antiseptics  of 
chemical  character  are  valueless,  they,  at  least,  in 
all  probability,  do  no  harm  ;  give  the  patient  the 
benefit  of  the  doubt,  and  employ  them. 

2d.  Always  employ  an  anaesthetic,  lest  the  com- 
plaints of  the  patient  should  frustrate  the  investi- 
gation, or  at  least  render  it  superficial  and  uncertain. 

3d.  Always  make  an  incision  which  will  admit 
the  whole  hand,  one  which  will  admit  two  fingers 
only  is  hardly  warrantable.  If  possible,  let  but 
one  man's  hand  be  passed  into  the  abdominal 
cavity  ;  in  a  multitude  of  counsel  there  is,  in  these 
cases,  danger.  The  brain  which  guides  the  hand 
should  be  competent  for  deciding  the  question  at 
issue, 

4th.  Never  hurry  an  exploratory  incision,  but 
never  prolong  one  unnecessarily ;  let  discussion  as 
to  diagnosis  occur  after  the  peritoneum  is  closed, 
not  while  it  is  open  ;  and  let  the  fact  be  ajipreciated 
that  the  clinical  lecture,  which  is  so  common  at  this 
moment,  is  always  a  source  of  danger. 


A  DOMESTIC  DEVICE  FOR  NIPPLE 
SHIELDS. 

The  old  adage  that  "  there  is  no  new  thing  under 
the  sun,"  was  prettily  contradicted  by  one  of  my 
patients  who,  suffering  with  fissured  nipples — so 
sensitive  and  painful  that  their  contact  with  any 
fabric  or  dressing  caused  intense  distress — in- 
vented for  herself  almost  perfect  nipple  shields,  by 
suspending  from  a  ribbon  about  the  neck  two 
deep,  wire  lea  strainers. 

They  were  held  in  place  by  a  properly  fitting 
waist,  and  the  nipples,  thus  covered,  were  entirely 
free  from  any  irritation. 

She  had,  moreover,  such  a  copious  supply  of 
milk  that  it  was  otherwise  quite  impossil3le  to 
keep  the  nipples  dry.  This  was  remedied  by  the 
ready  passage  of  the  milk  through  the  wire  gauze 
to  a  la>er  of  absorbent  cotton  covering  the  tea 
strainer. 

Not  until  she  began  to  employ  this  method  of 
protecting  the  nipples  did  the  process  of  healing 
go  on  satisfactorily. 

This  young  mother's  clever  device  has  been  a 
source  of  great  comfort  in  a  number  of  similar 
cases  which  have  since  then  come  under  my  care. 

I  believe  that  this  use  of  the  tea  strainer  is  quite 
novel,  and  trust  that  its  value  may  be  tested  by 
some  of  your  readers. — Frank  Holyoke,  M.D.,  in 
Boston  Med.  and  Surg  Journal. 


LOCAL  REMEDY  FOR  NEURALGIA. 

A  mixture  of  one  part  of  iodoform,  to  ten  or 
fifteen  of  collodion,  if  spread  repeatedly  upon  a 
neuralgic  surface  until  it  attains  a  thickness  of  one 
to  two  millimetres,  is  said  to  be  quite  effective  in 
the  treatment  of  certain  neuralgias.  If  the  first 
application  does  not  speedily  terminate  the 
neuralgia,  those  who  have  used  this  mode  of  treat- 
ment direct  that  its  application  should  be  con- 
tinued. It  seems  especially  valuable  in  the  relief 
of  neuralgias  of  the  trigiminus.      It  also  seems  of 


value  to  be  applied  along  the  spine,  particularly  at 
painful  points  in  what  is  called  spinal  irritation. 
These  observations  are  by  no  means  new,  and  yet 
they  seem  worthy  of  further  consideration. — 
Neurological  Rcvieio. 


BOUGIE  TREATMENT  OF  CHRONIC 
GONORRHEA. 

Dr.  J.  Ajipel,  Monatshcftefiier  practischc  Dcr- 
matologie,  7,  1886,  reports  on  the  use  of  sounds, 
covered  by  a  medicament  in  chronic  blenorrhea  of 
the  urethra.  The  method  was  first  employed  by 
Unna.  It  appears  to  be  of  importance  to  pay  at- 
tention to  the  chemical  changes  that  may  occur  in 
the  influence  of  medicament  upon  the  material  of 
the  bougie  and  vice-versa.  In  cases,  failures  ap- 
pear due  to  this  possibility.  Appel  has  found  an 
unalterable  preparation  to  be  a  mixture  of  90  parts 
of  vaseline,  ten  parts  of  paraffine,  two  of  balsam  of 
copaiva  and  one  of  nitrate  of  silver,  applied  upon 
block-tin  sounds. 

This  modification  is  said  to  heal  many  a  case  that 
has  resisted  all  treatment. 

The  Canada  Medical  Record. 

A  Monthly  Journal  of  Medicine  and  Surgery- 

EDITORS  : 

FRANCIS  W.  CAMPBELL,  MA.,  M.D.,  L.K.C.P.  LOUD. 

Editor  and  Proprietor. 
E.  A.  KENNEDY,  M.A.,  M.D.,  Managing  Editor. 

ASSISTANT  EDITORS: 
CASEY  A.  WOOD,  CM.,  M  D. 
GEOKGE  E,  AKMSTEONG,  CM.,  M.D. 

SUBSCRIPTION  TWO  DOLLARS  PER  ANNUM. 

All  communications  and  Eichangps  must  be  addressed  to 
t/ie  Editors, Drnwer356,  Post  Office,  Montreal. 

MONTREAL,  FEBRUARY,  1887. 

ANNUAL  OF  THE    MEDICAL  SCIENCES. 

Dr.  Chas.  E.  Sajous,  of  Philadelphia,  with  the 
assistance  of  one  hundred  and  fifty  corresponding 
editors  and  sixty-four  associate  editors,  has  under- 
taken to  publish  a  digest  of  the  medical  literature 
of  the  civilized  world  each  year.  It  is  proposed 
to  procure  information  from  medical  men  in  all 
countries  with  which  postal  communication  exists, 
from  journals,  and  new  publications,  etc.  The 
information  will  be  classified  and  referred  to 
associate  editors.  Due  credit  will  be  given  each 
author  and  journal.  The  annual  will  be  strictly 
non-partisan.  The  work  will  consist  of  five  royal 
octavo  volumes  of  about  five  hundred  pages  each, 
fully  illustrated  with  cuts,  maps,  and  chromo- 
lithographs. The  price  will  be  $15  per  set, 
delivered. 


THE  CANADA  MEDICAL  RECORD. 


119 


COLLEGE  OF  PHYSICIANS  AND 
SURGEONS  OF  ONTARIO. 
'I'lie  corner  slonc  of  the  Iniildiiig,  which  this 
body  is  to  occuijy  in  Toronto,  was  laid  on  the  26lh 
of  January  hxst  by  tlic  President,  Or.  H.  H. 
Wright.  It  will  be  a  fine  building,  and  a  credit  to 
the  profession  of  our  sister  Province.  The  Quebec 
College  is  to  continue  its  perambulations  between 
Quebec  and  Montreal  as  of  old,  the  folly  of  this 
system  ncit  being  evident  to  those  governors  of 
the  College  who  hail  from  old  "  Stadacona." 


APPROPRIATION  FOR  THE  INTERNA- 
TIONAL MEDICAL  CONGRESS. 

The  United  States  Congress  was  asked  to  vote 
.$50,000,  but  have  declined  to  give  this  amount. 
The  sum  of  810,000  was,  however,  appropriated 
just  before  adjournment. 

It  is  provided  that  this  amount  is  to  be  expend- 
ed under  such  regulations  as  the  Secretary  of  the 
Treasury  may  prescribe,  also  that  no  part  of  the 
appropriation  shall  go  toward  paying  the  personal 
expenses  of  any  delegate  and  no  money  shall  be 
expended,  except  upon  vouchers  to  be  approved 
by  the  Secretary  of  the  Interior. 


PAY  OF  AMERICAN  ARMY  AND  NAVAL 
MEDICAL  OFFICERS. 

The  "  Medical  News  "  says .—"  The  pay  of  the 
Assistant  Surgeon  in  the  Navy,  for  the  first  five 
years  after  his  first  appointment,  is,  per  annum, 
when  at  sea,  81,700;  when  on  shore  duty,  $1,400; 
when  on  leave  or  waiting  orders,  $1,000.  After 
five  years'  service,  his  pay  becotnes,  at  sea,  $  i  ,900  J 
on  shore  duty,  $1,600  ;  and  when  waiting  orders, 
|i,200.  There  seems  to  be  no  good  reason  for 
the  difference  in  pay  for  sea  and  shore  duty. 

The  pay  of  the  Assistant  Surgeon  in  the  Army, 
for  the  first  five  years  after  his  appointment,  is,  per 
annum,  $1,600,  and,  after  five  years,  $2,200.  "For 
the  first  ten  years  of  service,  or  thereabouts,  the 
pay  of  the  Army  medical  officer  is  somewhat 
greater  than  that  of  the  Navy  medical  officer. 
But  promotion  is  more  rapid  in  the  Navy  than  in 
the  Army,  owing  to  the  fact  that  the  Navy  has 
more  officers  in  the  higher  grades.  Thus,  of  i8o 
medical  officers  in  the  Navy,  there  are  1 5  with  the 
rank  of  Colonel,  and  1 5  with  rank  of  Lieutenant- 
Colonel  ;  while  of  192  medical  officers  in  the  Army, 
there  are  5  Colonels  and  10  Lieutenant-Colonels. 
The   result  of  this  is  that  while  in  the  Army  it 


requires  about  twenty  years'  service  to  reach  the 
rank  of  Major  and  full  Surgeon,  in  the  Navy  it 
requires  a  little  less  than  fifteen  years  to  attain 
this  grade.  Taking  it  altogether,  there  is  very 
little  difference  in  the  pecuniary  emoluments  of 
the  two  services." 


LACTATED  FOOD. 

The  Wells  and  Richardson  Company  have  sent 
us  a  copy  of  their  Dietetic  Annual  for  1887.  ^'  '^ 
full  of  interesting  and  valuable  information  regard- 
ing Dietetics,  and  is  well  worth  possessing.  It,  of 
course,  deals  considerably  with  the  particular  food 
for  infants  and  invalids,  which  they  manufacture — 
in  the  use  of  which  we  have  now  had  considerable 
experience.  It  is  called  "  Lactated  Food,"  and 
is  well  liked  by  children.  Unlike  many  foods  it 
contains  milk  sugar  and  not  cane  sugar,  which 
latter  often  causes  indigestion.  It  is  a  food  which 
we  can  heartily  recommend  to  our  readers  for  infant 
feeding  and  the  nourishment  of  invalids — See  Adv. 


GLEANINGS. 

Prof.  Bartholow  of  Philadelphia  says  : 

Failure  of  voice  from  simple  mucous  laryngitis 
or  fatigue  can  often  be  wonderfully  relieved  by 
small  doses  of  nitric  acid  every  two  or  three  hours, 
to  be  given  well  diluted. 

Prof.  Bartholow  still  continues  to  advocate  the 
use  of  carbolic  acid  in  typhoid  fever.  He  states 
that  no  form  of  treatment  has,  in  his  hands,  been 
so  successful.  It  modifies  the  disturbances  of  the 
intestinal  tube,  reduces  temperature,  and  promotes 
quiet.  Two  drops  of  a  solution  consisting  of  equal 
parts  of  carbolic  acid  and  Lugol's  solution  may  be 
given  every  three  hours. 

The  Health  fournal  says  : 

When  a  patient  is  choked  or  strangled,  break  an 
egg  as  quickly  as  possible  and  give  him  the  white 
(do  not  beat  it),  and  it  will  almost  certainly  dis- 
lodge the  obstacle. 

The  New  York  Medical  Record  says  : 

Dr.  G.  C.  Simmons  recommends  the  use  of  spec- 
tacles with  plates  of  mica  for  persons,  such  as 
cooks,  who  suffer  from  conjunctivitis  through  ex- 
posure to  the  heat. 

Professor  Bartholow  recommends  salicylic  acid 
for  removal  of  bile  pigment  from  the  blood  after 
the  cause  of  the  jaundice  has  been  removed.  Its 
action  is  prompt  and  satisfactory. 


120 


THE   CANADA   MEDICAL   RECORi). 


PERSONAL. 

Dr.  William  Gardner,  Professor  of  Gyneco- 
logy, McGill  University,  has  been  elected  a  Vice- 
President  of  the  British  Gynecological  Society. 

Dr.  R.  Palmer  Howard,  Dean  of  the  Faculty  of 
Medicine,  McGill  University,  has  been  named,  at 
its  centennial  celebration,  an  associate  fellow  of 
the  College  of  Physicians,  Philadelphia. 

Mr.  Lawson  Tait,  F.  R.  C.  S.,  of  Birmingham 
has  accepted  a  vice-presidency  of  tiie  Interna- 
tional Medical  Congress,  to  be  held  in  Washington 
this  coming  summer. 

Dr.  Cotton,  of  Mount  Forrest,  Ont.,  is  said  to  be 
about  to  remove  to  Toronto. 

Dr.  Spendlove  (M.  D.,  Bishops'  College,  iS8o), 
of  Beebe  Plain,  intends  to  commence  practice  in 
Montreal. 

Dr.  Charles  E.  Casgrain,  of  Windsor,  a  gradu- 
ate of  McGill  University  (1851),  has  been  appoint- 
ed to  fill  one  of  the  vacant  senatorships. 

Dr.  Wm.  Crothers  (M.  D.  McGill,  1S76)  has 
just  been  licensed  to  practice  in  the  State  of  Cali- 
fornia.    His  residence  is  San  Francisco. 


OBITUARY. 

Dr.  A.  M.  Sloan  died  at  Listowel,  Ont.,  on  the 
30th  of  December  last,  of  Typhoid  fever.  His 
loss  is  deeply  felt  by  all  who  knew  him.  He  was 
the  son  of  Dr.  Sloan,  of  BIyth,  Ont.,  to  whom  we 
tender  our  deep  sympathy. 

Dr.  Barrett,  of  Toronto,  died  the  middle  of  this 
month,  at  the  age  of  71  years.  He  was  a  well- 
known  physician  and  teacher  in  the  Toronto 
School  of  Medicine.  He  was  also  the  founder  of 
the  Women's  Medical  College  in  Toronto,  which 
he  lived  to  see  in  a  flourishing  condition. 


DR.  JOSEPH  MORLEY  DRAKE. 

It  is  with  feelings  of  more  than  usual  sadness 
that  I  chronicle  the  death  of  Dr.  Drake,  which 
took  place  at  Abbotsford,  Quebec,  on  the  26th  of 
December  last.  The  friendship  between  Dr. 
Drake  and  myself  began  in  1850,  when  I  was  but 
a  small  boy ;  at  that  tmie  Dr-  Drake  was  a  clerk  in 
the  drug  store  of  Mr,  S.  Jones  Lyman,  on  the 
corner  of  Place  d'Armes  square  and  Notre  Dame 
street,  while  1  resided  on  the  opposite  side  of  the 
square.  It  was  my  delight  to  go  over  and  assist 
him  in  some  trivial  work — for  about  him  there 
was  an  attraction  which  drew  my  heart  to  him 
then,  and  which  made  the  friendship  thus  begun 
continue  up  to  the  day  of  his  death.  Little  idea 
had  either  of  ns,  then,  that  we  would  both  enter 
the  medical  profession — and  both  in  time  become 
engaged  in  the  work  of  medical  teacliing.  The 
history  of  my  departed  friend  is  worth  recording, 
for  it  is  one  which  can  be  pointed  to  as  worthy  of 


emulation.  He  was  born  in  London,  England,  in 
1828,  and  in  it  received  his  general  and  scientific 
education.  At  the  anepf  17  he  came  to  Canada, 
a  certified  analytical  chemist.  He  filled  twositua 
tions  before  he  entered  the  employ  of  Mr.  Lyman, 
with  whom  he  continued  for  some  time,  attaining 
full  control  of  the  establishment,  then,  ])erhai)s,  the 
most  aristocratic  in  the  city.  Like  many  other 
chemists,  he  became  enamored  of  medicine,  and 
determined  to  adopt  it  as  his  profession.  Our 
friendship  always  strong  now  became  firmly  comen- 
ted,  for  we  sat  on  the  same  bench,  carved  our 
names  side  by  side,  were  medical  students  to- 
gether. Need  I  say  more  ?  Yes,  just  this,  that  while 
my  friend  avoided  the  excess-;s,  which  sometimes 
are  thought  to  be  essential  to  the  embryo- 
medico,  he  gave  his  whole  energy  to  developing  the 
best  which  was  in  those  who  surrounded  him. 
Not  a  student  in  the  College  during  his  term  but 
loved  him,  and  many,  scattered  to  the  four  winds  of 
heaven — his  old  class-mates — but  will  recall  with 
loving  memory,  the  clear,  healthy  English  com- 
plexion, and  light  curly  hair  of  their  old  chum- 
Joseph  Morley  Drake,  and  mourn  his  comparatively 
early  death.  Graduating  a  year  before  him, although 
much  his  junior,  he  followed  suit,  receiving  in  1861 
his  M.D.  at  McGill,  taking  the  highest  position 
the  Faculty  could  bestow.  He  was  at  once  ap- 
pointed House  Surgeon  to  the  Montreal  General 
Hospital,  which  he  filled  with  entire  satisfac- 
tion for  eight  years.  Soon  after  leaving  this 
position  he  was  elected  one  of  the  attending 
Physicians  and  Surgeons  to  the  Hospital,  and  was 
appointed  to  lecture  on  Clinical  Medicine.  Physio- 
logy was,  however,  his  favorite  and  on  the  death 
of  l^r.  Fraser,  he  succeeded  him  in  that  branch. 
Dr.  Drake  was  a  good  lecturer,  but  his  strength 
was  not  equal  to  the  work  he  had  undertaken.  Of 
a  nervous  disposition,  and  for  many  years  suffer- 
ing from  mitral  disease,  he  overworked  himself 
and  the  only  hope  of  prolonging  life  was  by  restrict- 
ing himself  to  the  jnactice  of  his  profession.  This 
was  tried,  but  the  demands  of  a  constantly  increas- 
ing clientele  soon  showed  that  even  this  was  more 
than  his  strength  could  stand.  Then  a  severe 
blow  came  in  the  death  of  his  wife.  His  consti- 
tution,much  shattered  by  repeated  severe  attacks  of 
cardiac  asthma,  was  unable  to  withstand  the 
prostration  of  his  nervous  system,  which  followed. 
His  energy  was  gone,  everything  had  to  be  laid 
aside,  and  amid  the  universal  regret  of  all  his 
confreres,  he  retired  from  piactice.  He  soon 
after  went  to  reside  at  Abbotsford,  coming  oc- 
casionally to  Montreal ;  when  he  did  so,  his  old 
friends  were  always  anxious  to  meet  him,  and  I 
recall  more  than  one  meeting  wiiere  all  were 
young  again.  How  pained  all  his  intimate  friends 
were  when  they  heard  of  his  death,  no  words  of 
mine  can  express.  A  true  man,  a  noble  physician, 
has  gone  ;  the  sphere  in  which  he  lived  and  moved 
is  much  better  because  Joseph  Morley  Drake 
lived  in  it. 

F.  W.  C. 


THE  CANADA  MEDICAL  RECORD. 


Vol.  XV. 


MONTKEAL,  MARCH,  1887. 


No.  6. 


ORIUINAL  COMMUNICATIONS. 

I.i'K.  r  Iniiii  111,-  lliil, 121 

Cliiii.iil  :,,  .liii.'  126 

Til.'  Myji-ii,'  nl    II,,.  ||:,i,    127 

SICIETY  PROCEEDINGS. 

Mt'dii',».rhiruigioal    Society  of  Mont^ 

IVHl : 130 

Con'«\'<|),,lulr1lri'  ^:i!i 

PROGRESS  OF  SCIENCE. 

Sprilim'tl  .1, lints 


Suiiii-  rinctifal  Su;:^rsl  ioiiti  oil  the 
Treatment  ut  lH|«lillnTi:i. 13U 

Uaniaiiiflis  in  tlic  Ti«'atiin'nt  of  Dis- 
eases of  tho  Skin 140 

Chronic  PniHtatis 142 

EDITORIAL 

Th-'Kew  Medical  Ari  ii.r  iln.-  riovinco 

of  (Quebec  143 

College  of  Physicians  and  SurgeouS, 
l;«j  i         Province  of  Quebec 144 


Montreal    ;\Iedi<'a!    Sehools    Examina- 
tions  .  ,.,    144 

Pro|p'ist'd  Clianges  in  Preliminary  Ex- 
am inat  inn.  , 144 

NvTvoUK  Headache 144 

New  Medical  Journal  in  Montreal 144 

llydr;ihtns      (Janadennib    in     Uterine 

lla-morrliafre 144 

Pnc'iinunia  in  New  York 144 

Personal 144 


(L)Fi6iiial  6Qii(niiu(icaf(0iiS. 


LETTER  FROM  THE  HUB. 

Editors  C.'\NAi)A  Medical  Record. 

De^r  SiR.s: — A  hospital  is  not  only  an  indica- 
tion of  the  liberality  and  benevolence  of  the  inhabi- 
tants of  a  city,  but  also  a  good  means  of  judging 
of  the  standing  of  its  medical  fraternity.  If  it  be 
well  apiioiiUed  and  arranged,  and  thoroughly  up 
to  modern  rei|uircments  in  its  internal  management 
and  detail,  if  it  be  all  that  a  hospital  should  be 
in  everything  that  goes  to  make  up  a  hospital, 
then  will  the  medical  jirofession  be  of  equally 
as  high  a  standard.  It  has  been  said  that  it  is  the 
medical  men  that  make  the  hospital,  this  cannot 
be  gainsayed  ;  but  I  think  the  hospital  does  a  grea^ 
deal  in  making  the  medical  men.  Honors  are 
about  even,  however.  Distinction  is  conferred  in 
both  cases.  Judged  in  this  light  the  citizens  of 
Boston  have  reason  to  be  proud  of  the  efficiency 
of  its  hospitals  and  the  high  status  of  its  medical 
men.  I  shall  refer  to  the  medical  profession  anon, 
and  wish  at  present  solely  to  confine  myself  to  the 
hospitals.  Boston  has  a  goodly  number  of  hospi- 
tals and  dispensaries.  It  would  be  scarcely  pos- 
sible within  the  limits  of  a  letter  to  do  justice  to 
them.  I  can,  therefore,  but  mention  their  more 
prominent  features.  The  Massachusetts  General 
is  the  oldest  hos])ital  in  Boston.  It  dates  a  great 
many  years  back,  in  the  small  numbers  of  the 
century.  A  great  many  of  the  most  eminent 
physicians  and  surgeons  in  Boston  have  gained 
their  experience  there.  The  main  edifice  is  a 
large  grey  stone  building,  with  a  portico  in  front 


supported  by  massive  ionic  pillars.  Tliis  is  the 
original  building  of  the  hospital,  and  although  of 
a  considerable  age,  it  has  not  become  "  dim  with 
the  mist  of  years,  "  but  its  stonework  looks  as  fresh, 
I  should  think,  as  the  day  when  it  was  first 
erected.  While  we  must  call,  in  the  strict  sense  of 
the  word,  the  Ma.ssachusetts  an  old  hospital,  yet 
it  has  had  so  many  additions  and  im])rovements 
that  it  has  lieconie  a  thoroughly  modern  one, 
equipped  according  to  the  latest  views.  New 
wards  have  been  built  and  the  old  ones  renovated. 
I'he  main  building  (the  old  jiart  of  the  hospi- 
tal) consisted  of  one  long  building  without  any 
wings  ;  now' there  are  several  other  buildings,  each 
entirely  separate  and  connected  with  the  others 
by  passageways,  whose  sides  consist  of  a  series 
of  glass  windows  making  them  light  and  cheer- 
ful, in  which  convalescent  patients  sometimes  sit. 
The  hospital  contains  over  200  beds.  It  is  con- 
trolled and  supported  by  private  individuals.  It  is 
wealthy  and  excellently  managed.  The  wards  are 
large,  well  ventilated  and  kept  scrupulously  clean. 
In  the  main  building  the  larger  wards  have  a  large 
chimney  in  the  centre  with  grates.  The  bath-rooms 
and  lavatories  are  well  isolated  from  the  wards, 
and  perfect  in  their  appointments  and  conveni- 
ences. A  small  kitchen  is  attached  to  each  ward, 
to  which  the  meals  are  brought  from  the  main 
kitchen  and  distributed  to  the  patients.  The  floor 
and  stairs  of  the  two  main  halls  are  of  stone,  and 
reminds  one  somewhat  of  some  ancient  castle  you 
might  see  in  Great  Britain,  such  as  the  Tower  of 
London,  etc.  There  is  an  elevator  in  the  main 
building.  There  is  one  ward  consisting  of  a  series 
of  separate  rooms.     Noisy  or  troublesorq^,   an4 


122 


THE   CANADA    MEDICAL    RECORD, 


contagious  or  infectious  patients  are  kept  there.  Ou 
either  side  of  this  ward  are  glass  sitting-rooms, 
which  make  it  extremely  cheeiful  for  the  patients. 
The  Massachusetts  seems  to  have  solved  the 
difficulty  of  heating  hospitals  in  winter.  The 
wards  are  heated  by  steam  by  indirect  radiation, 
the  corridors  by  direct.  There  is  a  large  engine 
room  with  several  huge  boilers  in  it.  This  sup- 
plies steam  to  all  the  hospital  by  a  network  of 
pipes  running  beneath  the  floor  of  each  ward. 
Registers  are  distributed  over  the  wards.  Hot  or 
cold  air  can  be  had  at  will.  The  tem|)erature  can 
be  regulated  to  a  nicety.  In  the  London  hospi- 
tals the  open  grate  is  the  means  used  for  heating, 
which  is  not  only  the  best  way  of  heating  but  also 
of  ventilating.  This  is  all  very  well  for  the  mild 
winter  of  F'.ngland  ;  but  in  a  country  where  Jack 
Frost  reigns  supreme  it  is  out  of  the  question.  It 
would  well  repay  those  thinking  of  building  or 
improving  a  hospital  to  make  a  visit  to  the  Mas- 
sachusetts and  get  an  insight  into  its  facilities  for 
heating.  The  out-])atient  dcjjartment  and  amphi- 
theatre are  in  a  sejtarate  red  brick  building  of  two 
stories.  All  the  various  divisions  of  medicine 
have  a  se[)arate  room,  the  women  are  seiiarate 
from  the  men.  There  are  large  waiting-rooms  for 
the  ])atients.  The  ojierating  theatre  is  cajiable  of 
holding  400  students.  It  is  well  equipped  with 
instruments  ;Bigelo\v's  ap[)aratus  is  to  be  seen  here, 
and  is  in  frequent  use.  Under  one  of  the  cases 
may  be  seen  an  object  of  considerable  historic 
interest,  to  wit,  the  sponge  with  which  ether  was 
first  administered.  On  one  side  is  the  Etheiizing 
room,  and  leading  off  this  are  several  rooms  in 
which  patients  are  put  until  ihey  come  out  of 
ether.  Saturday  is  the  regular  operating  day,  at 
II  o'clock.  The  first  row  of  the  amphitheatre  is 
reserved  for  physicians.  The  most  noted  opera- 
tors here  are  Homans,  Porter,  Warren,  Ileach, 
Cabot,  Richardson,  etc. 

The  main  kitchen  and  laundry  are  in  a  separate 
building.  During  the  past  year  2,327  patients 
were  treated  in  the  wards,  and  17,016  in  the  out- 
patient dejiartment.  The  skin,  the  throat,  eye,  ear, 
gynaecology,  etc.,  are  all  well  represented. 
Dr.  J.  C.  White  has  his  famous  skin  clinique 
at  the  Massachusetts.  There  is  a  considerable 
ground  around  the  hospital,  a  neat  lodge  marks 
the  entrance.  A  training  school  for  nurses  is 
connected  with  the  hospital,  nurses  are  also  spe- 
cially instructed  in  the  care  of  the  insane,  the 
McClean  Insane  Asylum  being  connected  with 
the  hospital. 


The  City  Hospital  is  considered  by  many  the 
finest  in  Boston.  It  certainly  js  the  largest.  It 
is  built  on  the  pavillion  "system,  and  is  situated  on 
Harison  avenue.  New  Worcester  square.  It  has 
a  very  imposing  appearance  as  you  approach  it. 
In  the  centre  is  a  square  building  with  a  fine  dome. 
The  view  from  this  is  superb.  It  has  a  large 
portico  wiih  Corinthian  pillars.  There  are  also 
Corinthian  pillars  at  the  back.  Massive  stone 
steps  leid  up  10  the  main  entrance.  This  build- 
ing is  devoted  almost  entirely  to  official  business. 
The  main  hall  is  spacious  with  marble  floor,  on  the 
left  hand  side  is  the  reception  room,  on  the  right 
the  superintendent's  and  the  assistant  supcrinttn- 
dent's  office  and  parlors.  Behind  these  are  the 
dining-rooms  and  matron's  room,  on  the  second 
floor  are  sleeping  apartments  for  officials.  The 
operator's  room  was  originally  in  the  Dome  ;  it  is 
siill  there,  but  no  operations  are  performed  in  it. 
In  front  of  the  main  entrance  is  a  large  piece 
of  ground  which  in  summer  is  highly  cultivated. 
Leading  oft'  this  building  are  two  open  passage- 
ways ;  that  on  the  right  goes  to  the  medical  side, 
that  on  the  left  to  the  surgical.  The  left  leads 
into  a  hall  from  which  you  enter  the  amphitheatre  ; 
this  is  well  Iniilt  and  holds  a  large  number  of 
students.  On  the  wall  hangs  a  picture  of  the  late 
Dr.  Thorndyke,  formerly  one  of  the  leading 
surgeons  here.  On  the  ground  floor  are  chairs 
for  the  staff  to  witness  the  operations.  As  in 
the  Massachusetts  the  first  row  of  the  amphi- 
theatre is  reserved  for  physicians.  The  oi)erating 
tables  and  mode  of  carrying  the  patients  to  and 
from  the  room  are  perfect.  Patients  are  etherized 
in  a  room  leading  into  the  operating-room  and 
then  brought  into  the  theatre.  The  surgical  in- 
struments are  kept  in  the  theatre  under  glass  cases, 
every  instrument  desired  is  at  hand.  There  is  a 
splendid  arrangement  for  irrigating ;  at  the  side  of 
the  theatre  is  a  shelf  on  which  are  placed  bottles 
containing  the  different  solutions  used,  as  carbolic 
arid  etc.  These  bottles  are  connected  by  rubber 
tubing  to  one  main  tube  ;  this  is  carried  out  by 
means  of  a  brass  rod,  which  is  made  to  swing  in 
various  directions  and  brought  right  over  the 
operating  table,  from  this  hangs  the  rubber  tub- 
ing with  nozzle,  and  gives  a  considerable  fall  of 
fluid.  By  turning  the  tap  connected  with  each 
bottle  you  can  have  any  solution  you  wish.  The 
conveniences,  such  as  dressings,  apparatus,  appli- 
ances, etc.,  are  everything  that  one  could  wish  for. 
Two  nurses  are  in  attendance  at  each  operation. 
After  the  operation  the  ])atient  is  taken  into  a 


•ritE   CAi^ADA    MEDICAL   UECORb. 


lis 


si'p.MatL'  iiKiiii  and  ix'iiiiiins  iiiilil  iic  miners  I'ldiii   I 
the  ether ;  tlieie  are  3  or  4  rooms  siiecially  devoted 
to  this,  then  they  nrc  taken  back  totlic  wards.     OfT 
the  operatnig  room   is  a  sphiit  room,  containing 
e\ery  variety   of  splint  ;   tliere   is  also  in  this  a  car- 
penter's table  and  tools  to  make  splints  with,  etc., 
as  reipiired.      It  is  not  nnusual  to  see    two  o|iera- 
tions  going   on  at   the  same  time.      i''riilay    at    11 
o'clock  is  the  usual   operating  day,  a  large  variety 
of  operations    may  be  seen  here.     The    surgeons 
of  note  are  Checver,  (lay,  liradford,    IJoUes,  IJin- 
rell,  etc.,  yon  are  almost  always  sure  to  sec  one  of 
Boston's  noted  surgeons  heri.- watching   the  opera- 
lions.     A  list  of  operations  is   now    [xisted    up  at 
ihe  lodge  where  you  enter,  so  that  you   may   see 
the  programme  for  the   day.     One  is  also  kept  in 
the  operating  room  and  checked  off  as  the  opera- 
tions are   coni|ileted.      Listerism  is  adopted    here 
without   the  s])ray.     Ksmark'.s  band  is   used    for 
controlling     hemorrhage.     Patients     are      bound 
down    to  the  operating   table  by   a  strong  leather 
strap  which   buckles,  it  surrounds  the  limbs  and 
table;  this  does  away  with  the  necessity  of  hav- 
ing assistants   to    hold    the    limbs.     In    the   same 
building  as  the  amphitheatre  is  a  receiving  room 
for  surgical  cases,  the  surgeon's  private  or  consult- 
ing room,    the   house  surgeon's    waiting-room    or 
library.     Another    jiassage-way     leads    from     the 
building  into  the  surgical  pavillion.     This  consists 
of  three   large   wards,  each   containing     2S   beds. 
The  wards  are  beautifully  fresh  and  clean,    light, 
airy,  and  cheerful,  the   beds  are  all  of  iron  ;  the 
heating  is  by  indirect  radiation.    Off  each  ward  are 
bath  rooms  and  lavatories, hopper  closets, places  for 
the  dejecta,   etc.,  and  guarded  with    strictest  sani- 
tary precaution.     There   is  also  a  small  kitchen, 
and   nurse's  room  ;  in  the  hall  are  cupboards  for 
keeping  the  medicine,  and  a  small  stock  of  the 
most  important  drugs   are   at   hand   ready  for  im- 
mediate use.     The  surgeons  make  their   visits   in 
the  morning  at  about   half  past  nine  or  ten  ;  in 
fact    the    morning    is    the    time   physicians    and 
surgeons  do  their  work  at  all   the   hospitals   in 
Boston.     Going  b.ick  to  the  operating  room  we 
leave    this  building    again  from    the    back    part 
by  an  open  passage-way,  and    come   to  a  surgical 
ward,  the   largest   and   finest  in  the  hospital  ;   this 
is    extremely  well  ventilated,  off  this   is  a  plaster 
room   for  making   bandages,  etc.,  this  completes 
the  surgical  wards.     Starting  from  the  .main  build- 
ing again  and  going  to  the  right  we  come  to  the 
medical   side.     The  space   corresponding    to  the 


aniphilheatre  is  occupiefl  by  a  medical  ward.      In 
this  building  are  reieiving  rooms  for  medical  cases, 
the  physician's  consulting  room,  and  house   i)hysi- 
cian's  waiting  room.     Leaving  tliis  we  come  to  the 
medical  iiavillion,  which  corresponds  in  size,  num- 
ber of  wards,cleanliness,etc.,to  the  surgical  wards. 
Open  landings  or  bridge-like  ways  connect  these 
buildings.    Leaving  the  medical  pavillion  from  the 
top  uartl.we  go  to  the  top  story  of  the  first  medical 
building.     In  this  is  a  large  gyniecological   ward. 
Next  this  is  an  ojierating  room  for  gynecological 
operations,with  3  or  4  tables  in  it,and  a  good  assort- 
ment of  instruments.   In  this  building  are  a  number 
of  private  wards  for  paying  patients.     Going  from 
the  medical  building  by   a  landing  we  come  to  a 
large  medical  ward  of  28  beds  ;  this  corresponds 
to  the  surgical  ward  in  the  opposite  side  ;  from  this 
we  go  by  an   enclosed  corridor   into  a  building 
devoted  to  isolating  wards.     There  are  a  series  of 
separate  rooms.   Two  wards  are  in  this  building, 
male  and  female  ;  from   this   we  go  to  view    the 
boiler  room  ;  immense  engines  and  boilers  supi)ly 
the  whole  hosjiital    with   steam  ;  near  this   is   the 
morgue    where  sudden  deaths  and   unrecognized 
persons    are  brought.     There   are  several   tables 
with  marble  slabs  on  which   the  bodies  are  laid. 
Above  is   the   autopsy   room,   which  is   large  and 
well  appointed  ;  there  is  a   small    nuiseum  in   this 
where  pathological  specimens  arekejtt;  autopsies 
are  not  as  readily  obtained  as  with  you.  Near  this 
is  the  laundry,  worked  almost  entirely  by  steam. 
.\fter  going  through  a  corridor  we  come  to  the 
main  kitchen.     The   cooking  is  done  entirely  by 
men.    I  was  fortunate  in  seeing  it  when  they  were 
serving  out  meals.     It  is  managed  by  the  steward, 
who  keeps  all  the  provisions  for  the  hospital,  and 
has  charge  of  the  diet  table,  etc.     The  ice  house 
and  various  larders  are  remarkably  neat  and  well 
stocked  ;  off  the  main  kitchen  is  a  smaller  kitchen, 
which   is    used   to    fill    special    orders   and    pre- 
pare delicacies  for  the  patients  ;  near  this  is  a  large 
green-house,  where  plants  are  kept  to  supply  the 
surroimding  gardens  of  the  hospital.     In  the  sum- 
mer months  there  are  a  number  of  canvas  tents  or 
wards  spread  over  a  considerable  space  of  ground, 
these  work  splendidly,  and  are  very  happy  in  their 
results.     Two  isolated  wards  for  infectious  diseases 
are  in  course  of  erection.     The  total  number  of 
beds  at  present  is  425,  but  when  the  new  wards 
above  mentioned  are  completed,  60  more  beds  will 
be  added.     In  the  wards  3,550  patients  have  been 
treated,  and  8,271  in  out-patient  departiaient  dur- 


124 


THE   CANADA  MEDICAL  EECORI). 


iiig  the  year,  average  cost  of  each  patient  $7.64, 
per  week.     The  out-patient  department    is  small 
and  not  in  keeping  with  the  other  sections  of  the 
hospital.     They  are  about    to  build  a    new  out- 
patient department.     All  the  branches  of  medicine 
are  represented.    Dr.  Williams,  Boston's  celebrated 
opthalmologist,is  still  attached  to  the  eye  clinique 
here.     In  the  Massachusetts  and  City  hospitals 
all  the  various  details  of  admitting  and  dismissing 
patients,    registration  of    diseases,    etc.,    are  ex- 
cellently   conducted.     Each    has    an  ambulance 
corps  attached  to  it,  conducted  by  a  medical  officer  ; 
each  have  also  large  convalescent  homes  in   the 
country.    Connected  with  the  city   hospital    is    a 
magnificent  home  for  nurses,  the   finest  on   this 
continent.     The  bLiilding  is  next  the  hospital  and 
is  of  fine  architecture   and  admirably  fitted  out. 
There  is  a  splendid  training   school  for  nurses  in 
connection  with  the  hospital.    The  nurses  resemble 
those  you  see  in  the   London  hospitals,  and  are 
equally  as    good.     The  Massachusetts   and  City 
Hospitals      will    compare     favorably     with    any 
other    the     world     over.       There    are    hospitals 
larger  in  size  and  grander  in  architecture,  such  as 
St.  Thomas'  in  London,  the  Hotel  Dieu  in  Paris, 
the  Edinburgir  Lifirmary,  etc.,  but  there  are  none 
better   kept    and   managed    or    more    thoroughly 
equipped ;  and  there  is  a   sweetness  and  absence 
of  odor  about  them  which  you  do  not  generally  find 
in  hospitals.     The  staff  of  each  is  drawn  from  the 
'  most  eminent  and  rising  men  in  Boston. 

The  Carney  Hospital  is  situated  in  South  Bos- 
ton. Its  location  is  the  most'  delightful  of  any 
hospital  in  the  city,  being  on  a  high  hill,  and  com- 
manding a  lovely  view  of  the  harbor  and  surround- 
ing country.  It  numbers  about  150  beds  ;  it  is  not 
completed.as  yet  only  a  single  wing  being  finished  ; 
other  buildings  are  to  be  put  up  shordy  ;  the  wards 
are  large,  well  kept,  and  remarkalily  well-lighted  ; 
they  are  divided  into  medical  and  surgical,  it  has 
a  good  out-patient  department ;  the  hospital  has  a 
large  number  of  private  wards.  Boston  physicians 
frequently  send  their  cases  there  ;  the  air  is  very 
pure,  consumptives  are  admitted  to  the  hospital. 
The  Carney  may  be  said  to  be  the  cradle  of  ovario- 
tomy in  Boston.  There  are  two  special  rooms 
devoted  to  ovarian  operations.  Dr.  Homans,  the 
eminent  Boston  ovariotomist,  gained  Wu  experience 
here,  he  does  not  believe  in  Listerism.  The  culin- 
ary department  and  laundry  are  neat  and  well 
attended  to.  The  dispensing  is  done  by  the 
sisters,  they  also  have  charge  of  the  hospital ;  they 


are  extremely  pleasant  in  showing  visitors  around. 
The  medical  staff  consists  of  rising  young  Boston 
physicians. 

The  Children's  hospital  has  but  lately  been 
erected,  and  is  still  in  an  unfinished  state,  another 
wing  and  out-patient  building  must  be  added  ere 
it  is  completed.  It  contains  at  present  about  60 
or  70  beds,  it  is  on  Huntington  avenue,  near  West 
Chester  Park ;  two  large  wards  are  comiilcted, 
when  all  is  complete  in  will  contain  100  beds. 
These  wards  are  very  fine  and  thoroughly  equip- 
ped, each  contains  ir,)n  cots  whose  sides  swing 
out ;  children  are  admitted  from  two  years  old  to 
twelve.  During  the  last  year  the  number  treated 
at  the  out-patient  department  was  908.  At  pre- 
sent the  out-patient  department  is  in  the  basement. 
The  hospital  has  a  nice  Utile  operating  room,  with 
etherizing  and  recovery  rooms,  and  well  filled  dis- 
pensary. Although  all  the  large  hospitals  in  Bos- 
son  have  fine  dispensaries  attached  to  them,  it  is 
not  required  that  Harvard  students  should  go 
through  a  course  of  dispensing  before  graduating. 
This  is  comi)ulsory  in  all  English  schools.  It  seems 
to  me  that  a  knowledge  of  the  various  medicines, 
their  doses  and  how  to  put  them  up  is  a  very  neces- 
sary thing  for  a  practitioner.  The  Children's  Hos- 
pital has  also  connected  with  it  a  workshop,  where 
splint  and  apparatus  are  made.  The  fixtures  and 
aj)[)ointments  are  of  the  best,  there  is  a  neatness 
and  newness  about  the  whole  building.  A  con- 
valescent home  is  connected  with  the  hospital 
at  Wellesly.  The  sisters  of  St.  Margaret  have 
charge  of  the  hospital,  it  is  well  supplied  with 
efficient  nurses. 

The  Massachusetts  eye  and  ear  infirmary  is  the 
finest  institution  of  its  kind  on  this  continent,  and 
ranks,  I  am  told,  next  to  Moorfields  ;  it  is  in  a  very 
desirable  location,  looks  on  the  Charles  river,  and 
fronts  on  Charles  St.  It  contains  about  70  beds, 
and  has  several  large  rooms  for  treating  out-pa- 
tients, each  room  has  one  or  two  dark  rooms  for 
ojjthahnoscopic  examinations.  One  room  is  devoted 
entirely  to  vision  testing  ;  there  is  a  large  general 
waiting  room  for  eye  patients.  The  walls  of  the 
rooms  are  of  painted  brick.  A  room  is  specially 
devoted  to  ear  cases,  with  waiting-room  outside. 
In  the  basement  is  the  Dispensary,  upstairs  are 
numerous  wards  ;  there  is  a  large  and  well  lighted 
o[ierating  room  which  commands  a  lovely  view  of 
the  Charles  river  and  surrounding  country.  Several 
darkened  rooms  are  near  this  to  receive  patients 
after  cateract  operations,  etc. ;  a  large  number  of 


•rttE   CANADA   MKDICAL   RECORT). 


125 


operations  are  done  in  tiiis  instiuition.  During 
the  past  year  cocaine  has  entirely  su|)erseded  the 
use  of  ether.  The  niinil)er  of  patients  treated  last 
year  was  12,399,  '^^  ''I's  8,558  were  eye  cases,  and 
3,261  ear;  splendid  oi)|)ortiniites  for  studying  the 
eye  and  ear  may  be  had  here, although  little  clinical 
instruction  is  given.  The  stafTconsists  of  die  most 
noted  oculists  of  Boston.  Dr.  Hasket  Derby, 
vice-president  of  the  American  Opthnlmological 
Society,  is  the  .senior  opthalmic  surgeon.  Dr. 
Chandler,  a  graduate  of  Bishops  College,  Montreal, 
is  one  of  the  Assistant  Surgeons.  The  infirmary 
is  excellently  conducted  and  managed. 

The  Boston  Dispensary  may  be  founil  at  the 
corner  of  Bennet  and  Ash  St.,  a  new  building  has 
been  erected  at  a  cost  of  $50,000.  During  the 
jiast  year  36,956  patients  were  treated.  Two 
stories  of  the  building  are  in  use,  there  are  1 4  rooms 
devoted  to  all  the  different  branches  of  Medicine 
and  Surgery,  the  eye,  ear,  throat,  disease  of  the 
skin,  genito  urinary  surgery,  Gynecology,  ortho- 
jKodic  surgery,  diseases  of  the  rectum,  etc.,  each 
room  has  a  desk  for  the  physician,  a  gyneocological 
table,  an  open  fire-grate,  electric  bell,  and  chemi- 
cals for  testing  urine  and  cupboard  for  coats.  The 
chairs  in  the  room  are  of  the  old  puritan  style,  up- 
stairs there  is  a  large  lecture  room  for  giving  clini- 
ques  in.  In  both  stories  there  is  a  large  hall  or 
waiting-room,  with  benches  placed  opposite  each 
room,  where  the  patients  wait  their  turn.  The 
women  are  separated  from  the  men  is  most  cases. 
The  Dispensing  room  is  large  and  well  conducted. 
Patients  pay  locts  for  each  bottle  of  medicine,  and 
are  given  numbered  cards  for  each  room. 
'I'here  is  splendid  material  in  each  department  for 
clinical  instruction.  Attached  to  the  Dispensary 
are  a  number  of  district  physicians  distributed  over 
the  various  wards  of  the  city.  They  attend  the 
poor  at  their  houses,  and  send  prescriptions  to  the 
Dispensary  to  be  made  up.  The  poo;  of  Boston 
are  well  supplied  with  diet,  kitchen,  etc.  By  getting 
an  order  from  a  physician  a  great  many  of  these 
poor  are  given  blankets,  etc. 

There  is  a  capital  arrangement  in  the  gyneco- 
logical room  classes  are  held  here  the  greater  por- 
tion of  the  year.  It  is  very  embarrassing  to  a  pa- 
tient to  confront  a  large  number  of  students.  This 
is  avoided  by  having  an  iron  bar,  running  across 
the  middle  of  the  room,  to  which  is  attached  two 
curtains  which  draw  together.  The  students  sit 
behind  the  curtain  and  the  patients  enter  in  front, 
where  they  are  placed  on   the  gynecological   table 


by  the  muse  in  attendance.  The  table  is  then 
pushed  between  the  curtains  ;  these  are  ilrawn 
around  her  above  the  hips.  She  is  then  e.xaniined  by 
the  physician  and  student  without  seeing  either 
of  them. 

During  the  summer  months  a  ['(^lyclinic  is 
established  at  the  Dispensary,  courses  are  given 
in  every  branch  of  medicine  and  surgery,  and  may 
be  had  by  graduates  or  students  at  Irom  S20  to 
$25  each  course.     They  extend  about  six  weeks. 

The  St.  Elizabeth  is  a  hospital  devoted  entirely 
to  woman  and  her  ailments.  It  is  situated  on  a 
large  square  on  West  Brookline  st.  It  numbers 
about  So  beds,  it  has  also  an  out  door  department, 
and  is  splendidly  kept. 

The  Women's  Free  Hospital  admits  only  women 
suffering  from  their  peculiar  comjjlaints.  It  has  a 
gooil  out-jiatienl  department,  contains  20  beds. 
The  Harvard  students  are  instructed  in  Gyneoco- 
logy  by  Assistant  Professor  Baker  here  ;  there  is 
also  a  dispensary  for  women  devoted  entirely  to 
Gynecology,  and  under  the  care  of  Drs.  Cluidwick 
and  Farlow. 

House  of  the  good  Samaritan. — 'I'hrough  the 
kindness  of  Dr.  Bradford,  the  leading  Orthopodic 
I  surgeon  in  Boston,  I  was  permittei!  to  see  the 
hospital.  It  is  a  small  building  devoted  to  two 
classes  of  jiatients,  women  whose  chronic  ailments 
do  not  permit  them  to  enter  the  Massachusetts 
and  City  Hospitals  and  young  children  who  suffer 
from  hip  or  spine  disease,  club  foot,  etc. 

The  Marine  hospital  at  Chelsea  receives  from 
the  shipping  of  the  port  a  large  number  of  patients 
from  foreign  countries  and  distant  parts  of  the 
United  States.  Good  facilities  are  offered  for 
studying  venereal  diseases. 

The  Boston  Lying-in  Hospital  is  on  McLean 
St.,  here  every  opportunity  is  given  for  becoming 
well  n]i  in  obstetrics.  On  Blossom  St.  is  the  West 
Knd  Nursery  and  Infant's  Hospital,  here  babies 
and  infants  are  treated.  Dr.  Haven  who  has  de- 
voted more  time  to  the  study  of  infantile  diarrhea 
and  feeding  than  any  other  physician  in  Boston. 
is  in  charge  here.  Besides  this,  there  is  a  large 
Infant's  Home. 

The  Boston  Lunatic  Hospital  is  in  South  Bos- 
ton, it  is  capable  of  admitting  200  patients. 

The  above  mentioned  are  the  principal  hospitals 
and  dispensaries  of  Boston,  but  there  are  numerous 
other  charitable  institutions.  The  medical  men 
and  officers  attached  to  these  institutions,  are  e.\- 


126 


tllE  CANADA  MEDtCAL  RtiCOllti. 


tremely  courteous  and  kind  to  visitors,  explaining 
things  nnd  showing  one  around.  Althougli  Boston 
lias  three  clini(|ues  in  skin  diseases,  and  the  throat, 
I  may  be  wrong,  but  there  seems  to  me,  to  be  room 
for  a  special  hospital  in  these  branches  either 
separately  or  combined.  The  clinical  advantages 
for  students  studying  at  Harvard  University  are 
excellent,  they  have  the  privilege  of  attending 
all  the  hospitals.  There  is  a  vast  amount  of 
clinical  material,  from  which,  if  one  is  industrious 
anil  a|iplies  oneself,  much  can  be  learned.  Clinical 
lectures  are  given  in  all  the  numerous  hospitals  by 
the  different  Professors,  assistant  professors,  and 
instructors  during  the  session.  Classes  are  formed 
and  practical  instruction  is  given  in  all  the  special 
branches  of  medicine,  such  as  Dermatology,  Oto- 
logy, Opthalmology  ijaryngology,  Orthopodic 
surgery,  etc.  Special  instruction  is  given  in  men- 
tal diseases  at  the  Insane  Asylum.  There  are 
twenty-five  ai)pointments  made  in  the  various 
hospitals,  annually,  for  internes  or  house  surgeons 
and  physicians  and  the  same  number  for  assistants 
in  the  out  patient  department,  these  are  held  for 
the  term  of  eighteen  months  at  the  Massachusetts 
and  City  hospitals,  at  the  Lying  in,  four  months, 
and  Woman's  Free  Hospital,  nine  months.  Tl.e 
a|)pointments  are  all  made  by  competative  examin- 
ation. Although  the  Harvard  students  have  every 
facility  for  witnessing  operations,  clinical  lectures, 
]jractical  demonstration,  etc.,  I  do  not  think  that 
they  ha\e  the  Ircedom  of  the  wards,  that  the  stu- 
dents in  Kngland  and  Canada  have.  They  do  not 
become  so  thoroughly  impregnated  with  the  hospi- 
tal atmosphere  and  the  jxitient  in  all  his  clinical 
bearings.  Classes  of  twenty  follow  the  surgeon  or 
jihysician  around  the  wards,  but  there  is  no  "  clerk- 
ing "  or  "  dressing"  done  by  the  students  in  the 
wards,  they  gain  this  knowledge  when  they  become 
mternes,  buir  all  cannot  become  internes.  There 
is  a  little  dressing  done  at  the  out-door  depart- 
ments, this  seems  to  me  to  be  the  weak  point  in 
the  clinical  teaching  of  Harvard.  For  skilful  in 
terrogating  and  reporting  cases,  and  dexterity  in 
dressing  gives  one  an  experience  which  is  of  im- 
mense value  in  practice  and  tends  greatly  to  one's 
success.  Although  this  is  a  loss  to  the  student,  it 
is  a  gain  to  the  patient  at  least  while  in  the  hospi- 
tal, t!ey  have  more  quiet  and  are  net  botiiered  by 
the  presence  of  students,  and  have  the  house  sur- 
geon and  iihysician  to  attend  to  them. 

J.  L.  F. 
JbosTON,  March  iSth,  1887. 


A   CLINICAL   LECTURE. 

Delivered  at  the  Montreal  General  Hospital,  December  13th,  1886, 

BV 

F.  WAVLANDCAMPIiELL.'M  D..  L.R  C.P.,  Lomlon. 
l.>i:an    anil    I'rofessor  of  Praclicc  of  Medicine,  Medical    Faculty    Uni- 
versity of  Uishops  College. 

PROGRESSIVE  MUSCULAR  ATROPHY. 

The  patient  now  before  you,  Olivier  Sarasin, 
aged  41  years,  came  to  Hie  out-door  clinic  last 
Thursday,  complaining  of  cough  and  pain  in  his 
chest.  It  is  not,  however,  for  this  condition  that 
I  to-day  present  him  to  you,  but  because  he  pre- 
sents a  Well  marked  case  of  Progressive  Muscular 
.Atrophy,  or  Wasting  or  Creeping  Palsy  as  it  is 
commonly  called.  His  family  history  is  good.  His 
father,  mother,  and  four  brothers  (out  of  five)  are 
ali\  e,  and  the  fifth  was  accidentally  killed.  He  has 
not  any  sisters.  For  1 7  years  he  has  not  enjoyed 
good  health,  suffering  much  from  lumbar  pain. 
Three  years  ago  he  first  noticed  that  his  muscles 
were  getting  softer  and  then  smaller;  this  was 
accomjianied  by  gradually  increasing  weakness. 
Since  that  time  the  muscles  of  the  arms  and  of  the 
chest  have  continuetl  to  grow  smaller,  or,  to  use  a 
technical  term,  have  become  gradually  atrophied. 
The  origin  of  the  disease  is  very  obscure,  some 
authorities  claiming  that  the  mischief  is  in  the 
s])inal  cord,  while  others  contend  that  it  is  in  the 
muscles  themselves.  The  disease  generally  com- 
mences in  the  upper  extremities,  and  at  first  is 
limited  to  a  certain  number  of  muscles  ,  generally 
the  muscles  of  either  the  shoulder,  arm  or  forearm 
are  the  first  to  become  affected,  and  the  muscles 
of  the  ojjposite  extremity  rapidly  follow  suit.  Then 
it  gradually  spreads  over  the  entire  muscular 
system,  even  the  intercostal  muscles  and  the 
diajjhragm  may  be  involved,  causing  death  by 
Apntea,  or  the  muscles  of  deglution  becoming  in- 
volved death  by  inanition  ensues.  Only  the  vol- 
untary muscles  are  affected.  It  is  cases  such  as  I 
have  described,  and  where  the  whole  muscular 
system  is  involved,  that  are  exhibited  at  circus 
shows  and  museums  as  "  living  skeletons  "  which, 
in  truth,  they  are.  The  first  symptom  to  direct 
the  patient's  attention  to  the  fact  that  something  is 
amiss  is  weakness  of  the  muscles,  accompanied 
sometimes  by  pain  on  movement.  This  pain  is 
not  severe,  and  is  of  a  neuralgic  character,  the 
muscles  feel  cold,  and  their  temperature  is  below 
normal.  The  muscular  fibres  of  the  affected  mus- 
cles have  often  quivering  movements;  sometimes 
the  patient  may  not  be  conscious  of  it.  Sensation 
is  not  affected,  as  I  will  prove  to  you  by  this 
patient.     The  appetite  and  digestion  are  generally 


THE   CANADA    MKHirAL   KECORD. 


127 


uiKiU'cTlrd.  I'ull  |i(nV(.T  is  rclaiiu-il  o\'c|- llu  lil.iililrr 
ami  ii'ciuin,  though  wlieii  the  atrophy  extends  to 
tlic  niuscular  (Niat  of  the  intestines,  constipation 
is  the  rule.  The  arterleil  nuiseles  lose  their  power 
of  contraetini,'  under  the  electric  current  in  the 
proportion  ol  theii  atrophy.  As  is  implied  in  its 
name,  the  pidniessoi  the  disease  is  slow  ;  some- 
times alter  rcaehmg  a  certain  point  it  remains 
stationary  ;  in  a  lew  cases  recovery  occurs,  or  at 
least  the  iuiiher  progress  of  the  disease  is  arrested 
liefore  it  has  reached  a  condition  sul'ficieni  to  ilis- 
liguie  the  patient's  body,  or  interfere  with  the  pro- 
per working  of  the  affected  muscles.  It  may  last 
an  indefinite  nimil)er  of  years  before  tending 
to  a  fatal  issue.  The  jirognosis  is  most  unfavor- 
able, the  most  that  can  be  expected  is  that  the 
])togress  of  the  disease  will  be  arrested,  jn  th.it  its 
progress  will  he  slow.  It  has  been  known  to  last 
over  23  years.  It  is  met  with  principally  in  male.'-, 
and  no  condition  of  life  is  exempt.  'I'lie  treatment 
nuist  be  directed  to  the  arrest  of  the  disease. 
Undue  exertion  of  affected  muscles  must  be 
avoided  ;  their  circulation  and  nutrition  must  be 
cultivated  by  fiiction,  massage,  aiul  stimulating 
liniments.  Electricity  is  the  (  hief  remedy,  and  all 
fornrs  of  electricity  should  be  used  in  turn,  for  all 
do  good.  .Sinround  the  |)atient  with  the  best  of 
hygienic  inlluences. 


THE  HYGIENE  OF  THE  HAIR.* 

l!v  J,  LiisLiK  Foley,  M.O.,  L.  R.  C.  P.  (London;, 
Boston. 

Fonnetly  Professor  of   anatomy,   liisliop's  Colloj^e,  Mont- 
real ;  and  attending  ptiysician  to  tlie  Montreal 
Pisjiensary. 

The  hair  absorbs  considerable  of  the  thoughts 
of  mankind.  I  do  not  mean  to  infer  that  thought- 
absorption  is  one  of  its  physiological  functions  ; 
but  to  those  who  are  so  fortunate  as  to  be  blessed 
with  a  luxuriant  growth  of  hair  it  is  a  source  of 
pleasure,  pride  and  vanity,  as  its  loss  or  deficiency 
occasions  much  anxiety  and  chagrin.  To  the 
youth  the  first  appearance  of  a  hair  follicle  on  the 
upper  lip  is  not  only  an  indication  of  dawning 
manhood,  but  also  the  signal  for  the  purchase  of 
a  comiilcle  barber's  outfit  .(barring  the  scissors) 
— razor,  shaving-mug,  brush,  etc. — and  their  assi- 
duous use.  And,  as  years  advance,  an  exuberant 
beard  or  moustache   is  the   result   of  this  cultiva- 


Copied  from  the   iV.    }'.   Mediail  Journal,   . 


tion.  I'o  those  middle-aged  or  growing  old,  the 
first  sign  of  baldness  warns  us  that  we  are  no 
longer  young,  and  can  disguise  the  fact  no  more, 
alihough  various  and  ingenious  are  the  devices 
made,  in  combing  and  arranging  the  hair,  to  hide, 
as  it  were,  "  the  nakedness  of  the  land."  A  good 
head  of  hair  is  somewhat  of  a  rarity  at  the 
present  day.  All  desire  to  retain  their  hair, 
grieve  to  see  it  falling  out,  and  fondly  cherish  the 
few  remaining  locks.  We  have  but  to  enter  a 
a  barlier-sliop  to  verify  the  truth  of  this  remark, 
and  watch  our  fellow-creatures  getting  a  hair-cut. 
Observe,  for  the  most  part,  how  careful  we  are  in 
giving  directions  to  the  barber  what  manner  of 
cut  we  want,  how  ptmctilious  about  the  part  and 
the  way  it  is  brushed,  how  we  scrutinize  through 
the  mirror  before 'us  his  every  mani|iulation  in  the 
tonsorial  art,  and  how  self-satisfied  we  feel  when 
the  finishing  touches  are  comjjleted — oiling, 
combing,  Ijrushing.  How  proudly  we  stand  up 
and  look  at  ourselves  in  the  glass  when  all  is  o'er  ! 
While  all  desire  to  keep  their  hair,  few  do  the 
right  thing  to  retain  it.  One  naturally  runs  to  the 
barber,  but  generally  the  barber  is  the  hair's  worst 
enemy.  The  majority  of  people  consider  when 
they  keep  the  hair  a  respectable  length,  neatly 
brushed,  comljed  and  oiled,  and  have  an  occa- 
sional shampoo,  that  they  are  doing  all  that  is 
necessary.  As  far  as  appearance  is  concerned 
this  may  be  so,  but  it  will  not  add  much  to  its 
health  and  preservation. 

The  hair  should  be  looked  to  from  infancy  up. 
To  disregard  this  fact  is  to  render  one  liable  in 
after-years  to  a  diseased  condition  of  it,  or  a  defi- 
ciency. The  infant's  head  is  often  neglected, 
and  not  properly  cleaned.  As  a  consequence,  -a 
thick  scurfy  crust  often  forms  upon  the  scalp. 
This  irritates  the  skin,  and  gives  rise  to  an  eczema 
of  the  head.  This  should  not  be  allowed  to  occur. 
Tlie  baby's  head  should  be  washed  in  lukewarm 
water,  with  Castile  soap,  twice  or  three  times  a 
week.  This  should  be  practiced  from  birth  up 
and  the  hair  daily  brushed.  In  very  young  infants 
the  softest  brush  should  be  used.  As  the  child 
increases  in  years,  two  should  be  used — a  rather 
harsh  one  first  to  loosen  the  dirt,  dried  sebaceous 
material,  and  epithelial  scales  from  the  scalp,  and 
brush  it  out ;  then  a  fine,  soft  brush  to  smooth 
the  hairs  out.  A  fine  comb  should  not  be  used 
on  a  child's  head,  and  a  coarse  one  only  to  part 
or  lay  the  hair.  Too  Igreat  care  can  not  be 
lavished  on  the  hair  of  children. 


128 


THE   CANADA   MEDICAL   RECORD. 


With  the  adult's  hair,  as  with  child's,  cleanhness 
is  one  of  tiie  first  requisites.  The  scalp  should  be 
thoroughly  washed  at  least  once  a  month.  One 
oi'  th  best  cle  nsing  substances  is  the  yolk  of  an 
egg,  or  t!ie  white  of  an  egg  answ'ers  just  as  well, 
and  is  more  readily  removed.  This  should  be 
well  rtilibed  into  the  roots  of  the  hair,  then 
washed  out  with  tepid  water  and  Castile  soap, 
rinsing  with  clear  cold  water.  The  scalp  should 
then  be  thoroughly  dried  by  brisk  rubbing  with  a 
towel.  This  brings  a  roseate  glow.  Jf  too  dry,  a 
little  potnade  may  be  used.  Cocoa-nut  oil  is  the 
best.  Purified  beef-marrow  might  be  used,  but 
vegetable  oils  are  the  best  to  use,  as  they  do  not 
so  quickly  become  rancid.  Bear's  oil  and  hedge- 
hog oil  are  not  what  they  are  reputed  to  be.  A 
])roper  amount  of  pomade  is  not  only  harmless, 
but  useful  to  some  scalps,  especially  to  those  with 
little  oleaginous  material  to  kee[)  the  hair  supple 
and  glossy.  When  used  in  excess,  it  becomes 
harmful,  as  it  then  tends  to  cover  in  dirt.  Ahead 
besmeared  with  an  excessive  amount  of  oil  is  not 
only  deleterious  to  the  hair,  but  often  does  most 
serious  damage  to  my  laily's  tidy,  and  often 
leaves  one's  mark  on  the  wall  — if  not  on  the 
world.  Purchase  jjomade  or  oils  in  small  quan- 
tities, as  they  are  lialile  to  become  rancid  quickly, 
and  this  is  very  pernicious.  Use  them  with  scent, 
as  this  hides  their  rancidity.  If  you  desire  scent, 
adro]iofEau  de  Cologne  maybe  added  to  tlu' 
oil  before  using  it.  Oil  is  best  applied  imme- 
diately after  washing  the  hair;  it  penetrates  quicker 
then. 

When  there  is  a  tendency  to  the  accumulation 
of  scurf,  a  mixture  daily  of  equal  proportions  of 
80  per  cent,  alcohol  and  aromatic  spirits  of  am- 
monia with  a  quantity  of  soft  water  is  an  excellent 
wash.  This  makes  an  excellent  shampoo.  The 
fixed  alkalies,  such  as  borax,  salts  of  tart t,  soda, 
etc.,  should  not  be  used  ;  Ihcv  tend  to  diminish 
the  natural  elasticity  and  flexibility  of  the  hair. 

A  wineglassful  of  aromatic  spirits  of  ammonia 
added  to  a  ha  inful  of  water  is  very  cleansing  and 
refreshing.  Care  should  be  taken  that  it  does  not 
get  into  the  eyes.  The  shampoo  as  given  by  the 
barb'i-r  is  too  rough  and  vigorous,  and  the  conglo- 
meration he  ]juts  on  your  head  afterwaid  is  any. 
thing  but  beneficial.  While  oae  performs  daily 
ablutions  of  the  face,  hands  and  body,  the  head  is 
generally  left  out.  Tiiis  should  not  be  ;  it  is  as 
necessary  to  wash  the  scalp  as  any  other  part  of 
the  body.     The   hair   should    be   brushed   daily. 


Too  much  violence  must  be  guarded  against.  It 
should  be  brushed  gently  in  the  direction  in  which 
it  lies.  .'V  harsh  brush  should  be  used  to  cleanse 
the  scalp  of  dust  and  dandruff,  and  the  hair-shafts 
should  be  smoothed  and  polished  by  means  of  a 
softer  brush.  The  scal]j  should  receive  a  roseate 
glow.  This  insures  quicker  circulation  in  the  fol' 
licle  about  the  hair-papilla,  and  hence  the  growth 
is  invigorated.  Hair-tonics  have  the  same  effect 
upon  the  skin — viz.,  a  stimulating  effect  upon  the 
skin  capillaries.  Morning  and  night,  before  re- 
tiring, is  the  best  time  for  brushing  the  hair.  Too 
hard  brushing  tends  to  produce  dandruff  In 
brushing,  the  object  is  to  cleanse  it  from  extra- 
neous materials,  such  as  feathers,  dust,  dindruff, 
and  concrete  sebaceous  material,  which  often 
oozes  out.  upon  the  scalp,  to  make  it  smooth,  and 
to  bring  truant  hairs  into  the  right  place,  and  set 
at  harmony  discordant  filaments. 

Friction  polishes  the  hair  as  well  as  bandoline 
or  ointment.  The  end  we  seek  in  building  up  a 
scanty  hair  crop  is  a  proper  amount  of  blood- 
supply,  through  friction  and  hair-tonics.  The  ap- 
pended is  an  e\cellent  hair-tonic  : 

I^      Acid  Carbolic 3   ss.  ; 

'I'r.  nucis  vom 3   ij  I 

Tr.  cinchona;  ruhr 3  j; 

Tr.  cantharidis 3   ss.  ; 

Aq.  cologuiensis,    ) aaq.  s.  ad  3  iv.  M. 

01.  cocois,  j 

Apply  once  or  twice  a  day  to  the  scalp  by 
means  of  a  soft  sponge.  This  will  prevent  the 
hair  from  falling  out  if  it  does  not  produce  a  lux- 
uriant crop. 

Fine-toothed  combs  should  be  avoided,  and 
used  only  from  a  sportsman's  point  of  view — "  to 
catch  game."  They  have  a  tendency  to  peel  off 
the  scarf-skin  and  leave  a  denuded  surface  below, 
which  is  apt  to  end  in  disease,  pityriasis,  etc. 
Pr.  Leonard  gives  the  following  trite  remarks  in 
selecting  a  brush  or  comb  : 

"  A  hair  brush  or  comb  with  silvery  bristles  or 
teeth  too  sharp  is  not  good  ;  the  scalp  will  be 
scratched  by  the  one  and  the  hair  broken  by  the 
other.  A  pro])er  brush  is  made  up  of  bristles, 
varying  with  the  individual  as  regards  the  stifi'ness 
of  them.  The  clusters  should  be  evenly  set  into 
the  back,  equidistant  from  each  other,  so  that  the 
whole  surface  of  the  scalp  to  which  it  is  applied 
will  be  touched  by  some  one  of  the  bristle-bunches. 
Then  the  clusters  should  be  made  up  of  bristles 
of  slightly  unequal  length,  so  c^s  to  still  further 


'rilE  CANADA   MEDICAL   RECORD, 


i-l'J 


favor  the  111  u-.li  in  coveiilig  every  jiaii  (if  llie  scalp  ; 
by  tills  means  every  hair  will  be  rubbed  down  on 
all  sides,  and  there  will  l<e  no  streaks  or  spots  o' 
the  S('al|i  lelt  Lnitouehed. 

"  A  proper  comb  is  one  whose  teeth  are  even 
antl  regular,  with  points  not  sharp  but  roimded- 
It  should  be  held  up  to  the  light  so  as  to  detect 
any  splitting  or  roughening  of  the  teeth  on  the 
sides  ;  for,  if  they  are  so  roughened,  injur)-  to  the 
hair  througli  breakage  of  the  shaft  will  result. 
Should  the  teeth  through  any  cause  become  split, 
as  you  value  your  hair,  the  offending  members 
should  be  carefully  cut  from  the  comb  ;  the  slight 
space  on  the  scalp  that  would  thus  remain  un- 
touched would  be  of  no  moment.  Wire  brushes 
are  nothing  more  than  combs.  They  act  as  a 
stimulant  to  the  scalp,  but  are  not  equal  to  a  good 
bristle- brush." 

A  good  supply  of  oxygen  is  necessary  for  the 
healthy  growth  of  hair;  the  head  should  be  well 
aired.  'I'he  hat  has  made  sad  havoc  with  many 
a  caput.  Endeavor  to  go  bareheaded  as  often 
as  possible.  When  walking,  lift  the  hat  off  the  head 
frequently,  and,  if  the  sun  is  not  too  strong,  hold 
the  hat  in  your  hand  a  while.  The  blue  coat 
schoolboys,  formerly  of  Christ  Church,  London, 
who  wear  the  costume  of  Edward  \T,  go  bare- 
headed the  year  round.  They  wear  no  hats  in 
the  coldest  days  of  winter.  They  are  remarkably 
healthy,  and  have  a  redundant  crop  of  hair  which 
lasts  them  a  life-time.  If  we  must  wear  a  hat,  let 
it  be  light  in  texture  and  well  ventilated  from  the 
top.  One  reason  that  women  keep  their  hair 
longer  than  men  is  that  their  head-gear  allows  of 
better  ventilation.  Business  men  sometimes  wear 
their  hats  in  their  office,  or  have  a  special  hat  which 
they  put  on.  This  is  very  injurious.  The  brokers 
of  Wall  Street  are  noted  for  wearing  their  hats  in- 
doors as  well  as  out-doors.  They  are  also  noto- 
rious for  having  bald  heads.  This  may  account 
for  it.  When  the  head  is  well  shorn  of  its  locks 
this  does  not  apply. 

The  hair  should  be  cut  regularly  about  once  a 
montli.  Frequent  cutting  is  said  to  make  it  grow 
quicker.  Dr.  Pincus,  of  Berlin,  holds  that  it  dimi- 
nishes its  growth.  The  ends  of  the  hair  split, 
and  require  to  be  cut  off.  Sharp  scissors  should  be 
used.  Some  filaments  grow  faster  than  others 
and  need  to  be  cut  back  ;  others  are  impover. 
ished,  and  better  brushed  out  or  extracted.  The 
beard  should  not  not  be  shaved  during  its  de- 
velopment.      During    youth   the   natural   growth 


sliiiuUl  not  lie  disturbed.  Shaving  causes  the 
single  hairs  to  l)ecome  prematurely  strong  and 
hard.  It  also  alters  somewhat  the  color  of  the 
beard,  giving  it  a  tendency  to  turn  red  or  brown, 
In  middle  age  this  does  not  hold,  (^il  and  brush 
may  be  used  on  the  beard  according  to  inclination. 
I  have  often  thought  it  would  be  well  if  the  barber 
would  put  his  razor  in  a  weak  solution  of  carbolic 
acid  after  shaving  each  customer,  and  thus  prevent 
the  danger  of  infecting  them  with  some  dread 
disease,  barber's  itch,  etc.  We  have  Scriptural 
authority  for  wearing  the  hair  short.  St.  Paul 
says,  "  It  is  a  shame  for  a  man  to  wear  long  hair," 
Poets,  artists,  and  many  prominent  men  do  not 
seem  to  Iveed  this  sacred  injunction.  There  is  an 
old  canon  extant,  dating  as  far  back  as  1096  a.  d., 
which  declares  that  they  who  wear  long  hair  shall 
be  excluded  from  the  church  while  living,  and  not 
juayed  for  when  dead. 

With  regard  to  the  ladies,  their  hair  should  be 
brushed  rather  than  combed  daily,  its  tangles 
carefully  iniraveled,  its  split  ends  cut  off,  and, 
when  done  up,  it  should  1)0  bound  in  as  easy  rolls 
and  coils  as  possilile.  ( )ne  reason  for  this  is  to 
allow  as  free  ventilation  as  possible  for  the  scalp; 
the  other  that  you  may  not  break  the  hair  or  strain 
the  roots  by  tight  tension  upon  them.  Twisting 
or  tight  binding  should  be  avoided.  A  persistent 
mechanical  pressure  on  the  shaft,  by  obstructing 
the  flow  of  oleaginous  fluid  designed  to  soften  it, 
tends  to  dry  those  portions  which  are  beyond  the 
ligature.  ^  Ladies  should  loosen  their  hair  well 
every  night  before  retiring.  Crimping,  the  use  of 
curling-irons,  and  bleaching  the  hair  must  be 
avoided.  For  invalids  or  those  confined  to  bed, 
the  hair  should  be  oiled  daily,  and  then  combed 
with  a  coarse  comb.  The  skin  should  be  washed 
twice  a  week  with  a  sponge  and  a  little  soapy 
water.  The  water  may  be  either  cold,  lukewarm, 
or  warm. 

Loss  of  hair  is  generally  caused  by  a  permanent 
irritation.  In  adults,  heavy  head-covering  or  coif- 
fures may  cause  this  i  rritation.  Those  having 
Weak  hair  should  avoid  pads  ;  they  injure  the  hair, 
and  bring  oil  headaches. 

A  daily  shower-bath  on  the  head  is  injurious. 
Lotions  should  not  be  used ;  most  of  them  c(  n- 
tain  lead.  They  have  been  known  to  cause  para- 
lysis. Dyes  are  very  deleterious.  The  least 
harmful  are  those  containing  iron  or  nitrate  of 
silver. 

Tiring  brain-work,  strong  mental  agitation,  silent 


I>!() 


THi!  CANADA   MEDICAL   RECORD. 


grief,  continued  disturbance  of  sleep, exercise  a  re- 
action on  the  growth  of  the  hair.  In  cases  where 
there  is  a  dehcate  health  and  a  deficiency  of 
sebaceous  substance,  tincture  of  bearberry  renders 
the  hair  soft,  glossy,  and  flexible. 
22  Darmouth  Street,  Boston, February  22,  1887. 

MEDICO-CHIRURGICAL  SOCIETY 

OF  MONTREAL. 

Stated  Meeting, /an.   i^t/i,  1887. 

j.    C.    CAMERON,  M.   D.,  PRESIDENT,    IN 

THE  CHAIR. 

Bromide  Rash. — Dr.  Blackader  exhibited 
bromide  or  iodide  acne. 

Dr.  Stewart  asked  if  bromide  of  potassium  had 
been  administered  alone,  and  suggested  the  prac- 
tice of  combining  Fowler's  solution  to  prevent 
a  typical  case  of  bromide  acne. 

Dr.  Blackader  replied  that  he  usually  adminis- 
tered a  combination  of  the  bromides  of  potassium 
with  sodium  or  potassium  and  ammonium,  but  had 
forgotten  the  exact  prescription.  The  dose  was 
about  40  grains  daily, 

Wound  of  the  Interna!  Jugular. — Dr.  Bell 
exhibited  a  patient  who  had  recently  met  with  an 
accident  resulting  in  severance  of  the  internal 
jugular  vein.     The  patient  was  convalescent. 

Dr.  Shepherd  thought  that  the  laryngeal  trouble 
might  be  due  to  division  of  the  superior  laryngeal 
nerve,  with,  perhaps,  some  fibres  of  the  inferior 
laryngeal,  and  suggested  that  instead  of  permanent 
ligature  of  the  carotid  artery  a  temporary  ligature 
might  have  been  passed  about  the  artery ,  and  its 
effect  on  the  hemorrliage  noted. 

Dupuytren's  Contraction. — Dr.  R.  J.  B. 
Howard  read  a  short  paper  on  a  case  of  Dupuy- 
tren's contraction,  which  he  illustrated  by  a  care- 
fully made  dissection. 

Dr.  Shepherd  said  he  had  always  connected 
this  affection  with  a  gouty  diathesis.  It  was  very 
rare  in  this  country,  l)ut  rather  common  in  England. 
It  occurs  frequently  in  old  men,  especially  in  the 
right  hand,  probably  from  the  use  of  a  stick. 
Authorities  agree  that  it  is  rare  in  women,  but 
during  four  years  in  the  General  Hospital  he  had 
seen  only  one  case,  and  that  was  in  a 
woman. 

Puerperal  Eclampsia. — Dr.  Lapthorn  Smith 
than  read  the  following  paper  on  this  subject : — 


As  the  elements  of  doubt  as  to  the  cetiology  of 
this  disease  are  being  gradually  eliminated,  and  as 
the  mechanical  nature  of  its  origin,  which  was  not 
long  ago  scarcely  entertained,  is  being  more  gene- 
rlally  adopted,  I  propose  to  make  the  following 
case  the  text  for  a  brief  discussion  on  the  nature 
of  the  phenomenon  with  a  view  to  laying  down, 
somewhat  dogmatically,  a  certain  principle  of  treat- 
ment. This  I  think  I  am  able  to  show,  even 
witliin  the  limits  of  a  very  short  paper,  we  are  fully 
warranted  in  doing ,  and  if  such  a  thing  can  be 
done,  it  will  materially  help  many  of  us  younger 
men,  who  have  often  to  be  guided  by  the  expe' 
rience  of  others  who  have  not  always  very  distinct- 
ly told  us  what  their  experience  was  : 

Mrs.  M.,  aged  28,  married  at  24,  had  her  first- 
child  a  year  afterwards.  Two  years  after  mar- 
riage she  became  a  widow,  and  remained  in  that 
condition  until  nine  months  before  I  saw  her,  when 
she  was  married  again.  She  became  pregnant  the 
next  month,  and  when  she  had  reached  the  seventh 
month,  or  a  little  latter,  I  was  engaged  to  attend 
her  in  her  confinement.  As  I  was  informed  that 
her  feet  were  beginning  to  swell,  I  asked  for  a 
sample  of  her  urine,  which  on  examination  appear- 
ed clear  when  warmed,  but  very  muddy  on  cool- 
ing, and  was  found  to  contain  no  sugar,  but  was 
loaded  with  albumen.  On  examining  her  next 
day  I  saw  that  her  legs  were  full  of  dropsical 
effusion  ;  the  labia  were  so  swollen  with  liquid  that 
she  was  unable  to  sit  down ;  her  bowels  were 
confined  and  urine  very  scanty  ;  she  had  occasional 
slight  headaches  ;  no  disorder  of  vision  nor  of 
intellectual  faculties.  She  had  no  trouble  what 
ever  with  her  previous  confinement,  and  felt 
quite  well  during  the  first  six  months  of  tiiis  preg- 
nancy, but  her  abdomen  was  so  large  that  I 
suspected  twins,  especially  as  another  case  of 
eclampsia  which  I  attended  also  occurred  in  a  twin 
pregnancy.  I  gave  her  cathartics  and  a  mixture 
of  squills  and  digitalis,  and  placed  her  on  a  strict 
milk  diet.  As  this  failed  to  ameliorate  her 
condition,  after  a  week's  trial,  I  changed  it  to 
digitalis  and  iron,  with  no  better  result.  As  she 
was  rapidly  getting  worse,  and  toxic  symptoms 
began  to  manifest  themselves,  I  began  to  consider 
whether  it  would  not  be  better  to  induce  labor  and 
empty  the  uterus.  For  I  believe,  as  I  shall 
show  later,  that  the  albuminuria  and  uremia  are 
due  to  the  passive  congestion  or  inflammation  of 
the  kidneys,  caused  by  mechanical  pressure  on  the 
renal  veins  by  the  enlarged  uterus.     Before  taking 


THE   CANADA   MEDICAL   KECOHD, 


131 


wli.il   1  then  tlioiii;ht  was  a  very   iinportanl  stL'[) ,  I 
availed  myself  of  the  experience  of  my  friend  and 
tolleague,    Dr.  Kennedy,  who  agreed  with  me  as 
to  tin-  necessity  of  taking  action,  lull  who  thought 
it  better,   on  account  of  the  enormous  distension 
of  the   genitals  and  the  occlusion  of  the  passage, 
to  make  one  final    effort  to  reduce   the  amount  of 
emidation  in  the  skin.     We  accordingly  gave  her 
forty  grains  of  compound  jalap  powder  night  and 
morning,  which  |)roduced  about  a  (juart  of  watery 
evacuations   daily,    and   a    quarter  of  a  grain  of 
pilocarpine    every   four    hours,    which,    however, 
produced   no  effect    whatever  on  the  skin.     As  I 
feared  that    convulsions    would  come    on   before 
long,  the  amount  of  urine  passed  not  exceeding  a 
gill  daily,  I  left  a  bottle  of  A.  C.    E.  mixture  with 
the  nurse,  with  instructions  to   use  it   if  they  came 
on.     She  gradually   grew    worse  until    about    two 
weeks    from    the   time    I   first    saw   her,  when  the 
accumulation  of  the  toxic  agent  caused  an  explo- 
sion of  convulsive  movements  of  the  most  violent 
description,  which  were,  however,  easily  controlled 
by  the  aid  of  the  anaesthetic.     Dr.  Kennedy  again 
met    me    in  consultation    that  afternoon,  and  we 
decided  that  prompt  action  was  imperative  ;  so  we 
rendered  her  completely  unconscious,  dilated  the  os 
with  the  finger,  and  without  much  difficulty  deliver- 
ed her  of  a  living  and  dead  foetus — the  former  by 
the  forceps,  the  latter   by    the   feet.     There  must 
have     been     nearly     three    gallons    of    amniotic 
fluid.    She     rallied   well   and  felt  much    relieved, 
but  an  hour  later  the  convulsions   returned    with 
increased  severity.     She  remained  quite  uncons- 
cious all  evening  until   eleven  o'clock,  when  she 
was  induced  to  swallow  twenty  grains  of  chloral, 
which  was  repeated  three  times  during   the  night, 
with  the  result  that  the    convulsions    ceased    at 
three   o'clock   next    morning   and  did    not  since 
return.  But  she  did  not  remember  anything  of  what 
occurred  during  the  time  commencing  two  days 
before  the  convulsions  began  and  ending  a  week 
after   delivery.     Her  vision,  especially,  remained 
very  disordered,  not  being  able  to  see  distinctly 
the  things  which  she  did  see,  and  believing  that 
she  saw  many  objects   which  did  not  exist.     For 
instance,  she  was  quite  sure   that  she  saw  a  little 
boy    standing   on    the    bureau   breaking    dishes. 
Three  days  after  the  delivery  symptoms  of  puer- 
peral mania  became  very  marked.     She  asked  for 
a  knife  with  which  to  kill  a  man,  whom  she  suppo- 
sed to  be  in  an  adjoining  room,  and  it  required  the 
united  efforts  of  three  people  to  keep  her  in  bed. 


Dining  all  this  time  the  kidneys  continued  to  act 
very  freely,  as,  indeed,  they  began  to  do  an  hour 
or  two  after  the  uterus  had  been  emptied.  On  the 
seventh  day  she  became  so  violent  tliat  it  was  no 
longer  safe  to  keep  her  in  the  house,  as  neither 
chloral,  morphia  nor  atropia  had  any  effect.  On 
the  eighth  day  I  gave  her  a  large  dose  of  bromide 
of  sodium,  after  which  she  began  to  talk  in  a  ra- 
tional manner,  saying  that  the  medicine  had  done 
her  good,  and  inquiring  as  to  the  nature  of  her 
illness,  and  how  long  she  had  been  ill.  Unhappily 
this  improvement  only  lasted  a  few  days,  and 
shortly  afterwards  she  again  became  so  violent 
that  I  was  constrained  to  order  her  removal  to 
Longue  Pointc  Asylum,  where  she  now  is,  after  a 
year's  detention,  a  lunatic.  Her  features  have 
completely  changed,  and  although  quiet  and  docile  , 
she  evinces  many  of  the  characteristics  of 
puerperal  mania.  She  cannot  bear  to  see  her 
husband  or  any  of  her  former  friends,  although 
she  does  evince  pleasure  at  the  presence  of  her 
little  boy.  What  is  being  done  for  her  cure  I  am 
unable  to  say,  but  I  fear  that  her  recovery  is  at 
least  doubtful,  at  any  rate  remote. 

Sir  James  Y.  Simpson  was  of  the  opinion  that 
puer])eral  mania  was  the  direct  result  of  the  tem- 
porary disease  of  the  kidneys,  and  although  many 
able  authorities  differ  from  him  in  this  view,  I  am 
inclined  to  believe  that  the  mania  is  an  evidence 
of  the  co-ordinating  cells  of  the  nerve  centres 
having  been  bathed  for  a  considerable  time  in 
very  poisonous  blood,  and  that  the  relation  of 
albuminuria,  uremia,  puerperal  convulsions  and 
puerperal  mania  may  be  stated  as  follows  : 

A  moderate  amount  of  renal  congestion  causes 
albumen  to  appear  in  the  urine. 

A  greater  amount  of  renal  congestion  causes 
the  albumen  in  the  urine  to  increase  and  the  nor- 
mal quantity  of  urea  in  the  urine  to  diminish,  and 
at  the  same  time  the  urea  being  retained  in  the 
blood  and  bathing  the  nerve  centres  causes 
headache,  disordered  vision,  etc. 

A  still  greater  amount  of  urea  in  the  blood  and 
of  albumen  in  the  urine  causes  poisoning,  and  at 
the  same  time  starvation  of  the  nerve  centres,  and 
dropsy  of  the  brain  to  such  as  extent  that  irritation 
is  set  up  and  convulsions  ensue. 

And  if  this  condition  continues  for  a  considera- 
ble time  the  nerve  cells  are  seriously  altered  in 
nature,  so  that  even  when  the  cause  is  removed 
they  can  with  difficulty  or  not  at  all  recover  their 
normal  functional  activity.    But  a?  UQ  Que  can  tell 


132 


THE   CANADA   MEDICAL   RECORD. 


just  how  a  certain  poison  produces  a  certain  effect, 
1  am  willing  to  leave  that  still  in  the  realms  of 
theory  in  order  to  return  to  certain  definite  facts, 
which  now  seem  to  me  to  be  beyond  any  possible 
doubt.  And  the  first  conclusion  I  have  come  to 
after  a  close  study  of  some  twenty  authors'  obser- 
vafions  is,  that  puerperal  convulsions  are  not 
different  from  urwmic  convulsions,  and  that 
they  dejiend  entirely  upon  uraemia  and  its  conco- 
mitant albuminuria  and  accompanying  cedema  and 
urremia  ©f  the  brain.  That  the  uraemia  of  the 
])ueri)era,  unlike  ordinary  urasmia,  depends  on  a 
removable  cause,  namely,  ]iressure  on  the  renal 
veins,  or  on  the  veins  into  which  they  empty. 
This  is  the  opinion  of  many  eminent  authorities, 
and  the  one  which  is  best  supported  by  facts, 
notwithstanding  .some  slight  exceptional  evidence 
to  the  contrary.  One  of  the  most  significant  of 
these  facts  is  that  the  convulsions  come  on  always 
during  the  latter  half  of  pregnancy,  and  are  more 
frequent  and  more  severe  the  larger  the  uterus 
becomes.  Also,  that  they  are  more  frequent  in 
twin  pregnancies,  as  seen  in  my  second  reported 
case,  and  also  in  the  subsequent  history  in  my 
fit  St  reported  case,  who  narrowly  escaped  having 
them  in  her  next  pregnancy,  which  was  a  twin 
one. 

Another  strong  proof  of  their  meclianical  origin 
is  that  they  are  much  more  frequent  in  first  preg- 
gnancies,  when  the  abdomin.il  walls  are  most 
resisting  and  where,  consequently,  the  pressure  on 
the  veins  is  greatest.  That  we  get  many  of  the 
same  symptoms  in  men  or  in  non-pregnant  women 
if  from  any  cause  the  current  of  blood  out  of  the 
kidneys  is  retarded,  as,  for  instance,  in  mitral 
regurgitation.  Only,  in  these  cases  the  patient 
dies  before  the  uraemia  becomes  sufficiently  marked 
to  cause  convulsions.  The  fact  that  the  urine 
begins  to  be  secreted  generally  immediately  after 
delivery  ;  the  only  exceptions  being  when  the 
kidneys  have  been  damaged  beyond  repair. 

The  guiding  principle  of  treatment  which  I 
wish  to  lay  down  dogmatically  is  this  :  U'hat 
unless  for  grave  reasons  to  the  contrary  we  should 
induce  premature  labor  at  any  time  after  the 
seventh  month,  at  whicii  we  find  the  urine  of  the 
pregnant  woman  loaded  with  albumen  or 
considerably  deficient  in  urea.  By  freely  accept- 
ing this  couree  it  removes  all  doubt  and  hesitation 
in  our  treatment  of  these  most  anxious  cases. 
The  induction  of  premature  labor  at  the  seventh 
month,  or   even   earlier,    is    a   procedure   totally 


devoid  of  extra  danger  to  the  mother,  and  it  gives 
to  the  child  quite  as  good  a  chance  of  surviving  as 
to  allow  it  to  run  the  gauntlet  of  a  much  more 
tedious  labor  at  full  time,  when  its  own  system  is 
in  a  state  of  ursemic  convulsions  as  well,  and  when, 
perhaps,  it  must  be  borne  under  conditions  and 
surroundings  the  most  unfavorable.  That  the 
child  in  utero  suffers  from  urremia  just  as  much  as 
the  mother  is  amply  proved  by  cases  reported  by 
Cazeau.x  and  others,  and  our  experience  is  that 
few  children  born  during  pueriieral  eclampsia 
ever  survive  their  birth  very  long.  In  my  first 
case  the  child  died  during  the  convulsions,  and 
although  I  controlled  them  and  saved  the  mother, 
it  is  probable  that  her  life  was  purchased  only  at 
the  price  of  the  child's,  for  if  it  had  not  died,  and 
she  had  gone  on  increasing  in  size  as  I  then  (and  I 
now  think,  mistakenly)  intended  to  let  her  do, 
nothing  I  believe,  could  have  saved  her.  If  I 
had  followed  this  course  in  my  second  case,  which 
I  now  report,  I  do  not  think  that  the  mother 
would  now  be  in  the  asylum,  and  perhaps  one  or 
both  of  her  children  would  be  alive. 

Heretofore  we  have  been  left  to  interfere  in 
these  cases,  and  the  rule  has  been  to  try  to  carry 
them  on  to  the  ninth  month  by  medicinal  and 
other  treatment.  But  we  should  remember  that 
every  day  the  uterus  increases  in  size  the  disorder 
of  the  kidneys  becomes  greater  ;  and  the  longer 
we  delay  interfering,  the  danger  of  interference 
becomes  more  serious  ;  for  the  reflex  irritability  of 
the  nerves  becomes  such  that  the  slightest  irrita- 
tion of  tiie  periphery  causes  convulsive  impulses 
to  emanate  from  the  centres.  We  should  also 
remember  that  owing  to  the  mechanical  nature 
of  the  malady  we  cannot  count  upon  the  coopera- 
tion of  diuretics,  for  even  digitalis,  the  king  of 
diuretics,  often  fails  us  in  these  cases.  And  no 
wonder,  lor  how  can  a  medicine  which  only  in- 
creases the  secretion  of  urine,  because  it  contracts 
the  capillaries  of  the  kidneys  and  increases  the  flow 
of  blood  through  them,  have  any  effect  when  the 
current  of  blood  is  dammed  back  by  the  constric- 
tion on  the  veins. 

Puerperal  ursmia,  if  left  alone,  is  a  very  serious 
disease,  as  instanced  by  a  mortality  of  12  cases 
out  of  36  reported  by  Braun,  although  that 
mortality  is  higher  than  we  are  accustomed  to 
here.  Wieger  also  rejiorts  a  mortality  of  25  out 
of  65  cases.  In  luging  interference,  I  may  be 
advocating  something  that  many  practitioners  are 
already  in  favor  of  doing,  but  when  such  eminent 


THE   CANADA    MEDICA[,    RECORD. 


133 


names  ;is  (ioocli,  Si  liiodcr  and  I'Liyfair  are  on 
the  side  of  letting  them  alone,  I  think  that  if  the 
]iolicv  orprom|)t  inleiferenec  is  the  light  fine,  as  F 
believe  il  is,  it  is  (|uite  lime  that  some  detinite  law 
on  the  sulijei  1  should  lie  hiid  down  fni  oui  guid- 
ance. 

Disii/sswii. — Dr.  Ak.mstroni;  could  not  entirely 
agree  with  Dr.  Smith  in  his  method  ol'treatmenl. 
He  had  seen  many  cases  of  severe  alliuniinuria 
accomiianied  with  <edenia  where  convulsions  (hd 
ncjt  follow.  After  (|uoting  cases  where  even  ccni- 
\ulsious  supervened,  and  yet  mother  and  child 
were  carried  through,  he  held  that  only  in  the 
very  worst  cases  .should  premature  labor  be 
induced. 

Dr.  GuRD  said  he  had,  within  the  ]),ist  couple 
of  weeks,  treated  two  cases  of  puerperal  albumi- 
nuria accompanied  with  urremic  symptoms.  The 
tirst  was  a  lady  who  sent  for  him  at  the  end  of 
the  eighth  month  of  her  sixth  pregnancy,  siip|)osing 
herself  to  be  in  labor.  The  os  was  found  not  at 
all  dilated.  Twelve  hours  later,  finding  the  os  not 
dilating,  her  condition  was  gone  into  more  fully. 
The  pains  were  spurious,'  set  up  each  time  she 
micturated,  which  was  about  every  fifteen  or 
thirty  minutes,  giving  her  great  agony.  She 
complained  of  severe  headache,  thirst,  inability  to 
sleej),  drowsiness,  twitchings,  and  had  vomited 
several  times.  Temjierature  102°.  Her  feet 
and  ankles  hail  been  sh'ghtly  swollen  for  about 
three  or  four  weeks.  She  was  given  brisk  purga- 
tives, and  digitalis  infusion  and  iron  with  good 
results.  The  pains  ceased  and  all  the  urKmic 
-symptoms  abated.  The  urine  was  next  day  pas- 
sed voluntarily,  and  in  much  larger  quantities.  It 
contained  about  eight  per  cent,  of  albumen.  The 
following  day  urasmic  symptoms  returned.  In 
the  afternoon  of  tliis  day  she  had  what  the  nurse 
called  a  chill,  lasting  twenty  minutes,  all  her  symp- 
toms appearing  worse  toward  evening.  She 
was  given  a  bath  after  the  manner  practised  in 
Vienna,  and  reconmiended  by  the  Rraun,  which  is 
as  follows;  The  patient  is  to  be  put  into  a  bath  of 
99  °  temperature,  the  bath  to  be  covered  with  a 
heavy  blanket,  leaving  the  face  free.  The  tempe- 
rature of  the  water  is  to  be  gradually  increased  to 
lOD  or  112°.  She  is  to  remain  in  the  bath  for 
thirty  minutes.  A  towel  wrung  out  of  cold  water 
placed  on  the  head  relieve,-,  any  distressing  head 
sensations.  Whilst  in  the  bath  the  patient  is  to 
drink  large  quantities  of  water.  After  coming  out 
of  the  bath  she  is    to  be   covered   with   a   warm 


sheet  .ind  llu-n  enveloped  in  blankets,  when  almost 
immediately  free  perspiration  follows.  The 
sweating  is  allowed  lo  go  on  for  two  or  three 
hours.  This  bath  treatment  is  known  often  lo 
bring  on  genuine  labor  ;  it  did  .so  in  this  case. 
Shortly  after  getting  into  lied  she  was  taken  with 
good  labor  pains,  and  in  three  hours  was  delivered 
of  a  healthy  l)oy,  evidently  three  or  four  weeks 
before  lime.  Patient  made  a  good  recovery. 
I'rine,  cxainined  three  days  .ifter  delivery,  was 
free  from  albuii'.cn. 

The  second  case  was  that  of  an  untlersi/ed 
])riniipara,  whom  he  had  accidentally  heard  was 
much  swollen  about  the  feet,  legs  and  face.  On 
visiting  her,  she  was  found  very  <.edematous  and 
suffering  from  headache,  loss  of  sleep,  thirst,  very 
frequent  painful  micturition,  etc.  Her  urine  con- 
tained about  30  per  cent,  of  albumen.  She  had 
yet  two  weeks  to  go.  Under  purgative  avd  diu- 
retic treatment,  with  almost  exclusive  milk  diet, 
ail  the  symptoms  passed  away.  She  was  now 
comfortable  in  every  respect.  Albumen  gradually 
lessened,  till  now,  ten  days  after  treatment,  it  was 
only  I  2  per  cent.  * 

Dr.  Trenholme  thought  that  the  condition  of 
the  circulatory  system  had  mucli  to  do  with  the 
prognosis  and  mode  of  treatment.  In  mitral 
difficulty,  or  whenever  the  circulation  was  otherwise 
affected,  the  cases  were  much  more  serious.  He 
had  frequently  seen  marked  ledema  and  albumi- 
nuria in  iiatients  otherwise  sound,  and  no  serious 
trouble  followed.  He  thought  that  operative 
measures  should  not  be  resorted  to  if  the  circu- 
latory organs  were  sound  and  the  patient  otherwise 
healthy. 

Pathological  Sptximens — Dr.  Wm.  G.\rdner 
exhibited  the  following  specimens  and  related  the 
cases : — 

I .  A  bottle  of  fluid  removed  from  a  retro-peri- 
toneal cyst  of  the  left  loin.  The  patient,  female, 
aged  28,  unmarried,  asserted,  and  her  mother 
confirmed  the  statement,  that  from  childhood  she 
had  been  large  in  the  belly,  but  that  in  recent 
years  she  had  been  growing  larger  and  had  been 
suspected  to  be  pregnant.  Always  well  and  able 
to  work  till  a'week  previous,  when  she  suddenly 
took    ill    with    rigors,    high    fever,    perspirations, 


•^  On  the  17th  she  w.is  delivered  of  twins.  At  the  end 
of.i  (lay's  h.ird  labor  she  had  two  convulsions,  when  the 
forceps  were  applied  for  the  fust  chilil  ;  the  second  was 
extracted  by  the  feet.  On  the  22nd  all  were  doing 
well. 


134 


THE   CANADA   MEDICAL   RECORD. 


vomiting  and  severe  pain  and  tenderness  in  the 
left  loin.  On  examination,  a  rounded  smooth 
tnnior  occupied  the  left  loin,  enlarging  the  abdomen 
consideraljly  on  that  side,  and  extending  beyond 
the  median  line  to  the  left;  upwards  it  reached  the 
edges  of  the  ribs  ;  downwards  it  reached  the  mar- 
gin of  the  pelvis,  but  did  not  dip  into  that  cavity. 
There  was  absolutely  nothing  further  to  be  had  in 
the  way  of  a  history.  Urine  healthy.  The  nature 
of  the  case  being  doubtful,  and  the  symptoms 
urgent,  it  was  decided  to  explore  by  abdominal 
section.  An  incision  two  inches  long  was  made 
in  the  median  from  the  imibilicus  downwards.  On 
opening  the  cavity  the  cyst  was  found  to  lie  be- 
hind the  peritoneum  and  intestines.  The  colon 
lay  in  front,  and  in  such  a  position  as  to  render 
the  management  of  the  case  too  difficult.  This 
opening  was  closed  and  another  made  over  the 
most  prominent  part  of  the  tumor,  about  three 
inches  to  the  left  of  the  median  line,  on  a  level  of 
the  umbilicus.  On  getting  in  over  the  tumor  it 
was  tapped,  and  70  ounces  of  a  dark-brown  turbid 
fluid  containing  numerous  iridescent  crystals  of 
cholesterine  was  removed.  The  opening  was 
enlarged,  its  edges  stitched  to  the  edges  of  the 
abdominal  incision,  and  a  glass  drainage-tube  left. 
From  the  moment  of  the  operation  the  girl  ceased 
to  have  pain,  fever,  or  any  other  symptom.  The 
discharge  was  slight.  The  cavity  shrank  rapidly, 
and  when  patient  was  discharged,  twenty-six  days 
after  the  operation,  wearing  a  short  piece  of  rubber 
drainage-tube,  it  was  almost  obliterated.  The 
fluid  contained  a  large  quantity  of  pus.  That  it 
was  evidently  an  old  one,  possibly  congenitally, 
springing  from  near  the  kidney,  and  had  suddenly 
taken  an  inflammatory  action.  Dr.  Gardner  said 
that  of  course  the  treatment  wnsopen  to  criticisms 
inasmuch  as  the  fluid  could  h.;ve  reached  from  the 
loin  posteriorly  without  opening  the  jieriloneal 
cavity,  but  he  felt  more  at  home  in  ojiening  the 
abdomen  than  tiie  loin,  and  the  result  seemed  to 
justify  the  course  pursued. 

Dr.  Ross  related  a  similar  case  that  occurred 
in  the  })ractice  of  Dr.  Roddick,  four  years  ago.  A 
cyst  in  the  neighborhood  of  the  kidney  was  tapped, 
and  found  to  contain  a  brown  fluid  filled  with 
crystals  of  cholesteria. 

2.  A  cysto-sarcomalous  tinnor  offhc  07'aries  and 
litems,  removed  si.'c  days  ago  t"rom  a  young  mar- 
ried woman  of  21,  the  mother  of  one  child  a  year 
and  a  half  old.     The  tumor  had  been  noticed  first 


in  October,  '86,  and  had  grown  rapidly,  causing 
much  pain,  emaciation  and  interference  with 
functions  of  both  bladder  and  bowel.  It  was 
uneven,  hard  in  parts  aind  elastic  in  others,  pre- 
dominating on  right  side.  The  whole  vaginal 
roof  was  a  hard  mass,  the  vaginal  portion  oblitera- 
ted, and  the  os  felt  only  with  great  difficulty. 
There  were  adhesions  to  omentum,  extensively  to 
colon  and  rectum,  and  to  the  whole  floor  of  the 
pelvis.  The  ftmdus  uteri  was  smelted  into  the 
mass,  and  the  operation  was  finished  by  encircling 
tilt  cervix  with  Koeberl's  clamp,  and,  after  amputa- 
ting, se(  uring  it  with  pins  externally  at  the  lower 
angle  of  the  wound.  The  hemorrhage  was  free  ; 
some  of  the  cysts  burst  during  removal.  The 
cavity  was  well  washed  out  with  plain  warm  water 
and  drained.  Pulse  ran  high,  160  and  over  during 
the  operation,  and  hypodermics  of  brandy  were 
freely  given.  Every  symptom  had  been  favoiable 
till  the  sixth  day.  The  day  after  the  operation  the 
[)ulse  was  under  100,  and  the  temperature  had 
been  normal  for  five  days.  'I'he  temperature  then 
rose,  remained  high  with  fluctuations  for  six  days. 
She  is  now  on  the  nineteenth  day,  quite  convales- 
cent. The  wire  was  ait  and  the  clamp  removed 
on  the  third  day. 

Hydrocephalus. — Dr.  W.  G.  Johnston  exhi- 
bited a  case  of  chronic  hydrocephalus,  obser- 
ved in  making  an  autopsy  upon  a  patient  who 
died  of  secondary  cancer  in  lungs  and  liver.  The 
primary  growth,  a  scirrhus,  was  removed  from  the 
left  mammce  by  Dr.  Roddick  sixteen  months  before. 
I'atient  had  been  under  observation  off  and  on 
during  this  entire  period),  without  any  cerebral  or 
mental  symptoms  having  been  noted.  Convolu- 
tions flattened.  Lateral  ventricles  distended, 
containing  over  eighteen  ounces  clear  fluid  ;  the 
venre  galeni  involved  in  dense  mass  of  fibrous 
tissue,  apparently  of  inflammatory  origin.  They 
were  not  obliterated.  No  other  abnormality  be- 
yond small  mass  of  secondary  cancer  external  to 
dura  in  course  of  anterior  meningeal  artery. 
Fontanelles  closed  by  bony  union.  Skull  cap 
flattened  and  bones  very  thin,  maximum  being 
1-6"  and  minimum  i-io"  over  convexity.  Cranial 
cavity  capacious. 

Tumor  of  the   Prostate — Dr.    Bell  exhibited 

specimens  from  a  case  of  tumor  of   the  prostate, 

and  read  the  following  history  of  the 
case  : — 

J.  H.,  aged  60,  a  farmer,  was  admitted  to  hos- 


tllE  CANADA   MEDICAL   RECOKD. 


185 


jiital  Oct.  9tli,  iS66.  Ho  was  suffering  from 
general  cystitis,  acute  prostatitis  and  right  epidi- 
dyniitis,  and  retention  of  urine.  He  had  always 
been  a  rcgnlar  and  temperate  liver,  and  had  en- 
joyed the  best  of  hcaliluintil  three  years  ago,  when 
he  had  some  hemorrhoids  removed.  He  had 
never  h;id  venereal  disease  of  any  kind.  From 
that  time  he  siilTered  from  frequent  micturition, 
inal)ility  to  empty  his  Madder  at  times,  and  his 
mine  alwa\s  containetl  a  whitish  deposit  when 
jjassed.  He  had  been  taught  to  use  a  gum  elastic 
catheter,  and  for  two  months  before  coming  to 
hospital  he  had  been  obliged  to  use  it  every  day, 
and  seldom  made  water  without  it.  On  admission, 
his  prostate  gland  was  very  much  swollen,  tender, 
hot  and  painful.  He  passed  about  si.vty  ounces 
of  urine  daily,  which  was  neutral  or  faintly  acid  in 
reaction,  and  deposited  on  standing  from  20  to  25 
percent.  l)y  vohmie  of  muco-pus.  There  was  appa- 
rently no  albinnen  in  the  urine  beyond  that  produ- 
ced by  the  pus.  He  had  a  subfebrile  temperature, 
but  his  general  condition  was  good.  He  was  orde- 
red to  be  kept  in  bed  on  milk  diet,  with  linseed 
tea  and  water  ad  lib.,  hot  hipliaths  and  opium  suj)- 
positories  when  necessary,  and  his  bladder  was  em- 
])tied  three  times  daily  with  a  soft  rubber  catheter. 
The  acute  inflammatory  symptoms  soon  subsided, 
the  pus  in  the  urine  diminished  very  considerably, 
his  temperature  became  normal,  and  he  was  very 
much  better  in  every  respect,  but  could  not  empty 
his  bladder.  From  the  12th  of  November  the 
bladder  was  washed  out  daily  with  jilain  warm 
water.  He  improved  steadily  until  the  29th  No- 
vember, when  he  had  a  severe  chill  and  great 
pain  in  the  right  loin.  The  urine  became  scantier 
and  was  loaded  with  ]ius  for  a  few  days,  but  soon 
became  more  abundant  and  less  purulent  again. 
The  patient  became  dull  and  somnolent  with  dry, 
brown  tongue,  moderate  fever  and  obstinate 
anorexia,  and  gradually  sunk  and  died  on  the  iSth 
ot  December. 

At  the  autopsy,  Dr.  Johnston  re|)orted  the  mid- 
dle lobe  of  prostate  enlarged,  and  containing  a 
small  abscess.  Bladder  mucosa  somewhat  conges- 
ted. Ureters  normal.  Both  kidneys  enlarged 
slightly  and  hypersemic  ;  a  little  mucus  secretion  in 
pelves,  which  were  otherwise  normal.  Throughout 
cortices  a  few  small  sujjpurating  points  correspond- 
ing with  and  apparently  originating  in  pysemic 
infircts.  Spleen  enlarged  and  soft.  No  further  ex- 
amination was  allowed. 


Bo/tlt'ifjanchmc, 


Charleston,  S.  C,  Feb.  14,  1887. 
Kilitors  Canada  Mkd.  Record. 

(ji.N  ri.EMKN  : — I  felt  complimented  by  your  in" 
sertion  of  my  paper  on  the  Heart  in  your  issue  for 
December  ;  but  one  or  two  errors  will  very  likely 
confuse  your  readers  when  the  subject  is  one 
which  is,  at  best,  very  comple.\,  and  requires  abso- 
lutely definite   language. 

Onp.^G,  ist  column,  the  word  "covered  "  should 
be  "coupled  ;"  2nd  cohunn,  i6th  line,  the  word 
"valves"  which  the  printer  has  inserted,  (A-j/Aty^ 
t/ie  sl-zisc- :  for  the  vciitricks — (not  the  valves, — ) 
"are  being  filled  from  the  auricles." 

In  printing  the  ''Formula"  it  should  be  placed 
thus  to  be  understood  by  your  readers  : 
Stenosis, 
Insufficiency. 


Insuffcicnc) 
Stenosis. 

(  A  tleranged  isl  sound,  etc.,  elc 
e  Base. —   l 


(  A  deranged  2nd  st)und,  etc.,  etc. 
.\  deranged  ist  sound,  etc., etc. 


At  the  Base.- 


At  the  ajiex- 

A  deranged  2nd  sound,  etc.,  etc. 
With  best  respects  and  best  wishes  yours, 

F.  PEVRE  PORCHER,  M.  D. 
I  have  always  read  your  Journal  with  great  plea- 
ure,  your  selections  also  being  specially  good. 

J?/^Q6ieM  of  Scii'/ice. 

SPRAINED  JOINTS. 
By  Edmund  Owen,  ¥.  R.  C.  S.,  London,  Eng. 
Surgeon  to  St.  Mary's  ami  Children's  Hospital. 

A  sprain  is  the  result  of  a  twist  or  wrench  which 
has  stretched  the  fibrous  capsule  of  an  articulation 
and  its  synovial  membrane,  but  which  has  not 
sufficed  to  cause  either  fracture  or  dislocation.  The 
injury  should  be  treated  upon  exactly  the  same  sur- 
gical principles  as  those  which  guide  us  in  dealing 
with  a  fracture  or  dislocation  of  a  joint  ;  yet  a  joint 
which  is  "  only  sprained  "  is  somewhat  ajit  to  ob- 
tain but  scant  professional  attention.  Though  the 
common  saying  teaches  that  "  a  sprain  is 
worse  than  a  break,  "  the  unfortunate  subject  of  a 
sprain  is  usually  contented  with  doing  the  best 
that  he  can  for  himself  with  arnica,  cold  water,  or 


Ih 


I'UE   CAKADA  MEDICAL   RUdORD. 


oil,  as  chance,  experience,  or  advice  may  suggest, 
seeking  the  surgeon's  aid  only  for  the  remote  and 
often  intractable  complications.  In  unliealthy 
subjects,  and  especially  in  children,  want  of  treat- 
ment often  entails  articular  troubles  which  run  a  lin- 
gering course  and  may  end  disastrously  ;  and  even 
with  the  strong  a  severe  sprain  is  apt  to  involve  a 
long  continued  eufeeblement  of  the  part. 

Immediately  after  the  sprain  there  is  want  of 
pliability  in  the  joint,  due  in  part  to  the  pain  and 
tenderness  caused  by  the  violence,  in  part  to  the 
tension  of  the  sensory  nerve  filaments  from  the 
sudden  effusion,  -and  in  jjart  also  to  the  mere 
mechanical  effect  of  the  presence  of  blood  and 
other  fluids  in  and  around  the  joint.  In  certain 
situations  a  serious  wrench  of  an  articulation  may 
give  no  visible  sign  upon  the  surface  of  the  body ; 
especially  is  this  the  case  with  the  hip,  the  shoul- 
der, and  the  spinal  articulations,  all  of  which  are 
thickly  covered  ;  stiffness  will  then  be  the  only 
objective  sign  indicative  of  the  lesion. 

If  a  joint  in  the  lower  extremity  be  seriously 
sprained,  temporary  but  absolute  rest  for  it  should 
be  insured  by,  if  practicable,  putting  the  patient  at 
once  to  bed;  by  raising  the  limb  on  a  pillow,  or  in 
a  swing  cradle,  until  the  heel  is  above  the  level  of 
the  chin,  so  as  to  hinder  capillary  and  venous  con- 
gestion, and  by  applying  firm  and  even  compres- 
sion. I  am  convinced  that  judiciously  ajjplied 
compression  not  only  checks  further  effusion,  but 
also  promotes  the  absorption  of  tluid  which  has 
been  already  poured  out  ;  and,  as  a  rule,  the  i)a- 
tient  experiences  immediate  comfort  from  it.  At 
times,  however,  it  is  possible  that  from  the  tender- 
ness of  the  skin,  or  from  mere  a])prehension,  the 
ixitient  will  not  submit  to  the  comjiression  imme- 
diately after  the  injury.  Then  one  must  be  con- 
tent to  apply  either  the  ice-bag  or  an  evaporating 
lotion.  Cold  plays  a  double  part  :  by  stimulating 
the  vaso-motor  nerves  it  causes  a  contraction  of 
the  small  arteries,  with  the  effect  of  checking  fur- 
ther hemorrhage  and  inflammation  and  limiting 
the  effusion,  and  by  numbing  the  sensory  nerves  it 
diminishes  pain.  The  lotion  should  not  be  used, 
however,  as  is  often  done,  as  a  water-dressing  un- 
der oil-si. k.  It  must  be  apjilied  on  a  single  fold 
of  lint  with  the  fluffy  side  outwards,  so  that  eva- 
poration may  proceed  with  energy.  The  lint  must 
never  be  allowed  to  get  dry,  nor  should  the  limb 
be  covered  over  with  bed-clothes.  If  a  man 
sprains  his  ankle  when  out  in  the  fields  it  should 
as  quickly  as  possible  be  put  into  running  water, 
and  then  be  firmly  bandaged  with  strips  of  wetted 
handkerchiefs  ;  the  boot  should  be  worn,  if  he  can 
get  it  on  again,  for  the  sake  of  the  compression  it 
affords,  but  it  is  better  not  to  remove  the  boot  at 
all  imtil  the  joint  can  be  bandaged.  Nothing  short 
of  absolute  rest  in  bed  suffices  when  a  child  sprains 
a  joint  in  the  lower  extremity ;  he  must  not  be 
trusted  to  lie  on  a  sofa,  for  he  would  soon  be  off 
of  it.  Where  the  hip-joint  is  sprained  the  limb 
should  be  raised  and  rest  insured  in  the  extended 
position  by    the    application   of  the   weight   and 


jiulley;  so  that  if  matters  do  not  clear  up  there 
will  be  no  need  for  further  change  of  piosition.  A 
s[jrain  is  often  the  beginning  of  an  attack  of  hip 
joint  disease. 

In  the  case  of  the  kne'e  being  sprained,  tlie  leg 
would  be  extended  ;  in  tlie  case  of  the  ankle  being 
sjirained,  the  foot  would  be  put  up  at  a  right  angle. 
But  in  each  instance  the  limb  should  be  carefully 
bandaged  upwards  before  the  comjjression  is  ap- 
plied, or  edema  may  follow  ;  complete  rest  would 
be  still  further  ensured  by  adjusting  a  splint  to  the 
side  or  back  of  the  limb.  Compression  may  be 
applied  by  means  of  a  roller  of  domette,  or  by  the 
additional  aid  of  plastic  splinting  moulded  on. 
With  children  a  well  padded  flexible  metal  s]j|iut 
is  of  great  service,  but  a  casing  of  jjlaster  of  Paris 
and  house  flannel  answers  even  better. 

1  have  at  present  two  men  under  my  care,  each 
with  a  se\erely  sprained  ankle,  the  part  being 
swollen  and  discolored,  and  the  foot  stift'  and 
useless.  The  foot  and  leg  have  been  immobilised 
in  well-lined  plaster  of  Paris  casings,  and  thus  the 
patients  are  quickly  enabled  to  get  out  of  bed  and 
go  about  with  crutches,  without  risk  or  discomfort. 
In  neither  of  these  men  was  a  fractnre  to  be 
detected. 

When  an  ankle  is  greatly  swollen  from  a  recent 
injury,  and  signs  of  fracture  are  not  evident,  it  is 
not  advisable  to  conduct  the  examination  for 
obtaining  a  knowledge  of  the  exact  nature  of  the 
injury  in  too  inquisitive  a  manner.  If  the  limb  be 
treated  on  the  jninciijles  enunciated  above,  it  will 
be  we  1  eitiier  for  a  severe  sjirain,  or  for  a  fracture 
without  disjilacement.  Possibly  the  patient  might 
be  unsettled  at  not  being  definitely  informed 
whether  there  be  fraetme  or  not,  for  the  oft-re- 
peated question  of  the  patient  or  ])arent  as  the  sur- 
geon examines  the  part  is,  "  Is  the  bone  broken  ?  " 
But  I  am  speaking  merely  of  the  principle  involved 
in  the  surgery. 

Absolute  rest  is  demanded  as  long  as  heat  of 
the  surface  or  intraarticular  pains  persist.  As  the 
pains  subside,  recourse  must  be  had  to  frictions 
and  rubbings,  and  the  use  of  stimulating  liniment 
and  cold  douches.  The  rubbings  should  i>e  exe- 
cuted always  in  the  direction  of  the  venous  and 
lymphatic  return,  and  may  be  combined  with  firm 
fingerings  about  the  part,  and  with  the  rubbing-in 
of  oil.  When  eff^usion  ]3ersists  in  the  painless 
joint,  one  may  apply  over  the  joint  the  even  com- 
]iression  of  a  Martin's  elastic  roller  for  a  certain 
length  of  time  each  day,  the  skin  being  duly  pro- 
tected by  a  soft  covering.  This  is  a  highly  satis- 
factory method  of  treatment  in  cases  of  chronic 
thickening  and  effusion.  Leslie's  soap-strapping, 
too,  when  evenly  and  liberally  applied  over  a 
sprained  joint,  is  an  excellent  therapeutic  measure 
in  the  days  following  close  ujion  the  injury. 

At  other  times,  nothing  seems  to  render  such 
efficient  aid  as  a  wetted  calico  bandage.  Compres- 
sion in  some  form  is  needed. 

On  physiological  grounds,  the  early  treatmeilt 
of  a  sprained  joint  by  fomentation  or  poultices  is 


TllK  CANADA   MEDICAL   UECOUD. 


1:5/ 


inexpedient.  'J'lie  application  of  waimlli  pnidu 
CCS  a  vascular  fulness  of  the  part,  and  a  relaxed 
condiliun  of  tissues  which  are  in  need  of  iieing 
tone<l  up  and  stienj;lhened  ;  though  if  synovial 
inllainmation  of  an  acute  kind  follow  on  the  s|)rain, 
leeches  anil  fomentations  may  not  improhahly  l)e 
indicated  later  on.  For  the  promotion  of  tiie 
absorption  of  the  lingering  products  of  efl'usion, 
an  alternation  ofdouchings  under  streams  of  hot 
and  cold  water  gives  valuable  aid.  In  no  stage  of 
the  pathological  process  associated  with  a  sprain 
should  arnica  solution  be  applied.  One  has  met 
with  instances  in  which  painful  and  seriinis  celluli- 
tis has  followeti  its  use,  even  when  there  had  been 
no  previous  lesion  of  skin.  How  is  it  that  arnica 
first  obtained  its  reputation  in  the  treatment  of 
sprains,  and  how  has  that  reputation  managed  to 
survive  so  long  ? 

A  surgeon  was  driving  his  wife  in  the  country 
when  the  pony  fell,  and  the  occupants  of  the  car- 
riage were  thrown  out  into  the  road.  Wiien  1  saw  him 
a  few  hours  after  the  accident  he  was  wearing  his 
right  arm  in  a  sling,  the  elbow  being  at  an  obtuse 
angle.  He  said  that,  in  the  fall,  the  right  hand 
(in  which  he  was  holding  the  reins)  and  the  arm 
were  doubled  and  twisted  imderneath  him,  and 
that  though  he  was  sine  no  bone  had  been  broken, 
he  could  neither  bend  nor  straighten  the  elbow  on 
account  of  the  severe  sprain  which  it  had  received. 
He  said  that  on  his  way  home,  and  certainly  well 
within  an  hour  of  tlie  fall,  on  ]ilacing  his  left  hand 
under  the  damaged  elbow  he  found  a  soft  swelling 
which  seemed  jiretty  near  as  large  as  an  egg  ;  his 
wife  could  also  feel  through  his  coat  sleeve.  Hav- 
ing taken  the  limb  out  of  the  sleeve  and  removed 
some  water-dressings,  universal  and  extensive 
effusion  in  the  articulation  was  evident ;  the  dis- 
tended synovial  membrane  was  specially  bulging 
about  the  head  of  the  radius.  The  intra-articular 
pain  was  intense.  There  was  no  contusion  of  the 
skin,  nor  any  definite  ecchymosis ;  movement 
caused  great  distress.  Beginning  at  the  fingers  we 
firmly  bandaged  the  extremity  with  a  roller  of 
domette  (which  from  its  softness  and  elasticity 
adapts  itself  with  delightful  evenness  and  comfort), 
drawing  tlie  turns  which  surrounded  the  swollen 
joint  itself  more  closely  and  firmly  for  the  sake  of 
compression.  Then,  having  bent  to  the  proper 
form  of  the  arm  a  padded  flexible  iron  splint,  and 
carefully  adjusted  it,  the  elbow  was  jiacked  round 
with  cotton-wool,  and  having  enclosed  all  in  a 
second  and  wider  domette  roller,  and  having  got 
the  patient  to  bed,  we  arranged  the  arm  upon  a 
pillow.  The  compression  and  security  afforded 
by  the  roller  and  splint  gave  great  satisfaction.  On 
the  second  day  we  re-adjusted  the  sjilint  and  ban- 
dages, which  had  now  become  slack.  Most  of  the 
tenderness  and  swelling  had  departed.  Two  days 
later,  and  at  other  intervals,  we  tightened  up  the 
bandage,  finding  always  steady  improvement.  In 
ten  days  the  splint  was  removed,  and  cautious 
use  of  the  arm  was  allowed,  but  for  the  entire 
removal   of  the  stiffness  a  course   of  shampooing 


iVcim  a  professional  rubber  was  resorted  to.  'J'he 
elTusion  which  had  come  on  so  quickly,  within  an 
hour  (if  the  injury,  was  evidently  not  inflammatory 
m  its  nature;  probably  it  consisted  of  synovia, 
blood  and  serum. 

The  other  occupant  of  the  cirria^c  had  severely 
sjjrained  her  left  ankle,  whicii  was  painful,  stiff, 
and  full  of  sero-synovial  effiision.  There  was  no 
fracture.  The  swelling  was  confined  within  the 
limits  of  the  synovial  membrane  ;  it  did  not  extend 
up  above  the  external  malleolus  in  the  manner  so 
characicristic  of  Pott's  fracture.  'J'he  iieaiinent 
adopted  consisted  in  surrounding  the  ankle  with 
an  evcji  layer  of  cotton-wool,  and  in  bandaging 
from  Ihc  metatarsus  upwards  with  a  soft  roller,  the 
turns  of  which  were  continued  well  u\y  the  calf  of 
the  leg.  'I'he  fool  thus  firjiily  encased  was  raised 
upon  a  pillow.  In  a  few  days  all  the  excess  of 
synovial  fluid  had  disappeared,  luit  the  firmly 
applied  band.ige  was  still  worn.  In  a  week  she 
began  to  use  her  foot,  and  was  finding  comfort  in 
having  it  and  the  ankle  rubbed  with  oil  several 
times  during  the  day.  On  the  occasion  of  my 
first  interview,  the  jjatient  volunteered  the  imjior- 
tant  clinical  statement — that  after  the  accident  her 
foot  and  ankle  were  fairly  comfortable  until  her 
boot  was  removed.  Probably  if  a  bandage  of 
plaster  Paris  casing  could  have  been  applied 
inmiediately  after  the  accident,  but  little  joint 
effusion  or  edema  would  have  occurred.  Centainly, 
compression  of  a  recently-sjirained  joint  gives 
results,  both  as  regards  ex]jedition  and  thorough- 
ness, with  which  those  obtainable  by  the  system  of 
eva])orating  lotions  can  not  be  compared. 

If  the  sprained  joint  be  in  tlie  thumb  or  finger, 
much  jiain  and  want  of  pliancy  may  result.  A 
small  splint  should  be  moulded  on  ;  firm  compres- 
sion with  a  pad  of  cotton-wool  and  a  soft  bandage 
exercised  ;  and  the  hand  worn  in  a  sling — it  should 
not  be  left  free  except  for  the  cold  douchings.  A 
few  days  absolute  rest  is  expedient. 

Even  long  years  after  all  the  local  signs  of  a 
sprain  have  passed  away,  a  jerked  or  sudden 
movement  of  the  joint,  or  a  change  in  the  weather, 
reminds  the  subject  that  the  part  is  not  absolutely 
sound.  Nearly  twenty  years  ago,  I  severely 
sprained  my  left  wrist  at  football,  and  to  this  day 
it  has  not  absolutely  recovered.  I  cannot  flex  or 
extend  it  as  I  can  its  fellow.  A  sudden  move- 
ment of  it  is  often  accompanied  with  audible 
crackling  and  discomfort.  From  a  close  and 
interested  observation  of  this  joint  I  feel  convinced 
that  in  the  crevices  between  the  articular  surfaces 
of  the  bones,  and  against  the  attached  parts  of 
the  capsule  out  of  the  way  of  pressure,  there  are 
gowing  delicate  and  injected  fringes  of  the  syno- 
vial membrane.  The  synovial  -fluid  is  thin  in 
quality  and  in  excess  of  the  normal  amount  ;  there 
are  no  adhesions  inside  the  articulation,  but  there 
is  ])robably  some  shortening  of  the  extra-articular 
fibrous  tissues,  which  were  implicated  in  the 
inflammation — a  shortening  secondary  to  inflam- 
matory  thickening.     Probably  this  shortening  of 


1S8 


THE  CANADA   MEDICAL  RECORD. 


the  fibrous  tissues  plays  the  important  role  of  a 
perpetual  splint  shielding  the  enfeebled  synovial 
membrane  from  further  shock  and  distress.  On 
no  accoimt,  therefore,  will  these  adhesions  be 
broken  down  or  stretched  by  manipulation  ;  such 
a  treatment  is  contra-indicated  by  the  pain  which 
closely  attends  any  attempt  at  more  than  the 
accustomed  movements  of  the  joint.  The  very 
audible  crackling,  which  even  a  bystander  may 
sometimes  hear,  on  working  the  joint  is  the 
result  of  the  altered  synovial  fluid  being  quickly 
driven  by  the  movements  of  the  joint  between  the 
vascular  fringes. 

Occasionally,  when  a  joint  has  been  wrenched 
by  a  recent  accident,  and  is  in  consequence  pain- 
ful and  useless,  the  manijjulative  examination 
which  it  receives  from  the  surgeon  is  the  means  of 
removing  much  of  the  pain,  as  well  as  restoring  a 
good  deal  of  the  lost  function.  I  am  satisfied 
that  such  improvement  is  real,  and  not  merely 
subjective.  Yet  because  in  the  weakly  and  ailing 
such  a  therapeutic  measure  might  probably  be 
attended,  either,  immediately  or  remotely,  by  disas- 
trous results,  and  because  of  its  utterly  speculative 
nature,  it  is  not  to  be  recommended  as  routine 
practice,  though  it  may  well  be  kept  in  reserve  for 
rare  and  special  occasions.  It  certainly  has  a 
close  and  important  bearing  upon  bone-setting. 
A  man  sprained  his  ankle,  the  surgeon  examines 
and  reports  accordingly  ;  but,  because  no  bone 
is  broken,  he  perhaps  speaks  of  the  lesion  in  a 
careless  or  offhanded  manner,  and  does  not  insist 
on  the  necessity  of  rest  and  of  other  appropriate 
treatment.  So  the  ankle  does  not  get  sound,  and 
the  faithless  patient  resorts  to  a  quack,  who  at 
once  finds  "  a  small  bone  out  of  place."  Then 
come  a  sudden  twist  and  a  crack,  and  lo  !  "  the 
bone  is  in  again.  "  The  patient  believes  that  a 
bone  has  there  and  then  been  restored  to  its  place, 
because  he  is  at  once  absolutely  more  comfortable, 
and  can  not  only  move  the  joint  freely,  but  can 
even  accept  the  advice  to  throw  away  his  crutch 
or  his  stick,  and  walk  on  his  damaged  foot  without 
further  help.  Perhaps  he  is  told  to  go  home  and 
apply  ice ;  at  any  rate  from  that  time  he  considers 
himself  to  be — and  indeed  is — cured.  Forcible 
maniijulation  is,  of  course,  the  bone-setter's  pana- 
cea. I  have  known  him  to  employ  it  in  the  case 
of  fracture  of  the  surgical  neck  of  the  humerus, 
and,  as  may  be  excepted,  with  very  serious  results. 
In  the  case  of  recent  sprain,  however,  the  patient 
cannot  but  believe  that  the  bone-setter's  statement 
is  true,  because,  beyond  a  doubt,  his  manipulation 
has  proved  effectual. 

The  following  report  illustrates  the  point : — A 
gentleman  of  highly  nervous  temperament  came 
to  me  with  considerable  bruising  of  the  deltoid, 
the  day  after  receiving  a  fall,  which  might  have 
been  attended  with  much  more  serious  consequen- 
ces. The  arm  was  so  stiff  at  the  shoulder-joint 
that  he  could  not  raise  it  to  dress  himself,  nor 
could  he  touch  the  ear  of  the  opposite  side  whilst 
his  elbow   was   brought  toward  the  front    of  the 


chest, — it  remained  permanently  though  slightly 
abducted.  Any  movement  of  the  arm  was  attend- 
ed with  pain  and  distress.  There  was  no  defi- 
nite hollow  beneath  the  acromion  process,  nor 
any  other  unequivocal  sign  of  dislocation.  There 
was  a  great  element  of  obscurity  in  the  case  ;  the 
patient  was  in  pain  and  apprehension,  and  expres- 
sed his  fear  that  the  shoulder-bone  was  "  out.  " 
A  consultation  on  the  case  was  not  attainable, 
and  the  course  of  action  had  to  be  decided.  So, 
to  err  upon  the  safe — if  error  there  might  be — and 
in  order  to  make  a  thorough  and  practical  exami- 
nation of  the  joint,  I  agreed  with  him  that  there 
was  "displacement  of  the  shoulder-bone,"  and 
laying  him  upon  the  floor,  with  my  heel  in  the 
axilla,  I  flexed  the  fore-arm  to  slacken  the  biceps, 
rotated  and  pulled  down  the  arm,  and  thenadduct- 
ed  it  ?•/  et  arte  and  in  a  most  determined  manner. 
There  was  no  click,  or  the  sign  of  a  re-adjustment 
having  taken  place,  but  immediately  on  .the  jiatient 
rising  from  the  ground  he  said  that  he  was  much 
more  comfortable  ;  he  had  lost  most  of  the  pain  ; 
he  could  move  his  arm  with  comparative  freedom  ; 
and  to  his  delight  and  my  satisfaction  he  dressed 
himself  without  assistance.  He  was  convinced 
that  I  had  reduced  a  dislocation.  In  my  own 
mind  I  was  sure  that  I  had  not,  but  for  obvious 
reasons  I  did  not  tell  him  that  the  success  attend- 
Hig  my  treatment  was  worthy  of  a  more  exact 
diagnosis.  It  is  with  no  sense  of  pride  that  I 
record  the  case ;  nevertheless,  it  might  be  expe- 
dient to  adopt  this  treatment  on  another  similar 
occasion.  With  a  hyper-sensitive  and  nervous 
patient,  and  a  fat  or  swollen  shoulder,  it  is 
occasionally  impossible  to  affirm  without  the  aid 
of  an  anajsthetic  that  there  is  no  displacement. 
Traction  on  the  bent  elbow  with  the  heel  in  axilla 
enables  the  surgeon  to  make  the  necessary  exami- 
nation. Certain  am  1  of  this, — that  my  nervous 
]>atient  would  not  have  examined  him  if  1  had  first 
said  that  I  thought  there  was  no  displace- 
ment. 

I  have  observed  the  same  course  of  events  in 
other  cases.  For  instance,  a  man  has  just 
damaged  his  ankle,  which  is  now  painful,  swelled, 
and  stiff;  a  thorough  manipulative  examination 
reveals  no  definite  lesion.  But  immediately  after 
the  handling  the  patient  finds  the  food  so  much 
better  in  every  respect  that  he  talks  too  liglitly 
of  his  injury  and  wishes  at  once  to  walk  about. 
Or  an  elbow,  knee,  or  wrist,  is  stiffened  by  a 
recent  wrench.  On  being  thoroughly  overhauled, 
nothing  is  foimd  absolutely  wrong  with  it ;  but 
the  patient,  though  a  sufferer  during  the  exami- 
nation, finds  the  joint  greatly  improved  by  it.  'J'he 
surgeon  will  rightly  refuse  to  include  such  a  spe- 
culative therapeutic  measure  in  his  routine  prac- 
tice ;  but  its  blind  employment  by  the  charlatan 
is  the  means  of  securing  many  a  triumphant 
success. 

Where  a  limb  is  stiff  from  chronic  muscular 
rheumatism,  much  good  may  often  be  done  by 
massage,  and   by  sudden  movements  imparted  to 


THE    CANADA    MEDrCAl,    RECORD. 


139 


it,    the  stiffness  disappearing   by  magic,  whilst  no 
harm  can  follow  the  treatment. 

Stifhiess  may  follow  on  a  sjirain  from  effusion 
taking  jilaee,  not  into  the  synovial  membrane  of 
the  artuulation,  Init  into  a  sheath  in  connection 
\\\[\\  :i  nrijiliboring  tendon.  One  has  often  to 
treat  siuh  effusion  in  the  sheaths  of  the  extensors 
of  the  tluinil)  and  wrist,  and  also  in  those  of  the 
tendons  of  the  tibial  muscles  and  of  the  extensors 
of  the  toes.  It  is,  of  course,  easy  to  differentiate 
between  an  articular  and  a  thenar  effusion  ;  the. 
same  principles  direct  the  treatment  in  each  case 
I  Iku'i-  ai  the  present  time  under  my  care  a  wrist 
whit  h  is  stiffened  from  slight  effusion  into  the 
.shiMth  III  the  radial  extensors;  great  relief  is  being 
alforded  by  the  firm  compression  of  a  domette 
roller  which  is  kei)t  constantly  wet. —  T//t: 
Practil  loner. 


SOME  PRAC  riCAL  SUGGESIION.S  ON 

THE  TREATMENT  OF  DIPHTHERIA. 

Dr.  Wm.  Porter  {^founial  American  Medical 
Associa/ion') : 

Diphtheria  is  a  connnon  disease,  and  it  is  one  of 
he  most  fatal.  As  one  illustration  of  many,  in 
iive  years  there  were  17,193  cases  in  New  York 
alone  and  7,293  deaths.  It  is  a  disease  that  every 
physician  will  be  called  to  treat  sooner  or  later, 
ami  being  called  must  act  promptly.  This  is  not 
the  place  for  a  long  essay  upon  the  different 
theories  of  diphtheritic  contagion  and  progress, 
rather  let  us  enter  at  once  upon  the  discussion 
of  the  practical  questions  involved  in  conducting 
the  disease  to  a  favorable  issue. 

Let  me  very  briefly  sketch  tlie  manner  of 
invasion  according  to  conclusions  which  seem 
most  reasonable  and  are  by  many  accepted  : 

1.  Diphtheria  is  contagious — or  rather  porta- 
gious,  and  of  parasitic  origin. 

2.  It  is  most  readily  imi)lanted  upon  a  mucous 
membrane  denuded  of  its  epithelium. 

3.  It  is  probably  always  local  in  its  incipiency, 
sometimes  becoming  rapidly  systemic,  though  in 
rare  cases  apparently  systemic,  from  the  beginning. 

To  further  explain  rather  than  to  argue  these 
propositions,  let  me  say  that  the  best  protection 
against  diphtheria  is  mucous  membrane  entirely 
healthy  ;  and  an  ordinary  acute  or  subacute  laryn- 
gitis or  pharyngitis  is  a  condition  favorable  to  the 
implanting  of  the  diphtheritic  genn.  When  the 
epithelial  layer  is  intact  the  diphtheritic  germ  finds 
no  foothold,  but  when  there  is  an  abrasion  or 
denudation  of  the  lining  membrane,  the  diph- 
tlieritic  bacteria  first  attach  ihcinselves  to  the 
surface  so  prepared  for  them.  This  is  the  local 
period  of  the  disease,  and  no  micrococci  are  found 
in  the  blood — there  is  no  constitutional  symptom. 
Sometimes,  though,  there  may  be  rapid  surface 
involvement,  and  free  formation  of  the  charac- 
teristic meinbrane,  there  may  still  be  little  ab- 
sorption of  the  diphtheritic  virus. 

Many  of  these  almost  purely  local  conditions 


suggest  a  doubt  as  to  their  specific  nature.  It  is 
well  to  give  the  [jatient  the  benefit  of  the  doui)t, 
and  to  treat  urgently  all  suspicious  looking  exuda- 
tions upon  tlie  surface  of  the  resjiiratory  tract. 
Practically,  a  certain  number  of  cases  of  diph- 
theria are  constittitional  from  the  beginning,  the 
point  of  infection  being  in.  some  recess  of  the 
nasc;-|)harynx  or  larynx  and  easily  over  looked — or 
is  beyond  the  range  vision.  I  am  not  sure  but 
that  infection  may  occur  t'rom  primary  invasioir  of 
the  membrane  of  the  alimentary  canal.  Klebs,  in 
the  second  Congress  of  tlie  Oerman  Physicians, 
speaks  of  a  diphtheritic  involvement  of  Peyer's 
ixtlches,  resembling  the  reticular  appearance  in  the 
earlier  stages  of  typhoid.  In  by  far  the  greater 
number  of  cases  the  rapid  multiplication  of  the 
bacteria — whether  sphero — bacteria  as  are  foiind  in 
severe  cases,  or  whether  short  and  slender  rods  as 
in  milder  cases — produces  an  inflammation  of 
the  mucous  membrane,  exudation  takes  place,  the 
epithelial  cells  die,  and  the  bacteria  pass  into  the 
blood  and  rapidly  nniliiply  thoughout  the  circu- 
lation. Even  should  ux-  deny  with  Beale  that  the 
contagium  is  bacteria,  we  still  must  admit  that  the 
hypothesis  of  local  infection  furnishes  the  most 
rational  explanation  of  the  sequence  of  symptoms. 
Granting  this,  we  have  two  purposes  in  treat- 
incut  in  the  early  stages  of  diphtheria  ; 

1 .  To  destroy  or  render  harmless  the  local  mani- 
festation of  the  disease. 

2.  To  increase  the  power  of  resistance  in  the 
general  system  to  infection. 

In  dealing  with  tlie  false  membrane  all  measures 
which  would  tend  to  irritate  or  injure  the  air  pas- 
sages, should  be  avoided.  There  should  be  no 
tearing  away  of  the  exudation,  or  ajiplication  of 
caustics — ^nor  do  I  think  that,  excejit  in  cases 
where  there  is  only  a  small,  well  defined  patch 
of  membrane,  the  use  of  the  galvano-cautery  will 
prove  expedient.  To  prevent  absorption,  not  only 
should  we  avoid  making  new  abrasions  in  the 
throat,  but  I  have  thought  it  wise,  as  far  as  pos- 
sible, to  cover  up  those  that  already  exist. 

First  of  all,  it  is  well  to  remove  from  the 
nasopharynx,  or  pharynx,  if  that  be  the  site  of  in- 
vasion, whatever  of  accumulated  mucus  and  debris 
there  may  be.  This  may  be  readily  done  by 
means  of  a  small  syringe,  and  a  weak  solution 
of  salt  water,  or  of  Lysterine.  This  may  be  used 
either  through  the  nostril  or  directly  in  the  pharynx. 
To  loosen  the  attachments  and  hasten  the 
resolution  of  the  diphtheritic  membrane  many 
means  have  been  advocated. 

AVhen  the  patch  can  be  reached,  a  solution 
of  papayotin  may  be  applied;  or  better  still,  one  of 
trypsin.  This  last  used  in  solution,  as  suggested 
by  Fairchild  and  Foster,  or  still  better,  a  few 
grains  with  one  or  two  of  bicarbonate  of  soda, 
made  into  ,a  paste  with  water  and  spread  ujjon  the 
diphtheritic  patch,  is  the  most  rapid  solvent  I  have 
known.  If  the  local  disease  is  beyond  the  reach 
of  such  an  application,  aa  alkaliiie  solution  of 
trypsin  may  be  sprayed  UUQ  th?  P.Qse  or  larynx; 


140 


THE    CANADA    MEDICAL    RECORD. 


After  several  applications  of  trypsin  witliin 
the  hour,  a  still  father  attack  may  be  made 
upon  the  local  disease.  Having  used  more  or  less 
freely  most  of  the  germicides,  astringents  and 
antiseptics  commended  in  the  treatment  of  tli[)h- 
theria,  I  have  abandoned  all  else  for  a  solution  of 
equal  parts  of  the  tincture  of  the  chloride  of 
iron  and  glycerine.  I  have  cause  to  consider  this, 
when  well  applied  over  the  entire  extent  of  the 
diseased  surface,  an  almost  complete  bar  to 
the  progress  and  absorption  of  the  diphtheritic 
virus. 

1.  If  the  potency  of  the  disease  lies  in  the  rniiid 
multiplication  of  bacteria,  so  strong  a  chlorine 
solution  is  certainly  indicated. 

2.  If  absorption  takes  place  through  the  abraded 
surfaces  and  "mouths  of  lymphatics  open,''  as 
stated  by  Oertel,  we  would,  from  a  priori 
reasoning,  expect  some  good  from  the  local  use  of 
iron,  while  the  glycerine  may  be  something  more 
than  a  mere  vehicle,  in  that  it  may  by  aHinity 
relieve  to  some  extent  the  turgid  capillaries  of  the 
mucous  membrane.  The  apiilicalion  should  be 
made  frequently. 

Let  me  say,  in  urging  the  efficacy  of  this  agent, 
that  for  two  years  I  have  not  seen  a  case  of 
diphtheria  die  where  the  whole  of  the  false  mem- 
brane could  be  seen  and  repeatedly  covered  witli 
this  solution,  and  where  appropriate  general  treat- 
ment was  given.  Thrice  within  the  last  week,  and 
many  times  during  the  past  year,  I  have  seen 
the  characteristic  membrane  shrivel  up  and  be- 
come detached  under  the  intluence  of  tlie  iron  and 
glycerine. 

When  the  local  attack  is  out  of  reach  of  the 
direct  a|iplication  by  means  of  the  brush,  or  better 
still,  the  cotton  covered  probe,  tlic  case  is  very 
different. 

When  the  invasion  is  in  the  naso-pharynx,  or  in 
the  larynx,  the  result  may  well  be  dreaded. 
Even  in  such  instances  I  believe  the  best  pro- 
cediu'e  is  to  apply  the  iron  locally  by  spray, 
and  where  possible  by  the  cotton  covered  probe. 

The  covering  in  of  the  diphtheritic  patch  with 
tola  varnish,  as  recommended  by  Mackenzie, 
may  follow  the  thorough  use  of  the  iron  solution, 
and  is  doubtess  protective. 

Not  only  is  local  treatment  important,  but  it  is 
important  to  institute  it  eaily.  The  physician 
should  be  called  at  once  in  every  case  where 
there  is  a  doubt.  Parents  should  feel  that  they 
are  responsible  for  delay,  and  that  delay  is  exceed- 
ingly dangerous.  Many  cases,  that  during  the  first 
twenty-four  hours  are  easy  to  treat  and  curable, 
are  a  little  later  beyond  the  reach  of  the  most 
skilful. 

A  few  words  as  to  general  treatment.  Here, 
too,  I  have  no  sympathy  with  halfway  measures. 
First  of  all,  in  every  case,  I  nearly  always  counsel 
the  administration  of  enough  of  calomel  and 
soda  combined  to  thoroughly  evacuate  the  aliment- 
ary tract.  It  em[)lies  the  canal  of  any  accumu- 
lated material,  it  stimulates  im[)ortant  secretions, 


and  with  Ritter,  though  not  to  the  extent  to  which 
he  advocates  it,  I  believe  it  has  a  favorable  in- 
fluence upon  the  general  condition.  At  least  it 
clears  the  decks  for  action.  As  soon  as  the 
bowels  of  the  chiUl  have  been  well  moved,  and 
sometimes  not  waiting  for  that,  the  internal  use  of 
the  iron  and  i;lycerine  solution  (the  same  as 
that  used  in  the  throat)  may  be  begun  ;  for  we 
need  not  fear  any  chemical  reaction.  To  show 
that  others  are  falling  back  upon  this  well- 
known  agent,  let  me  quote  from  an  editorial  in 
a  recent  issue  of  the  New  En;^laiui  Medical 
l\/outlily: ''  It  is  interesting  and  somewhat  grati- 
fying to  note  that  after  each  excursion  into  the 
domain  of  experimental  medicine,  the  profession 
invariably  returns  to  the  older  and  more  effective 
method  of  treating  diphtheria,  which  consists  of 
tonic  doses  of  the  tincture  of  iron  and  a  system  of 
extreme  nourishment.'" 

To  anticipate  and  antagonize  general  invasion, 
the  general  as  well  as  the  local  treatment  should 
be  instituted  early.  Where  the  symptoms  demand 
I  prescribe  two  drops  of  the  iron  and  glycerine 
solution  for  each  year  of  the  child's  age,  in  a  little 
water  every  two  hours,  and  midway  between  each 
dose  the  diphtheritic  patch  is  to  be  touched  or 
sprayed  with  the  solution.  Thus  there  is  an 
opportimity  for  the  ferric  solution  to  be  brought  in 
contact  every  hour  with  so  much  of  the  diseased 
membrane  as  is  in  the  pharynx. 

I  have  not  discussed  much  of  the  poly-treaiment 
of  diphtheria  as  practised  to-day — nor  have  I  time 
to  outline  the  emergencies  which  may  arise,  as 
I  had  thought  of  doing.  My  object  has  been 
to  jiroiw.se  a  plain  and  direct  method  of  treatment 
which  any  one  may  use  and  whicii  is  not  an  ex- 
periment. 

Many  other  remedies  are  often  to  be  added. 
Pilocarpine,  when  the  skin  is  dry  and  there  is 
spasmodic  laryngeal  contraction  ;  quinine,  when 
the  fever  is  excessive  ;  steam  from  slacking  lime, 
when  respiration  is  labored  and  the  respiratory 
tract  dry ;  and  tracheotomy  or  intubation  when 
the  larynx  is  greatly  obstructed. 

Let  me,  in  conclusion,  suggest  that  the  physi- 
cian demand  of  tlie  people  among  whom  he 
practices  that  they  call  him  at  once  when 
suspicious  symptoms  are  observed,  and  that  he 
answer  quickly,  act  jiromptly,  and  see  that  his  in- 
structions are  implicitly  obeyed.  To  treat  diph- 
theria is  to  fight  a  battle — there  should  be  no 
delays,  surprises,  nor  compromises. — -Medical 
Digest. 


HA.MAMELIS  IN  THE  TREATMENT  OF 
DISEASES  OF  THE  SKIN. 
Witch-hazel  has  long  been  recognized  as  a 
vahialilc  therai)eutic  agent,  both  for  internal  and 
external  use.  For  years  it  has  been  placed  upon 
the  market  by  vendeis  under  various  names,  and 
higlily  extolled  for  its  medicinal  action.  In  very 
many  diseases  it  has  fulfilled  all  the  claims  which 


THE    CANAHA    MKnrCAr,    Ki:('OKI). 


1 1 


have  been  made  for  it,  such  as  its  use  for  piles, 
Sores,  cuts,  and  .ill  luinorrliags.  It  has,  owing  to 
its  decided  actinn  in  liiosc  diseases,  become  in 
America  a  standard  domestic  remedy,  whicli  is 
trei|Ucntly  resorletl  to  by  pliysicians,  more  parti 
cularly  those  residing  in  the  country. 

Siieces^Cul  resuUs  iiave  again  and  again  been 
noted,  by  many  physicians,  of  the  ai:lion  of  this 
drug  in  numerous  (hseases  in  which  other  remeilies 
liave  failed.  Ringer,  among  others,  lias  noticed, 
1  may  say,  this  uniform  action  of  hamamelis,  and 
rei)orts  that  he  h.is  knt)wn  it  to  arrest  h;eniaturia 
in  four  cases  whicli  had  resisted  many  oilier 
remedies.  It  has  been  found  to  be  e(iually  effec- 
tive as  a  haemostatic  in  bleeding  from  the  lungs 
and  other  organs  .  Its  action  is  claimed  to  be  that 
of  a  vascular  sedative. 

Dnjardin-Heaumetz  thinks  that  it  has  an  action 
on  the  muscular  fil)res  of  the  veins.  Hector 
tniy,  however,  alleges,  after  testing  the  drug 
thoroughly,  that  it  shows  no  special  physiological 
action  on  the  vascular  system.  Several  American 
investig.itors  have  also  recently  denied  the  action 
claimed  for  hamamelis. 

Clinical  experience,  however,  is  more  reliable 
than  physiological  theory,  and  clinically  [  know 
of  its  value.  I  have  referred  to  it  at  greater 
length  in  a  paper,  oi;  its  general  action,  read 
before  the  Section  of  Therapeulics  at  the  last 
animal  meeting  of  the  British  Medical  Association. 
I  again  aftirm  that  it  possesses  undoubted  action 
in  lessening  local  inllammation. 

Abundant  evidence,  clinically,  has  been  fur- 
nished of  this  action  by  a  large  number  of  physi- 
cians, chielly  in  America,  in  which  country  it  is 
the  more  largely  used.  It  is  not  my  object,  in 
this  brief  paper,  to  give  an  extensive  rhume  of 
hamamelis,  but  to  limit  my  remarks  to  its  good 
effect  in  the  treatment  of  disease  of  the 
skin. 

Hamamelis  may  be  employed  in  diseases  of  the 
skin,  both  internally  and  externally.  Adminis- 
tered internally,  in  ihe  form  of  the  Huid  extract,  it 
appears  to  lessen  the  flow  of  blood  through  the 
vessels  in  inflammatory  affections  of  the  skin.  Its 
action  is,  [lerhaps,  more  decided  in  eczema,  espe- 
cially in  the  acute  and  subacute  forms.  In  cases 
in  which  the  disease  is  more  or  less  general,  the 
surface  red,  hot,  and  tumid,  the  use  of  from  one 
to  thirty  minims  of  the  fluid  extract  of  hamamelis 
in  water  or  on  sugar,  every  two  or  three  hours, 
often  has  a  most  decided  and  speedy  good  result. 
The  engorgement  lessens  and  often  disappears.  It 
may  be  necessary  in  order  entirely  to  remove  the 
disease,  to  apply,  in  addition,  some  appropriate 
local  treatment.  The  action  claimed  for  hama- 
melis is,  not  that  it  always  cures  the  disease,  but 
that  it  lessens  the  flow  of  blood  through  the 
vessels,  and  thus  relieves,  benefits,  and  hastens  a 
cure.  In  no  class  of  cases  will  witch-hazel  act 
so  well  as  in  those  unfortunate  infants  suffering 
from  pustular  eczema  or  crusta  lactea.  The  fluid 
extract  of  hamamelis  in  infantile  eczema    can   be 


administered  in  from  a  half  to  five  drops,  in  syrup 
or  milk,  every  two  or  three  hours.  In  many  cases 
its  use  will  cause  all  constitutional  excitement  to 
abate,  the  serous  or  sero-purulcnt  discharge  to 
lessen,  and  the  inflamed  and  swollen  condition  of 
the  tissues  to  decline.  It  will,  if  persisted  in,  very 
oflen  thus  bring  to  the  little  sufferer  the  greatest 
relief  from  the  high  vascular  excitement  and  the 
into'e.able  itching. 

Hamamelis  is  also  a  v,dual)le  remedy  locally  in 
eczema,  either  in  the  form  of  the  tincture,  or  in 
that  of  the  diluted  lliiid  extract.  In  some  cases, 
in  addition  to  its  internal  use,  it  may  also  be  well 
to  aiiply  Ihe  diug  locally.  In  others  the  tincture 
is  the  preferable  form  to  use,  from  two  to  eight 
drachms  being  employed  with  four  or  five  ounces 
of  water.  A  piece  of  old  muslin  is  saturated  in 
the  lotion  aiitl  spread  constantly  over  the  in- 
flamed part.  In  others,  again,  an  ointment  is  better 
borne,  and  can  be  prepared  by  incorporating  from 
a  half  to  two  or  UKjre  drachms  wiih  some  fatty 
vehicle — l.ird,  suet,  or  lanolin  being  always  prefe- 
rable. Hamamelis  thus  used  has  both  an  astrin- 
gent and  a  sedative  action  on  the  tissues,  and  will 
often  quickly  lessen  inflammatory  action  it  the 
part  to  which  it  is  applied. 

In  erysi|)elas,  I  have  known  some  good  results 
to  follow  from  its  internal  administration,  but  the 
results  so  far  are  not  sufl'icient  to  warrant  my 
recommending  it  as  a  remedy  to  be  depended 
upon  to  control  the  constitutional  symptoms  of 
this  disease.  Locally,  a  lotion  of  hamamelis,  one 
part  of  the  tincture  to  five  or  six  of  water,  may  be 
em|)loyed  in  erysipelas  in  addition  to  other  to[)i- 
cal  agents.  It  has,  by  its  evaporating  action,  a 
most  delightful  refrigerant  and  sootliing  effect 
upon  the  hot  and  tumid  skin.  Its  efficacy  is 
often  enhanced  locally  in  erysi])elas  by  adding  one 
or  more  parts  of  tincture  of  opium  to  the  lotion. 
Hamamelis  in  acne,  jiarticularly  in  the  pustular 
form,  acts  well  both  internally  and  locally.  It 
lessens  the  discharge,  and,  by  its  local  astringent 
action  in  the  form  of  a  lotion,  brings  great  relief 
to  the  inflamed  and  distended  glands.  In  rosa- 
cea, its  action  is  even  more  decided  by  its  con- 
trolling effect  upon  the  enlarged  capillaries  used 
both  internally  and  externally.  In  obstinate  ca.ses, 
I  usually  push  the  drug  to  full  doses,  giving  often 
as  much  as  two  drachms  three  or  four  times  daily, 
and  I  have  applied  at  the  sane  time  a  lotion  of  one 
part  of  the  tincture  in  four  or  five  of  water.  The 
lotion  is  Increased  from  time  to  time  until  it  is 
applied  in  full  strength.  The  enlarged  capillaries 
slowly  contract  under  its  continued  use,  the  en- 
gorgement lessens  and  the  tissues  of  the  part  tend 
by  degrees  to  become  normal. 

Hamamelis  in  the  form  of  the  tincture  is  a 
remedy  of  very  great  benefit  in  both  seborrhcea 
oleosa  and  sicca.  A  lotion  composed  of  one 
part  of  the  tincture,  with  three  or  four  of  water, 
removes  rapidly  the  greasy  and  g.istening  condi- 
tion ]3iesent  on  the  face  and  other  parts  of  the 
)  body  in  those  afflicted  with  seborrhcea  oleosa.     In 


142 


THE   CANADA   MEDICAL   RECORD. 


like  manner  it  removes  and  cleanses  the  surface 
of  the  scales  and  crusts,  and  has  an  astringent 
action  upon  the  follicles  in  seborrhcea  sicca.  Loss 
of  iiair,  which  so  often  follows  from  the  dry  form 
of  seborrhoja,  is  not  only  prevented,  but  the 
disorder  icnioved  by  the  local  application  of  the 
tincture.  In  employing  it  in  tliis  disease,  the 
tincture  sliould  be  a|iphed  in  full  strengtli,  or  with 
half  water.  The  efficacy  of  the  lotion  is  often 
increased  in  this  form  of  seborrhcea,  and  in  alopecia, 
by  the  addition  to  it  of  from  one  to  ten  grains  of 
corrosive  sublimate  to  each  four  ounces.  The 
tinctiue,  either  alone  or  combined  with  ten  to 
thirty  grains  of  Ijoracic  acid,  promptly  lessens 
and  often  thoroughly  arrests  the  excessive  secre- 
tion of  sweat  that  occurs  on  the  hands  and  feet,  and 
in  the  axillary  and  inguinal  regions.  It  acts  fre- 
quently in  a  similar  manner  in  fetid  secretion,  not 
only  in  lessening  and  slopping  the  discharge,  but 
in  allaying  all  unjjieasant  odor.  In  the  latter 
disease  the  action  of  hamamelis  is  often  enhanced 
by  the  addition  of  either  five  or  ten  grains  of 
corrosive  sublimate  or  boracic  acid.  The  same 
jireparation  of  hamamelis  alone,  or  combined  as 
above  recommended,  is  an  efficacious  a]jplication 
is  many  forms  of  itching  of  the  skin. 

Hamamelis  internally  is  a  useful  adjuvant  to 
other  remedies  in  the  treatment  of  certain  lf)rnis 
of  psoriasis.  It  is  more  especially  ada[iled  to 
those  cases  which  aie  attended  with  severe 
inflammatory  action  and  itching  of  the  skin.  The 
fluid  extract  of  hamamelis  in  large  and  repeated 
doses,  in  such  examiiles  of  psoiiasis  as  referred  to, 
will  often  lessen  the  local  symptoms  and  assist 
very  much  the  action  of  other  suitable  remedies 
in  controlling  or  removing  the  disease.  The  same 
preparation  just  alluded  to  is  also  of  great  utiliiy 
in  purpura,  esjiecially  in  the  simple  variety.  It 
must,  however,  be  given  in  full  and  frequently  re- 
peated doses,  until  the  desired  effect  is  jiroduced. 

Lastly,  I  desire  also  to  testify  to  what  has 
already  been  so  ably  reported  by  Dr.  Musser,  of 
{'hiladeljihia,  and  others,  of  the  value  of  hamame- 
lis in  the  tieatmenl  of  ulcers,  particularly  the 
varicose  form.  From  the  adr.iuiistration  of  full 
doses  of  the  fluid  extract,  and  the  local  application 
of  the  tincture,  I  have  very  often  observed  indo- 
lent, inflamed,  and  irritable  ulcerative  surfaces 
rajjidly  take  on  healthy  action,  and  be  finally 
cured.  In  employing  hamamelis  I  always  prefer 
for  internal  use  the  fluid  extract,  which  is  more 
certain  in  its  effect.  The  tincture  'is  usually 
sufficiently  strong  for  all  local  applications,  and 
very  often  it  becomes  necessary  to  dilute  it  with 
water. — Shoe.m.\ker,  The  Medical Bi(Le:in. 


CHRONIC  rROST.\TIS. 

r.y    W.  II.  Danfokth,     M.    D.,  in    North    Wesierii 
I,(iiiiit. 

Chronic  prostatitis  is,  in  the  majority  of  cases, 
the  result  of  a  gonorrhoea,  where  the  inllammation 
has  passed  the  compressor  urethras  or  the  prostate 
itself. 


Next  in  frequency  as  causes  come  masturbation 
and  excesses  in  venery,  as  these  habits  keep  up 
a  continual  congestion  in  the  prostatic  region  ;  but 
in  this  case  the  inflammation  is  chronic  from  the 
beginning,  and  usually. the  secretion  is  mucous 
aiid  not  purulent. 

The  disease  may  arise  from  stricture,  unskilful 
instrumentation,  irritating  drugs,  and,  perhaps, 
from  the  passage  of  concretions  and  sand  in  the 
urine. 

Probably  the  prostate  itself  is  not  always  afiect- 
ed  by  the  inflammation ;  for  it  is  often  found 
normal  in  size  and  not  tender  to  the  touch  ;  this 
is  most  noticeably  the  case  in  the  chronic  cases 
arising  from  masturbation.  For  this  reason  it 
seems  incorrect  to  apply  the  term  '■  prostatitis  "  lo 
every  inflammation  in  the  prostatic  urethra.  The 
inflammation  probably  always  begins  in  the 
mucous  membrane  of  the  urethra,  and  may  or  may 
not  extend  into  the  follicles  of  the  gland  later. 

If  we  adopt  Ultzmann's  view,  we  apply  the  term 
"  catarrh  of  the  neck  of  the  bladder  "  to  all  inflam- 
mations of  the  posterior  part  of  the  urethra, 
whether  involving  the  prostate  or  not. 

When  an  acute  attack  of  prostatitis  comes  on 
<luring  a  gononhcea,  it  is  announced  by  very  fre- 
(|uent  and  painful  micturition,  weight  and  throbbing 
in  the  i)enn,-um,  pain  on  defecation,  and,  perhajis, 
an  attack  on  retention.  The  symptotns  of  the 
chronic  form,  whether  from  an  acute  ca.se  or  other 
cause,  are  as  follows  :  (These  will  not  all  be  seen 
in  the  same  patient,  usually.) 

(i)  Increased  frequency  of  micturition,  but 
much  less  than  in  the  acute  form.  Ultzmann's 
says  :  "  Frequent  micturition  in  the  disease  of  the 
posterior  urethra  is  such  a  very  characteristic 
symi)tom,  that  froin  the  presence  of  this  sign  alone 
we  can  always  conclude  with  certainty  upon  a 
lesion  in  the  neck  of  the  bladder."  (2)  "  Bearing 
down  "  and  uneasiness  in  the  perineum  and  anus. 
(3 )  .Slight  i^ain  or  uneasiness  at  the  end  of  micturi- 
tion. (4)  Tenderness  around  the  prostate  on 
passage  of  a  sound.  In  long  standing  cases  the 
urethra  becomes  anresthetic,  and  this  symptom 
is  lost.  (5)  Inability  to  urinate  on  iriaking  the  "V 
attempt  is  a  prominent  symptom.  (6)  Ditiiinution 
in  the  force  of  the  stream  and  dribbling  after 
micturition.  (7)  Refle.x  spasm  of  the  compressor 
urethra  ;  this  is  of  common  occurrence.  (8)  Fre- 
quent erections  and  erotic  desires,  as  well  as  fre- 
quent seminal  emissions  at  night,  are  often  com- 
plained of;  but  in  cases  of  long  durations  the 
opj)osite  extreme  is  found,  and  partial  or  complete 
impotence  may  be  present,  causing  the  utmost 
depression.  (9)  There  may  be  a  discharge  o(  mucus 
from  the  urethra,  showing  the  presence  of  inflam- 
mation anterior  to  the  compressor  urethra  ;  when, 
however,  the  inflamtnation  is  confined  to  the  ])ros- 
tatic  urethra,  the  secretion  appears  only  in  the 
urine.  This,  of  course,  is  due  to  the  strength  of 
the  compressor,  keejiing  back  secretions  posterior 
to  it.  (10)  Mucus  may  be  discharged  from  the 
urethra  during   straining  at  stoolj  simulating  the 


THE   CANADA  MEDICAL   RECORD. 


14;$ 


discharge  in  speinKitonlicc.a,  tlie  microscope 
settles  this  point,  (ii)  When  the  urine  is  passed 
in  two  portions,  characteristic  appearances  are 
seen.  I'llzniann  siys,"  If  only  a  little  secretion 
has  collected  in  the  posterior  urethra  the  urine  in 
the  bladder  remains  uninHuenced,  and  if  we  have 
the  patient  urinate  successfully  in  two  glasses,  only 
the  first  i)ortion  of  the  urine  passed  will  appear 
turbid,  the  second  half  remaining  clear  and  trans- 
parent. If,  however,  the  secretion  in  the  posterior 
urethra  is  considerable  in  amount,  it  will  tlow 
back  into  the  bladder,  make  the  urine  more  or  less 
turbid  and  even  irritate  the  bladder  itself.  In 
this  case,  both  specimens  of  urine  (j)assed  into 
two  glasses)  will  appear  turbid.  However,  as 
a  distinction  from  a  primary  cystitis,  the  first  half 
of  the  urine  will  appear  more  turbid  than  the 
second,  and  will  contain  more  compact  tlakes, 
which  all  come  from  the  urethra,  and  which,  accord- 
ingly, are  absent  from  the  second  ]5ortion  of  urine 
passed."  (12)  These  "tlakes"  are  so-called 
"prostatic  shreds,"  and  consist  of  short,  thick, 
clumpy  masses,  which,  under  the  microscope,  are 
seen  to  be  collections  of  pus,  prostatic  epithelium 
and  mucus,  with  sometimes  a  few  spermatozoa. 
They  occupy  the  follicles  of  the  prostate,  are 
washed  out  by  the  urine.  (13)  Shreds  from  the 
anterior  urethra  may  also  sometimes  be  seen  in 
the  first  jiortion  of  the  urine  ;  these  are  longer  and 
thinner,  and  consist  of  pus  and  urethral  e|)itheliiHn. 
(14)  'I'he  urine  contains  mucus,  prostatic  epithe- 
lium, pus,  often  spermatozoa,  and  someiimes 
blood  corpuscles. 

A  trace  of  albumin  is  often  seen,  which  disap- 
pears when  a  cure  is  effected.  (15)  On  rectal 
examination,  the  prostate  is  usually  found  some 
what  enlarged  and  tender ;  it  may  be  normal  in 
size  and  not  tender.  In  which  case  the  infian>- 
malion  is  probably  mostly  in  the  mucous  mem- 
brane of  the  urethra.  (With  enlargement  of  the 
gland  there  may  be  residual  urine.)  (16)  Neu- 
ralgic ])ains  in  the  back  and  groin  are  frequent 
subjective  symptoms.  Dr.  F.  S.  Watson  says : 
"These  pains  vary  as  to  constancy  and  duration, 
and  may  be  entirely  absent." 

The  frequency  of  micturition,  with  pain,  and 
blood  appearing  at  the  end  of  the  act,  may  stim- 
ulate the  symptoms  of  stone  in  the  bladder.  This 
happens  only  in  the  acute  cases,  and  rectal  exami- 
nation and  sounding  make  the  diagnosis  clear. 
True  hyjiertrophy  of  the  prostate  occurs  only  after 
the  fiftieth  year,  and  can  hardly  be  mistaken  for 
an  inflammation. 

In  cystitis  the  pain  is  felt  above  the  symphysis 
pubis  instead  of  in  the  perineum  ;  the  urine  is  gene- 
rally alkaline  and  the  second  part  of  the  urine  is  as 
turbid  as  the  first.  Cystitis  is,  however,  often  asso- 
ciated with  a  chronic  catarrh  of  the  neck  of  the 
bladder. 

The  treatment  should  be  both  general  and  local. 

The  patient  should  take  no  alcohol,  he  should 
sleep  on  a  hard  mattress  in  a  cool  room ;  he 
should  take  moderate  exercise  daily  out  of  doors ; 


his  bowels  should  be  kept  open,  and  he  should  be 
given  tonics  and  plenty  of  nourishing  food.  The 
drine  must  be  kept  dilute  and  unirritating  by 
diuretics. 

For_  tliis  purpose  lienzoate  of  soda,  twenty 
grains,  given  four  times  a  day,  is  an  excellent 
remedy. 

Locally,  counter-irritation  to  the  pereneum  is 
beneficial.  One  side  of  the  raphe  is  to  be  painted 
with  cantharidal  collodion  or  tincture  of  iodine, 
and  in  a  few  days  the  other  side.  This  may  be 
kept  up  for  some  time,  and  will  usually  relieve  the 
sense  of  weight  and  uneasiness.  Care  must  be 
taken  to  prevent  the  irritant  from  touching  the 
anus. 

Together  with  this  the  jsrostatic  injection  of 
nitrate  of  silver  is  probably  the  best  remedy.  It 
is  best  to  begin  with  a  solution  of  •^wo  grains  to 
tlie  ounce,  and  increase  to  five  grains.  In  mak- 
ing the  injection  it  is  well  to  pass  a  good  sized 
sound  first,  in  order  to  stretch  the  urethra  so  that 
the  fluid  may  readily  penetrate  to  all  parts.  (The 
sound  should  be  lubricated  with  glycerine,  as  oil 
will  (orm  a  coating  over  the  urethra  and  modify 
the  effect  of  the  application.)  Then  a  drachm  of 
the  warmed  solution  is  to  be  injected  slowly,  the 
jjoint  of  the  syringe  having  been  located  at  i)ros- 
latic  urethra  by  the  finger  in  the  rectum. 

Ultzmann's  syiinge  catheter,  fenestrated  on  the 
sides,  connected  by  a  rubber  tube  to  small  .syringe, 
is  the  most  convenient  instrument  to  use. 

The  ajiplication  should  be  made  twice  a  week, 
using  no  more  than  a  five-grain  solution,  and  the 
treatment  kept  up  for  six  or  eight  weeks.  If,  in 
that  time,  no  improvement  is  noticed,  the  injec- 
tions should  be  discontinued  for  a  time  and  other 
means  employed. 

Combined  with  the  deep  injections  and  counter- 
irritation,  large  sounds  to  be  passed  once  or  twice 
a  week.  In  the  large  majority  of  chronic  cases 
the  above  treatment  will  bring  about  good  results. 
It  is  particularly  api>licable  to  the  chronic  "  mas- 
"  turbation  cases." 

The  Canada  Mkdical  Record. 

A  Monthly  Journal  of  Medicine  and  Surgery- 

EDITORS  : 

FRANCIS  ",V.  CAMPBELL,   MA..  M.D.,  L.K.C.P.  LOND, 

Eilit'H-  .and  I'lnpriet'tr. 

R.  A.  KENNEDY,  M.A.,  M.D.,  M.uiaKi"g  K.litor. 
ASSISTANT   EDITORS: 
CASEY  A.  WOOD,  CM.,  IMD. 
GEORGE  E,  AKIflSTHONG,  CM.,  M.D. 

SUBSCRIPTION    TWO    IIOLLAIIS    PEI!    AX.\UM. 

All  covimunication!^  and  J'UchaiUfea  vtttHt  Of  addressed  to 
the  Editors,  Untwer^oQ,  Post   O0ce,  Montreal . 


MONTREAL,  MARCH,  18S7. 


THE  NEW  MEDICAL  ACT  FOR   THE 

PROVINCE  OF  QUEBEC. 
The  committee  named  by  the  College  of  Physi- 


144 


tllK   CANADA  MEDICAt  RECJoili). 


cians  and  Surgeons,  to  prepare  the  new  Medical 
Bill,  have  placed  the  preparation  of  it  in  tlic  hands 
of  Mr.  Pagnuelo,  Q.  C,  who  has  submitted  to  them 
a  rough  draft.  Several  meetings  have  been  held, 
at  which  it  has  been  discussed  ;  but  after  mature 
deliberation,  it  has  been  decided  not  to  bring  it  be- 
fore the  present  session  of  the  Quebec  Legislature. 
In  this  decision  we  think  tlie  Connnittee  have 
shown  wisdom.  At  tiie  same  time  we  would 
suggest  that  tlie  time  when  it  was  intended  to 
bring  the  Act  into  force  must  of  necessity  be  ex- 
tended. We  also  hold  the  opinion  very  strongly 
that  the  Act  should  not  be  made  re-troactive.  On 
this  ]3oint,  we  know  there  is  a  very  strong  feeling 
among  the  students  of  the  various  schools,  and  as 
it  will  affect  them  materially  we  think  their  feelings 
should  be  consulted.  Especially  is  this  the  case, 
when  we  know  that  if  such  changes,as  are  proposed 
in  tlie  new  Medical  Act,  were  University  changes, 
students  who  had  actually  commenced  the  study 
would  not  be  affected  by  them.  This  is  the  rule  in 
Universities,  and  we  fail  to  see  why  the  College  of 
Physicians  and  Surgeons  should  adopt  a  different 
course. 


COLLEGE  OF  PHYSICIANS  AND  SUR 
GEONS,  PROVINCE  OF  QUEBEC. 
We  specially  direct  attention  to  the  advertise- 
ment of  this  College,  which  will  be  found  on  the 
first  page  of  the  Record.  'J'he  date  of  the  pre- 
liminary examination  for  the  admission  to  the  study 
of  Medicine  is  on  the  ^th  of  May.  In  our  last  is- 
sue it  was  erroneously  stated  to  be  the  i2lhof 
May. 


The  various  Medical  Schools  in  Montreal  closed 
their  lectures  the  end  of  this  month,  and  are  now 

engaged  on  the  examinations.     In  our  next  issue 
we  will  give  the  results. 


The  proposed  changes  in  the  i)rcliminary 
examination  for  admission  to  tlie  study  of  Medi- 
cine are  exciting  the  heads  of  the  two  Protestant 
Universities  in  this  Province.  We  projiose  to  deal 
with  this  question  in  our  next  issue.  In  the  mean- 
time, we  must  say  that  both  Universities  are  very 
much  to  blame  in  having  allowed  this  matter,  here- 
tofore, always  to  have  been  decided  by  their  Medi- 
cal Faculties.  The  sudden  awakening  which  has 
overtaken  them  is  likely  to  lead  to  some  unfor- 
tunate comjilications. 


NERVOUS  HEADACHE. 

Professor  Arnold  of  Baltimore  says  that  in  ner- 
vous headache  of  the  neurasthenic  variety,  he  has 
found  much  benefit  from  twenty  drops  of  Ether 
and  ten  of  the  Tincture  of  Canabis  Indicus.  It  is 
recomincnded  to  precede  this  remedy  by  a  good 
night's  rest,  obtained  from  chloral. 


NEW  MEDICAL  JOURNAL  IN  MONTREAL. 

We  have  received  the  first  number  of  "  Le 
Gazette  Medicale  de  Montreal  "  edited  by  Drs- 
Hingston,  Paquet  and  Dcsjardin.  It  is  elegantly 
printed,  and  the  names  of  tlie  editors  a  sufficient 
guarantee  of  the  character  of  its  contents. 


hydrastus  canadensis  in  uterine 
h.e:morrhage. 

Dr.  Reynold  W.  Wilcox  reports  in  the  N.  Y. 
Mi'iUcal  Journal  for  February  1 9th  forty-three 
cases  of  various  forms  of  uterine  htemorrhage,  in 
which  he  employed  the  Fluid  Extract  of  Hydraslus 
Canadensis  in  doses  of  twenty  drojis,  three  or 
four  times  a  day  in  a  wine-glass  of  water.  The 
result  was  excellent. 


PNEUMONIA  IN  NEW  YORK. 

The  very  variable  weather  which  New  York 
has  experienced  this  winter  has  been  prolific  in 
producing  Pneumonia,  and  that  of  a  fatal  type. 


PERSONAL. 

Dr.  Bell  and  Dr.  Sutherland  of  Montreal  jno- 
pose  leaving  for  Europe  some  time  next  month. 
]  )r.  Roddick  of  Montreal  has  left  Florida,  on  his 
way   home,  and   will  be    here  early    next   month. 

Dr.  Kennedy,  Registrar  of  the  Medical  Faculty, 
of  Bishop's  College,  has  gone  to  Colorado  for  the 
benefit  of  his  health.  He  proposes  to  remain 
away  till  early  in  May. 

Dr.  A.  Lapthorn  Smith  and  Dr.  George  T.  Ross, 
of  I!ishops  College  Faculty  of  Medicine,  leave  for      j 
Vienna  next  month,  where  they  will  pass  the  sum-      t 
mer  returning  in  time  for  the  opening  of  the  winter 
session. 


THE  CANADA  MEDICAL  RECORD. 


Vol.  XV. 


MONTREAL,    APRIL,    1887. 


No.  7. 


COUSTTEHSTTS. 


ORIGINAL  COMMUNICATIONS. 

Casu  nf  rut).-!!  (nslaii-.n 14r> 

(Jyiia'i-nhiyirui  iCriinrI    ....   14(; 

CORRESPONDENCE. 

Letter  from  New  York 147 

London  LetkT 14H 

C'orrtTtion 149 

PROGRESS  OF  SCIENCE. 

Chronic  INiruieiit  Ot()rrlia>a,  itB  Nature 
iiiul  Trealment 149 

Treatment  of  Pneumonia  in  Ihe  New 
York  Kospitiils 153 

Tlie  Tn'ut inciii  i-f  Pneumonia  in  the 
Philadclphiu  Hospitals 155 


Intubution  of  Llin  Larynx  tor  ( (hstruc- 
tions  arising  from  Inllamniatory 
(.'onditioiis 

PrccociouH  Cliildren 

Congenital  Hereditary  Atonic  Ijys- 
pepsia 

WartK 

A  New  Treatment  of  Gonorrhoea 

Tlie  Treatment  of  Khenmatism  in  tho 
UnivLTsilv  *>f  Pennsylvania 

^Vhat  Causes  \\\'ak  and  Tired  Kyos. . . 

Kczematous  Llcerationa  of  the  Cornea; 
Ec'/.i-ma  of  Ear  and  Seatp ;  Diag- 
nosis and  i'rpatment 

Some  Surgical  Hints 

Conium  for  Sleeplesness 

Psoas  Abscess ;  When  and  How  to 
Open  it 


TreatnioMt  of  Acute  TonsillitiK 102 

A  Kapid  Mi'thod  in   the  Treatment  of 

Frai'lnrcH W>2 

Chlorofnrm  in  Labor IC'f 

'i'o  I'rovenl  Mammary  Ab«  ;es8 ](j.'J 

A  Suggested  Alteration  in  the  Liquor- 
ice I'o  wdcr 163 

Varicose  Veins  and  their  Treatment  by 
Operation lUl 

EDITORIAL. 

Annual  Convocation   of    Ihe   Mudical 

Faculty  of  liishop's  College 166 

International  Congress  on  Inebriety...  168 
Personal 1G8 


(tln§inal  Qominunicaffoni. 


CASE  OF  TUBAL  GESTATION. 

By  Dr.  Carr  Hoi-stok  Roberts,  L.R.C.P.,  Loiul., 
M.R.C.S.E.,  L.vS.A.,  London. 

In  the  November  number  of  the  "Record"  for 
1882,  I  reported  a  case  of  Interstitial  Gestation 
which  terminated  fatally  at  tiie  end  of  the  second 
month,  from  spontaneous  rupture  of  the  sac  ;  per- 
haps the  following  brief  history  of  a  case  which 
ran  through  and  beyond  the  full  period  of  ordi- 
nary gestation  may  not  be  uninteresting. 

Mrs.  C,  a;t  35,  a  middle-sized,  intelligent  woman, 
with  a  healthy  physique,  who  had  been  married 
many  years,  but  had  never  had  any  family  and  had 
never  miscarried,  consulted  me  on  the  4th  June, 
1885,  suspecting  that  she  was  enceinte;  cata- 
menia  (which,  as  a  rule,  were  always  pretty  regu- 
lar) ceased  on  the  4lh  March  ;  all  the  usual  signs 
of  pregnancy  were  present,  and  with  the  exception 
of  the  abdomen  being  very  much  larger  than  is 
usual  at  so  short  an  interval,  there  was  nothing  to 
indicate  its  being  anything  more  than  an  ordinary 
case.  I  considered  her  to  be  pregnant,  but  that 
there  might  be  a  tumor  of  some  kind  in  addition, 
and  I  advised  her  to  wait  patiently  the  course 
of  events.  I  saw  her  from  time  to  time,  and  she 
continued  to  increase  in  size,  and  the  first  week  in 
August  she  felt  ftetal  movements.  On  the  4th 
October  she  again  consulted  me,  having  most  un- 
fortunately contracted  syphilis,  which  yielded  to 
Iodide  of  Potassium  (she  was  not  mercurialized); 
but  she  rapidly  lost  flesh,  the  abdomen  increased 
greatly  in  size,  but  the  "swelling  dropped,"    re- 


peated digital  examinations  failed   to  reach  the 
OS,  nor  could  a  sound  be  passed  ;  but  early  in  Oc- 
tober  foetal  movements   could  be  distinctly    felt 
and  seen,  and  the  fcetal  heart  heard.     She  suffered 
the  first  week  in  November  from  a  sharp  attack 
of  subacute  peritonitis,  which  left  her  very  prostrate 
and  very  much  emaciated,  and  she  became  subject 
to  attacks  of  most  acute  pain  which  were  only  con- 
trolled  by    Hypodermic    injections  of  Morphia, 
there  had  been  for   some  time  lacteal  fluid  in  the 
mammre,   she  also  complained  of  "crackling  in 
her   inside  like  the  crackling   of  parchment.  "    I 
came    to  the  conclusion   that    it  was    a  case    of 
Interstitial  Tubal  Gestation,  and  asked  Mr.  Alban 
Doran  to  see  tbe  case  with   me,  which  he  kindly 
did  on  several  occasions,  on  one  of  which  he  suc- 
ceeded in  reaching  the  os  and    finding  the  uterus 
empty,  it  was  decided  to  wait  until  the  ordinary  nine 
months    elapsed,    and   she    was    removed  to   the 
Samaritan   Hospital,  on  the   17th   February.     Sir 
Spencer  Wells  kindly  met  us  in  consultation,  and 
it  was  decided  to  operate  as  soon  as  a  bad  bed  .sore, 
which  she  unfortunately  had,  should  be  somewhat 
improved.     The  operation  was  performed   on  the 
26th  March,  1886,  and  on  opening  the  abdominal 
cavity,  a  large  tumor  was   exposed,  with  a  shiny, 
smooth  surface  of  a  dark  red  color  ;  it  was  tapped 
but  neither  fluid  nor  blood  escaped.    Fearing  that 
the  tumor  might  be  a  malignant  growth,  and  as  no 
foitus  could  be  felt  through   the  anterior  wall   of 
the  tumor,   Mr.   Doran,  assisted  by  Dr.  Bantock, 
cleared  away  adhesions,  which  were  very  intimate 
posteriorly  ;  in  so  doing  the  transverse  colon  and 
sigmoid  flexure  were  lacerated,  and  required  suture. 
The  cyst,  when  raised,  burst  on  its  right  side,  and 


146 


THE    CANADA   MEDICAL   RECORD. 


then  the  fcetus  was  seen  and  removed,  a  wire 
clamp  was  passed  round  the  root  or  base  of  the 
tumor,  and  a  drainage  tube  was  passed  into 
Douglas'  pouch  ;  there  was  little  or  no  hemorrhage, 
but  a  considerable  amount  of  shock,  and  the  patient 
succumbed  the  following  night.  The  uterus, placenta, 
and  other  parts  removed  are  at  present  being  dis- 
sected, and  the  result  I  hope  to  make  known  to 
to  your  readers  at  some  not  very  remote  period;  but 
I  may  incidentally  remark  that  the  fcetus,  a  full 
grown  and  remarkably  fine  tnale  child,  was  not  in 
the  least  offensive  or  decomposed,  but  entire  and 
in  a  very  good  state  of  preservation.  There  was  no 
doubt  about  the  pregnancy  being  tubul,  and 
altogether  the  case  was  a  very  remarkable  one 
amongst  these  fortunately  rare  cases.  Whether  an 
operation  if  performed  earlier  would  have  been 
more  successful,  what  share  the  syphilis  had  in 
impairing  the  mother's  health,  and  what  was  the 
cause  of  the  peritoneal  inflammation,  are  problems 
that  require  a  good  deal  of  solving.  The  length  to 
which  gestation  extended,  the  remarkable  state  of 
preservation  in  which  the  infant  was,  and  the  very 
great  state  of  emaciation  to  which  the  mother  was 
reduced,  she  was  quite  a  skeleton,  are  very  remark- 
able features  in  this  very  remarkable  case.  I  omit- 
ted to  say  that  the  specimen  referred  to  in  Novem- 
ber, 1882,  was  sent  to  the  museum  of  the  Royal 
College  of  surgeons,  and  is,  I  believe,  the  only 
perfect  specimen  in  that  or  any  other  museum. 
London,  60  Haries  St.  W.,  April,  1887. 


GYNECOLOGICAL  REPORT. 

By  E.   H.  Treniiolme,  M.D.,  CM.,  B.C.L.,  Professor  of 

Gynecology,  Medical  Faculty,  University  of  Bishop's 

College,  Montreal. 

VICARIOUS   MENSTRUATION. 

A  most  interesting  discussion  aroused  upon  this 
subject  has  lately  appeared  in  the  British  Medical 
Journal.  Dr.  Barnes  read  a  paper  upon  the  sub- 
ject, which  was  marked  by  his  usual  ability,  and  in 
which  he  related  a  number  of  cases  illustrative  of 
the  views  generally  held,  and  currently  accepted  as 
to  the  truth  of  vicarious  menstruation. 

Dr.  Wilkes,  who  was  present  at  the  reading  of 
the  paper,  by  invitation  of  Dr.  Barnes,  made  a  re- 
markable address  in  reply  to  the  views  advanced, 
and  expressed  his  adherence  to  views  he  had 
already  advanced,  as  to  the  sure  e.xistence  of 
vicarious  menstruation.  Dr.  Wilkes  said  his  scep- 
ticism as   to  the  e.\istence  of  an  affection,    long 


accepted  and  taught  by  lecturers  and  writers  upon 
diseases  of  women,  arose  from  personal  investiga- 
tion of  the  supposed  cases,  in  every  one  of  which 
he  found  that  the  positive  assurance  of  patients 
and  friends  as  to  the  periodicity  of  the  bleeding 
was  erroneous.  This  sta'tement  was  followed  up 
with  an  examination  of  the  cases  reported  by 
authors,  in  which  he  brings  before  us  their  paucity 
as  to  numbers,  and  more  liability  as  to  fact.  This 
quite  startles  one,  but,  nevertheless  Dr.  Wilkes' 
position  seems  well  taken,  and  he  can  only  be 
dislodged  therefrom  by  the  force  of  authentic  and 
carefully  reported  cases.  So  far,  he  says  710  one 
has  '•  given  a  straightforward  and  simple  case  of 
a  girl  bringing  up  blood  every  month,  of  the  truth 
of  which  there  could  be  no  reason  to  doubt  the 
accuracy."  After  referring  to  the  view  of  some, 
that  amenorrhcea  is  a  substantive  disease,  he  ex- 
presses his  opinion  that  in  an  enormous  majority 
of  cases,  it  is  a  symptom  and  a  consequence  of 
disease  elsewhere  ;  not  only  is  the  outward  dis- 
charge wanting,  but  as  the  physiological  process 
itself  is  in  abeyance,  there  is  no  room  for  the  pro- 
cess of  so  called  vicarious  menstruation.  In  con- 
clusion. Dr.  Wilkes  says  he  does  not  deny  the 
disturbance  which  often  takes  place  during  the 
menstrual  period,  and  that  an  hysterical  woman 
would  spit  up  blood,  or  that  an  ulcer  of  the  leg 
might  put  on  a  different  action  ;  but  that  this  is 
different  from  saying  that  the  processes  connected 
with  menstruation  take  place  through  the  leg. 

ANTISEPTIC  IRRIGATION. 

Dr.  Gushing  has  drawn  the  attention  of  the  pro- 
fession to  the  importance  of  vaginal  irrigation  in  all 
operations  upon  the  womb.  He  states  that  the 
vagina  is  a  very  hotbed  for  bacterial  colonies,  and 
that  in  a  great  many  cases,  even  in  the  best  society. 
an  old  and  unnoticed  gleet  in  the  husband  has 
given  rise  to  a  mild  and  forgotten  gonorrhaa  in 
the  wife,  so  that  gonocci  and  other  pathogenic 
germs  may  abound  in  the  vagina,  ready  to  be  car- 
ried into  the  uterus  on  the  sound,  or  get  into  any 
abrasion  or  cut  made  by  the  surgeon.  As  the  sub- 
limate solution,  which  is  the  best  for  destroying 
the  bacteria,  does  not  keep  well  in  water,  it  is  best 
to  prepare  it  fresh  daily.  For  private  practice, 
losenges,  containing  7-  1-3  grs.  of  sublimate,  com- 
bined with  amnion,  chlor.,  make  a  quart  solution 
of  1-2000.  For  hospital  use  3  ij  corrosive  sub- 
limate to  ^  i  glycerine  keeps  well,  and  by  mixing 
3  j  of  this  solution  with  two  quarts  of  water  gives 
1-2000. 


THE  CANADA  MEDICAL  RECOKD. 


147 


OVN/fXOLOGICAI,    TUKKAl'EUTICS. 

Under  this  heading,  Dr.  Ciirrie  draws  attention 
to  the  vahie  of  some  of  the  means  available  fur  the 
rehef  of  female  diseases,  and  tliiiiks  tliat  a  very 
considerable  portion  of  diseased  conditions  may 
be  treated  without  the  knife,  and  in  place  of  diviil- 
sions,  incising  the  neck,  and  intrauterine  ap- 
ph'cations,  we  should  substitute  a  regimen  of  rest, 
diet,  rubbing,  exercise,  etc.,  and  only  resort  to  surgi- 
cal procedure  when  these  means  fail.  The  author 
then  refers  to  laparotomy,  and  refers  apjjprovingly 
to  the  actual  cautery  as  a  useful  means  of  prevent- 
ing sepsis  and  hemorrhage  from  the  stump. 

In  hysterectomy  the  V  shaped  incision  is  approv- 
ingly spoken  of,  and  the  credit  of  the  operation 
properly  given  to  Schroeder,  though  the  question 
of  priority  of  the  operation  may  be  in  doubt,  inas- 
much as  Dr.  Trenholme  of  this  city  suggested  the 
operation  some  i  2  years  ago.  .Schroeder's  advice 
to  operate  upon  cancerous  uteri  and  ovarii  is  per- 
haps open  to  question,  in  fact  will  not  be  accepted 
if  the  results  following  the  operations  on  this  side 
of  the  ocean  are  to  guide  us. 

NEW    THEORV    OF    MENSTRUATION. 

Dr.  Johnston,  of  Danville,  Kentucky,  regards 
menstruation  as  a  result  of  a  glandular  function, 
and  that  tl  e  menstrual  organ  is  the  endometrium. 
He  finds  the  coating  of  columnar  epithelium  in 
young  girls  devoid  of  corpuscular  development ;  at 
13th  year  there  is  a  more  elaborately  developed 
columnar  epithelium,  and  the  beginning  of  a  cor- 
puscular layer  ;  while  at  20  there  is  an  abundant 
corpuscular  development,  forming  a  thick  endome- 
trium with  its  endometrium  in  process  of  removal; 
while  in  a  woman  of  60  there  was  little  endometrial 
structure,  and  almost  complete  absence  of  corpus- 
cular element  and  total  absence  of  epithelium.  Dr. 
Sutton  "of  Liverpool  "  agrees  with  Dr.  Johnston, 
that  the  epitl  elium  of  the  tubes  is  not  shed  during 
menstruation.  The  facts  thus  established  shew 
that  the  activity  of  the  ovaries  is  co  equal  with  life, 
while  that  of  the  uterus  is  limited  to  the  period  be- 
tween puberty  and  the  climateric,  and  it  is  during 
this  period  only  that  uterine  myoma  can  be  deve- 
loped. 

These  resources,  though  helpful,  and  doubtless 
correct  as  a  general  rule,  yet  fail  to  explain  cases 
of  menstruation  where  the  fallopian  tubes  were  im- 
pervious, and  the  uterine  cavity  was  entirely  con- 
cluded by  the  coalescence  of  the  endometrium,  as 
in  a  case  reported  some  2  years  ago,  by  Dr.  Tren- 
holme, and  uterus  exhibited  before  the  Medico- 
Chirurgical  Society  of  this  city. 


BoUe^})ondmc€. 


LETTER  FROM  NEW  YORK. 

New  York,  April,  1887. 

Dear  Record, — .Mthough  there  is  no  place  in 
the  world  where  Gynecology  has  reached  such  a 
high  stage  of  perfection,  yet  for  the  general  student, 
in  this  popular  branch  of  our  art,  there  is  little 
chance  here  of  advancing  his  studies,  owing  to  the 
restrictions  with  which  are  surrounded  the  physi- 
cians of  the  various  institutions  where  the  diseases 
of  women  are  treated.  The  staff  receive  you  with 
the  greatest  courtesy,  invite  you  to  hysterectomies 
and  ovariotomies,  to  operations  for  lacerated  cervix, 
and  for  lacerated  perineum,  but  to  take  you  into 
the  wards  or  out-i)atient  rooms  when  they  are 
diagnosing  and  treating  ordinary  cases,  is  a  thing 
which  they  have  not  the  power  to  do  ;  it  being 
against  the  rules  to  have  more  than  two  men  in 
the  room  while  a  woman  is  being  examined,  and 
those  two  are  the  doctor  and  his  own  assistant. 
The  best  plan  is  to  take  out  a  special  ticket  at  the 
Polyclinic,  where,  of  course,  there  are  no  restrictions 
as  to  the  number  of  students  present.  At  the 
Woman's  Hospital,  corner  49th  and  4th  avenue, 
the  operations  take  place  at  2  p.m.  sharp,  nearly 
every  day. 

At  this  institution  I  spent  a  pleasant  afternoon 
with  old  Dr.  Emmett.  There  was  a  difficult  case 
of  vesico  vaginal  fistula  to  be  operated  upon,  and 
as  he  was  not  feeling  very  well  he  handed  the 
instruments  over  to  his  nephew, Dr.  Baebe  Emmett, 
while  he  made  running  commentaries  on  this  and 
other  cases.  He  told  us  that  the  whole  of  the 
urethra  and  all  the  lower  surface  of  the  bladder,  as 
far  as  the  openings  of  the  ureters,  had  sloughed 
away  and  the  bladder  was  protruding.  He  said 
that  not  one  of  these  cases,  of  which  he  had  seen 
a  great  many,  was  due  to  the  use  of  the  forceps  ; 
but  rather  to  not  using  them,  and  that  they  only 
could  occur  in  places  where,  there  being  no  intelli- 
gent medical  man,  a  woman  was  left  for  several 
days  or  a  week  with  the  fcetal  head  impacted  in 
the  pelvis.  The  moral  he  drew  from  the  case  was, 
never  to  delay  applying  the  forceps  if  the  head 
does  not  recede  after  each  jiain,  for  he  said  that 
he  had  known  even  half  an  hours  pressure  to  cause 
sloughing. 

In  answer  to  a  question  I  asked  him,  about 
hysteriotomy  for  cancer,  he  replied  he  was  not 
favorable,  as  the   disease  nearly  always  returns. 


148 


THE    CANADA   MEDICAL   RECORD. 


He  was  much  opposed  to  the  cautery,  because  it 
leaves  behind  it  a  very  lowly  organized  structure 
(scar  tissue),  which  falls  a  ready  prey  to  the 
disease.  Besides  removing  the  cervix  almost  never 
removed  the  whole  disease. 

He  then  took  over  the  instruments,  and  operated 
in  a  few  minutes  on  a  case  of  lacerated  perineum. 
The  case  was  peculiar  in  that  there  was  no  lacera- 
tion, it  having  been  nicely  closed  up  by  some  other 
surgeon,  and  because  he  called  it  a  case  of  recto- 
cele,  although  the  operation  was  his  well  known 
and  improved  laceration  operation.  A  little 
further  modification  is  that  he  passes  his  needles 
from  above  downward,  so  as  to  draw  the  perineum 
up,  and  he  takes  care  not  to  put  any  stitches 
through  the  skin  of  the  labia,  all  the  stitches  being 
inside  the  vulva,  except  one  or  two  in  the  stem  of 
the  Y. 

I  went  down  to  Philadelphia  to  see  Goodell 
perform  forcible  dilation  of  the  uterus,  but  was 
disappointed,  he  having  done  one  the  day  previous, 
which  was  doing  well,  as  they  all  do.  He  is  care- 
ful to  keep  the  speculum  filled  with  sublimate 
solution  while  using  his  dilator.  Strangely  enough 
he  was  just  doing  the  same  operation  on  the 
perineum  that  Emmett  did  the  day  before,  and  gave 
the  same  reasons  for  it. 

Dr.  Osier  is  making  a  great  name  in  Philadel- 
phia as  a  teacher  and  consultant,  being  frequently 
called  in  by  his  elder  colleagues  in  difficult  cases. 
I  must  now  close, but  will  write  again  from  London. 
Yours  truly, 

A.   Lapthorn  Smith. 


LONDON  LETTER. 

De.\r  Record, — I  had  only  time  to  write  a  few 
lines  from  New  York,  and  I  omitted  to  mention 
that  Emmett,  in  answer  to  my  enquiry  as  to  what 
he  thought  of 

Alexander's  Operation. 
replied  that  he  did  not  believe  in  it,  for  the  rea- 
son that  the  benefit  resulting  from  it  could  not  be 
lasting,  and,  moreover,  that  any  good  obtained  by 
it  could  be  reached  better  by  other  means.  When 
in  Liverpool  I  made  a  point  of  interviewing  Dr. 
Alexander.  He  is  a  medium-sized  rather  young 
looking  man,  peculiarly  unaffected  in  manner,  ap- 
pearing more  like  a  Canadian  in  this  respect  as 
well  as  in  accent.  He  was  engaged  in  getting  up 
his  statistics  for  a  paper  to  be  read  at  the  Interna- 
tional Congress,  although  he  will  not  be  there  him- 


self, but  received  me  very  cordially,  and  arranged 
to  have  a  case  to  operate  on,  when  I  returned  to 
Liverpool  in  July.  He  said  he  was  more  in  favor 
of  the  operation  than  ever,  one  of  the  last  cases  he 
performed  having  been  copiplicated  with  inguinal 
hernia,  for  the  radical  cure  of  which,  as  much  as 
for  the  displacement  of  the  uterus,  he  0])erated. 
He  thinks  the  cause  of  disappointment  in  the  hands 
of  other  operators  is  that  they  do  not  pull  the  liga- 
ment out  far  enough,  it  generally  requiring  to  be 
shortened  as  much  as  four  or  five  inches.  He  is 
always  anxious  to  include  the  peritoneum  in  his 
ligature  for  closing  together  the  pillars  of  the  ring, 
the  material  for  his  ligature  being  silkworm  gut. 
This  he  leaves  in  for  several  months  if  it  does  not 
cause  any  irritation,  but  removes  it  sooner  other- 
wise. He  does  not  leave  any  deep  sutures  in,  but 
brings  them  right  through  the  skin,  and  ties  them 
on  the  surface. 

I  made  the  acquaintance  of  several  gynecologists 
in  Liverpool,  but  none  of  them  had  ever  done 
Alexander's  operation,  nor  did  they  seem  to  believe 
in  it. 

I  spent  an  afternoon  with  Dr.  Warren  of  the 
Infirmary,  and  the  leading  gynecologist  there,  who 
performed  an  exploratory  incision,  and  subse- 
quently drainage  for  removal  of  a  purulent  collec- 
tion in  the  abdomen,  resulting  from  the  breaking 
down  of  a  cancerous  uterus.  Speaking  of  ovarian 
and  tubal  disease,  he  said  dilatation  of  the  tubes 
was  a  very  common  condition,  and  in  support  of 
his  statement  he  proceeded  to  pass  Simpson's  sound 
through  the  tubes  of  half  a  dozen  women,  right  into 
the  peritoneal  cavity.  Tliis  potency  of  the  Fallopian 
tubes  made  clear  to  me  several  rather  puzzling 
cases,  in  which  I  had,  in  my  practice,  passed  the 
sound  a  distance  of  six  or  seven  inches,  much  to 
my  horror,  as  I  thought  at  the  time  that  the  patients 
must  have  been  pregnant,  but  they  were  not.  I 
had  merely,  without  knowing  it,  passed  the  sound 
through  the  Fallopian  tube.  Dr.  Warren  was  op- 
posed to  the  so  frequent  removal  of  the  ovaries  as 
was  practiced  by  Tait  and  others.  He  referred  to 
the  case  of  Dr.  Trulach,  one  of  the  leading  practi- 
tioners of  Liverpool,  who  was  dismissed  from  the 
Hospital  for  having  spayed  a  number  of  young 
girls,  somewhat  on  the  general  principle,  apparent- 
ly, that  girls  were  happier  without  ovaries  than 
with  them. 

In  London  I  found  Gynecology  in  such  a  dif- 
fused condition,  that  one  could  not  spend  one's 
time  very  profitably  in  studying  it   there.     It  is 


THte   CANADA   MEDICAL   RECORD. 


149 


stuck  on  generally  to  the  large  hospitals,  in  some  of 
which  even  the  gynecologists  are  not  allowed  to 
operate,  but  must  hand  over  their  cases  to  the 
surgeons  for  operation.  In  Guy's,  however,  they 
are  thinking  of  giving  the  Gynecologist  some  beds 
of  his  own.  From  general  practitioners  in  several 
parts  of  Kngland,  I  was  sorry  to  learn  that  the  pro- 
fession there  was  generally  in  a  bad  way.  The  licens- 
ing bodies  are  all  quarrelling  among  themselves, 
and  at  the  same  time  they  are  turning  out  such  an 
immense  number  of  doctors,  that  there  is  no  possi- 
bility of  a  quarter  of  them  gaining  a  living. 

The  more  intelligent  and   better  off  of  the  lower 
classes  are  attended  free  at  the  hospitals;  the  pau- 
pers are  attended  by  the  parish  doctor,  who  receives 
about  one  thousand  dollars  a  year  for  making  about 
fifty  or  sixty  visits  and  consultations  a  day,  includ- 
ing medicine,  to  do  which  he  employs  unqualified 
assistants  at  less  wages  than  he  pays  his  coachman  ; 
so  that  the  only  way  a  young  medical  man  has  left 
in  which    to  earn  his  living  is  to  attend  the  scum 
of  the  working  classes,  wlio  are  about  the  lowest 
of  the  low,  at  a  rate  of  about   three  pence  to  six 
pence  a  visit,  including  medicine.     If  lie  won't  do 
that  he  may  be  so  fortunate  as  to  get  a  position  as 
doctor  on  a   steamship,  at   from   twenty  to  forty 
dollars  a  month,  while  the  voyage  lasts,  and  paying 
his  own  expenses  when  she  returns  to  port  and  until 
she  sails  again.  The  only  other  career  open  to  him 
is  to  go  as  assistant    to  a   practitioner,  where   he 
generally  receives    the    same   pay,   but  not  nearly 
so  much  consideration  as  the  doctor's  servant  man. 
We  should  take  a  lesson  in  Canada,  while  there 
is  yet  time,  from  this  condition  of  the  profession  in 
Great  Britain,  and  by  raising   the  standard  of  en- 
trance and  increasingihe  number  of  years  of  classi- 
cal study  required,  before  being  even  allowed  to 
try  for  the    matriculation  examination,  prevent  a 
crowd  of  young  men  from  joining  the  ranks  of  the 
profession,  for  whom  an  honorable  living  is  not  to 
be  had.  We  who  permit  them  to  enter  our  ranks  are 
not  altogether  blameless  if  the  struggle  for  exis- 
tence compels  them  sometimes  to  resort  to  methods 
which  bring  disgrace  on  us,  as  well  as  on  them. 

It  is  quite  easy  for  a  butcher's  boy,  or  a  scaven- 
ger even,  to  get  crammed  sufficiently  in  a  year  or 
two  to  pass  our  present  entrance  examination,  but 
he  would  not  be  able  to  produce  a  certificate  of  nine 
years'  studies,  including  physics  and  philosophy. 
It  is  all  right  to  manufacture  medical  men  by  the 
hundred  for  the  United  States,  where  there  is  a  de- 
mand for  such,  but  they  should  be  stamped  "For 


export,"  while  the  number  of  those  who  are  to 
practice  in  Canada  should  be  kejjt  within  the  limit 
of  the  requirements  of  the  country. 

I  am  leaving  in  a  few  days  for  Paris,  where  I  am 
going  to  place  myself  under  the  instruction  of  Dr. 
Apistole,  who  has  attained  a  world-wide  celebrity 
through  his  remarkable  treatment  of  fibroid  tumours 
of  the  uterus  by  means  of  electricity.  I  shall  then 
write  again,  endeavoring  to  give  your  readers  some 
idea  of  the  wonderful  progress  electricity  has  made 
during  the  last  few  years,  as  a  therapeutical  agent. 
Yours  truly, 

A.  L.\pthornS.mith. 

London,  April,  1887. 


CORRECTION. 
Editor  Canada  Medical  Record. 

Dear  Sirs  : — Since  writing  my  last  letter  from 
the  Hub  I  have  had  the  pleasure  of  witnessing  an 
ovariotomy  by  Dr.  Homans  of  Boston  at  St. 
Margaret's  Hospital.  I  have  never  seen  an  ovar- 
iotomy more  quickly  and  skilfully  performed,  and 
with  less  display  and  pretence.  The  result  has 
been  excellent.  I  find  that  I  have  been  misin- 
formed as  to  Dr.  Homans'  views  of  Listerism.  I 
stated  that  he  did  not  believe  in  Listerism,  and 
have  wronged  him  greatly.  He  is  a  firm  believer 
in  the  use  of  antiseptics  ;  and  if  any  septic  germs 
float  around  it  is  not  from  the  want  of  the  spray 
and  every  aseptic  precaution. 

J.  L.  F. 

Boston,  April,  1887. 

J^f^^^USS  a/  Sdmu. 

CHRONIC  PURULENT  OTORRHCEA,  ITS 
NATURE  AND  TREATMENT. 

Condensed  from  a  paper  read  before  the  Philadelphia 

County  Medical  Society. 

By  Charles  H.  Burnett,  A.M.,  M.D., 

Professor  of  Otology  in  the   Philadelphia  Polyclinic,  etc. 

A  chronic  purulent  or  muco-purulent  discharge 
from  the  ear  is  usually  the  result  of  inflammation 
of  the  mucous  membrane  of  the  middle  ear,  and, 
as  such,  implies  the  existence  of  a  perforation  in 
the  membrana  tympani,  through  which  the  puru- 
lent matter  escapes  into  the  external  auditory 
canal.  The  perforation  in  the  membrana  tympani 
is  usually  in  that  part  of  the  membrane  below  a 
line  drawn  nearly  horizontally  through  the  short 
process  of  the  hammer — /.  e.,  the  so-called  mem- 
brana vibrans.  In  some  rare  but  very  important 
)  cases,  the  perforation  is  in  the   flaccid  membrane, 


150 


THE   CANADA   MEDICAL   RECORD. 


or  the  membrane  of  Shrapnell,  which  lies  above 
the  short  process  of  the  malleus. 

Chronic  otorrhoea  is  both  common  and  ini]:)or- 
tant,  is  met  by  all  practitioners  of  medicine,  and 
demands,  therefore,  their  careful  attention,  both 
on  account  of  the  annoyance  its  presence  gives  the 
patient,  and  the  danger  to  hearing  and  life  wliich 
lurks  in  its  persistence  in  the  middle  ear. 

Chronic  purulent  otorrhcea  generally  begins  in 
childhood.  The  original  cause  of  otorrhea  is 
chiefly  naso  pharyngeal,  and  Eustachian  tubal 
catarrh,  induced  by  coryza,  teething,  and  the 
acute  exanthemata.  Teethmg,  by  inducing  a  reflex 
irritation  in  the  middle  ear,  leads  practically  to 
catarrhal  inflammation  of  that  cavity,  perforation 
of  the  drum  membrane,  and  the  establishment  of  a 
chronic  running.  Purulent  inflammation  of  the 
middle  ear  is  almost  invariably  preceded  by  pain, 
and  often  constitutes  the  cause  of  earache  in  chil- 
dren. 

Among  the  causes  producing  purulent  otorrhtea 
in  adults,  must  be  named  swimming  and  diving  in 
cold  water,  plunging  the  head  under  cold  v>-ater, 
washing  the  head  and  allowing  it  to  dry  in  a 
draught  of  air,  and  also  the  use  of  cold  water  in 
the  nasal  douche,  and  the  inhalation  of  various 
patent  powders,  snuffs,  and  fluid  preparations 
advertised  for  the  cure  of  nasal  catarrh. 

Tuberculosis  of  the  lungs  is  also  a  cause  of 
subacute  and  chronic  purulent  otorrhcea.  This 
form  is  characterized  by  little  or  no  pain,  by  its 
tendency  to  affect  the  posterior  and  upper  parts 
of  the  drum  membrane  and  cavity,  and  by  its 
resentfulness  of  all  forms  of  treatment  but  the 
mildest.  It  is  supposed  to  be  due  to  reflex  inhi- 
bition of  vasomotor  power  in  the  arterioles  of  the 
ear,  supplied  by  the  carotids.  The  irritation 
which  thus  acts  reflexly  is  in  the  diseased  lung. 
The  irritation,  passing  by  the  pneumogastric  to 
the  sympathetic  system  in  the  neck,  inhibits  in- 
fluence over  the  caroiids.  Passive  dilat.ition  ensues 
in  this  vascular  tract,  and  those  parts  of  the  mem- 
brana  tympani  and  middle  ear  supplied  by  it 
undergo  passive  congestion  and  inflammation  of 
a  low  form,  without  much  or  any  pain,  the  puru- 
lent matter  ruptures  the  membrana,  and  an  otor- 
rhcea, chronic  from  the  outset,  is  established. 

The  tendency  to  ciironicity  in  all  aural  dis- 
charges is  favored  by  the  difficulty  of  keeping  the 
ear  clean,  and  by  the  improper  treatment  so  often 
instituted.  The  exposure,  too,  of  the  mucous 
lining  of  the  drum  cavity  to  the  atmosphere,  by 
means  of  the  perforation  in  the  membrana,  irritates 
the  mucous  membrane,  and  promotes  further  in- 
flammation. 

If  chronic  purulent  discharge  from  tiie  ear  is 
associated  with  and  kept  up  by  chronic  catarrh 
in  the  naso-pharynx  and  the  nares,  the  rhinitis 
mu-t  receive  due  attention,  or  the  discharge  will 
not,  without  great  difficulty,  be  checked. 

The  natural  tendency  of  chronic  purulent 
disease  in  the  drum  cavity  is  to  impair  the  hear- 
ing. 


After  the  destruction  in  the  membrana,  disorder 
in  the  ossicles,  impairment  of  hearing,  and  the 
establishment  of  a  chronic  purulent  otorrhoea,  the 
disease  may  continue  uneventfully  on  this  plane 
for  years. 

These  are  the  neglected  'cases  tending  to  the 
development  of  granulations  and  polypi  upon  the 
7IUIC021S  membrane  of  t/ie  cavity  of  the  drum.  As 
these  form  in  the  diseased  ear,  the  discharge  in- 
creases in  quantity,  and  the  hearing  grows  duller. 

Inspection  now  reveals  a  polypus,  or  perhaps 
two,  with  distinct  pedicles.  Or,  if  these  have  not 
yet  formed,  granulations  are  seen,  which  more  or 
less  obscure  a  view  of  the  drum  membrane. 
Aural  polypi  vary  in  size,  from  a  buckshot  to  a 
large  marrowfat  pea ;  or,  if  old,  and  sufficiently 
compressed  by  the  auditory  canal,  they  assume  the 
shape  of  the  latter,  and  finally  extend  from  the 
meatus,  after  attaining  a  length  of  one  and  one- 
half  to  two  inches. 

Instead  of  the  formation  of  polypi,  the  jjurulent 
disease  may  be  more  destructive,  and  produce 
death  of  the  mucous-periosteal  membrane  in  the 
drum  cavity,  and  of  the  subjacent  bone.  The 
death  of  osseous  tissue  in  the  aural  tract  may  take 
place  in  the  tegmen  tympani,  just  beneath  the  brain, 
or  in  the  so-called  antrum  of  the  mastoid  cells. 

When  the  tendency  of  this  disease  has  brought 
about  necrosis  in  the  regions  named,  the  affection 
has  assumed  a  most  serious  aspect,  because  a 
fatal  issue  may  now  be  induced  at  any  time  by 
either  an  embolic  process  in  the  brain,  the  lungs, 
or  the  liver.  Prior  to  this  course,  a  fatal  menin- 
gitis may  be  set  up  by  an  extension  of  the  disease 
through  the  roof  of  the  drum  ca^-ity,  or  through 
the  fenestrce,  and  thus  into  the  labyrinth  .and 
brain,  or  the  necrotic  disease  having  passed  into 
the  mastoid  cells,  the  lateral  or  sigmoid  sinus  may 
be  affected,  and  purulent  phlebitis  at  this  point 
aroused.  A  clot  then  may  be  formed  in  the  sinus, 
liieces  of  which  enter  the  circulation,  and  thus  an 
embolic  process  established  at  some  vital  point. 

In  chronic  otorrhoea,  warnings  of  the  unfavor- 
able advance  of  the  disease  are  given,  by  facial 
paralysis,  violent  ear  pain,  with  fever  and  deli- 
rium, and  inflammation  within  the  mastoid  cells. 

Facial  paralysis  indicates  an  invasion  at  the 
upper  and  back  part  of  the  drum  cavity,  and 
meningitis  may  ensue.  Inflammation  of  the  mas- 
toid cells  is  more  likely  to  be  followed  by  phlebitis 
of  the  lateral  sinus  and  its  consequences. 

Cases  of  chronic  otorrhea  with  mastoid  inflam- 
mation, and  phlebitis  of  the  lateral  sinus,  some- 
times terminate  fatally  by  embolism  in  the  lung  or 
liver,  without  any  cerebral  disease.  Patients  should 
be  encouraged  to  have  aural  discharges  stopped 
as  soon  as  possible,  whether  acute  or  chronic.  It 
is  an  injury  to  them  to  foster  in  their  minds  the 
idea  that  discharges  will  stop  of  themselves,  or,  if 
not,  that  they  had  better  continue  to  run.  Abnor- 
mal discharges  from  no  other  part  of  the  body  are 
allowed  to  run  on  disregarded,  and,  surely,  dis- 
charges from  the  ear  should  not  be,  for  they  are  as 


THE   CANADA   MEDICAL   RECORD. 


151 


aincnal)lc  to  proptr  tix-aliiiciil  :it  those  clsewliere, 
and  if  neglected,  may  become  serious.  From  the 
deep  and  peculiar  situation  of  the  drum  cavity, 
|iunilent  discharges  from  tlvs  part  of  the  head  are 
likely  to  be  retained,  and  to  untlcrgo  deconii)osi- 
tion.  'I'liis  favors  continuation  and  extension  of 
the  disease,  and  the  muco-periosteal  nature  of  the 
tissue  in  which  the  affection  has  its  seat  renders 
death  of  the  subjacent  bone  imminent,  with  con- 
sequent involvement  of  the  cranial  cavity.  The 
])atient,  therefore,  should  demand  of  his  physician 
an  intelligent  consideration  of  such  a  malady. 

Titat merit. -'V\\c  first  consideration  in  the  treat- 
ment of  chronic  purulent  otorrhiea  is  cleanliness 
and  cleansing.  Cleanliness  is  demanded  in  order 
to  jirevent  decomposition  of  the  discharge  in  the 
ear,  and  sejJtic  influences  from  such  a  nidus.  Cleans- 
ing the  ear  is  necessary  to  enable  the  surgeon  to 
make  a  diagnosis  of  the  condition  of  the  fundus 
antl  the  membrana,  and  in  order  to  prepare  the 
ear  for  treatment. 

Cleansing  the  ear  is  best  accomplished  by  the 
surgeon,  and  should  very  rarely,  if  ever,  be  entrust- 
ed to  the  patient.  It  is  best  effected  by  syring- 
ing with  tepid  water,  either  with  or  without  a 
disinfectant,  if  the  discharge  is  co]3ious  and  tena- 
cious. If,  liowever,  the  discharge  is  neither  copi- 
ous nor  thick,  the  ear  can  be  cleansed  by  a  small 
dossil  of  absorbent  cotton  on  the  cotton-holder. 
Failure  in  this  procedure  is  often  attributable  to 
the  use  of  too  thick  a  pledget  of  cotton.  This 
should  not  be  more  than  five  centimetres  in  dia-  j 
meter.  If  it  is  larger  it  gets  wedged  in  the  meatus 
or  in  the  canal,  the  fiuidus  is  not  reached,  or  only 
with  difficulty,  and  after  pushing,  which  is  painful 
to  the  patient,  abrasion  of  the  canal,  or  even  of 
the  deeper  parts  of  the  fundus  and  the  membrana, 
may  ensue. 

The  syringe  may  be  employed  without  illuminat- 
ing the  ear  by  the  forehead  mirror,  but  the  proper 
and  successful  employment  of  cotton  on  the  cot- 
ton-holder can  be  done  only  under  the  forehead 
mirror. 

In  infants  and  very  young  children,  with  very 
narrow  meatuses,  cleansing  is  most  conveniently 
done  by  syringing  with  warm  water,  the  return 
current  from  the  ear  being  caught  in  a  towel  held 
beneath  the  auricle.  After  syringing,  the  water 
must  be  carefully  mopped  out  of  the  fundus  of 
the  canal  by  absorbent  cotton,  in  order  to  gain  a 
view  of  the  diseased  parts,  otherwise  the  refraction 
of  the  water  will  give  a  very  distorted  view  of  the 
objects  seen  through  it. 

Cleansing  the  middle  ear  is  furthered  by  using 
some  form  of  inflation  of  the  tympanum. 

After  the  first  cleansing  of  the  external  auditory 
canal  and  its  fundus,  the  surgeon  should  find  out 
whether  the  perforation  is  above  the  so-called  folds 
of  the  membrana  flaccida  or  below  the  folds,  in 
the  membrana  vibrans.  Sometimes  a  perforation 
exists  in  both  these  portions  of  the  membrana 
tympani  at  the  same  time  ;  but  this  is  not  common. 
It  is  highly  important  to    determine  in    which    of 


these  parts  of  the  drinn  membrane  the  perforation 
lies,  since  the  treatment  must  be  modified  by  the 
position  of  the  jjerforation. 

Let  us  first  consider  those  cases  in  which  the 
lierforation  is  large  and  in  the  lower  part  of  the 
membrana,  the  membrana  vibrans.  'I'hese  are 
the  most  frequent. 

Earache  from  acute  inflammation  in  the  tympa- 
nic cavity,  in  such  chronic  cases  of  purulent 
otorrha-a,  must  be  combated  by  gentle  warm-water 
syringing  or  irrigation,  and  in  jirotecting  the  in- 
flamed mucous  membrane  with  insuflflation  of 
powdered  boric  acid.  These  insufflations  and  all 
others  can  be  done  either  with  the  blow-tube,  on 
the  ]jrinciple  of  the  blow-pipe,  or  by  the  hand  pow- 
der-blower. 

In  those  cases  of  acute  inflammation  in  chronic 
otorrlm;a,  with  large  perforations  in  the  membra- 
na, the  pain  can  often  be  allayed  by  the  use  of 
instillations  of  cocaine,  because  the  perforation  in 
the  membrana  permits  the  entrance  of  the  solution 
into  the  drum  cavity,  and  its  ready  contact  with 
the  mucous  membrane. 

Cocaine  solutions  instilled  into  an  ear  with  imper- 
forate membrana  tympani  are  important  to  quell 
pain  in  the  ear.  They  also  seem  valueless  even 
when  the  membrana  contains  a  small  perforation, 
because  they  still  seem  to  fail  to  reach  the  inflam- 
ed mucous  surface. 

If  coryza  is  present,  as  it  is  apt  to  be  in  these 
acute  attacks  in  chronic  otorrhceas,  it,  of  course, 
must  not  be  disregarded.  The  prognosis  in  these 
cases  is  favorable  as  to  restoration  to  a  relatively 
normal  or  healthy  state,  if  the  subject  is  in  ordinary 
health. 

It  is  in  these  cases  of  purulent  otorrhcea  with 
large  perforations  in  the  membrana  tympani,  that 
preference  should  be  given  to  the  so-called  dry 
treatment.  In  this  form  of  treatment  very  little 
water  is  used  for  cleansing,  and  only  when  the 
discharge  is  thick  and  copious,  and  hence  not 
easily  removed  by  absorbent  cotton.  The  reason 
for  this  preference  of  dry  treatment  is  that  the  use 
of  water  favors  the  continuance  of  the  discharge 
in  many  cases,  and  promotes  a  tendency  to  the 
formation  of  granulations  and  polypi.  If  syringing 
the  ear  is  to  be  done,  it  must  be  carried  out  by  the 
surgeon,  and  not  entrusted  to  the  patient.  After 
the  ear  is  cleansed  by  either  of  these  methods,  some 
form  of  boric  acid,  finely  powdered,  should  be  em- 
ployed by  insufflation.  This  enters  the  tympanic 
cavity,  and  hence  comes  in  direct  contact  with  the 
inflamed  mucous  membrane.  It  remains  there 
more  readily  than  fluid  preparations,  and  hence 
acts  longer.  The  beneficial  effects  are  due  to  the 
antiseptic  properties  of  the  boric  acid,  and  to  the 
protection  the  layer  of  powder  gives  to  the  mu- 
cous membrane. 

If  this  dry  treatment  does  not  give  entire  satis- 
faction, as  it  may  not  or  will  not  if  granulations  or 
ulcerations  exist  beyond  the  reach  of  the  powder 
thus  blown  in,  resort  may  be  had  to  instillations  of 
astringent  and  astiseptic  solutions,  as  silver  nitrate 


U2 


TDK    CANADA    MEDICAL    RECORD. 


— not  less  than  forty  grains  to  the  fluid  ounce  of 
water ;  or  carbolic  acid  solutions  from  three  per 
cent,  to  five  per  cent,  in  strength.  These  are  to 
be  put  in  the  ear  after  it  is  cleansed,  and  followed 
by  a  dressing  of  insufflated  boric  acid,  either  in 
simple  or  in  compound  powder. 

In  cases  of  chronic  purulent  discharge  from  the 
atlic  of  the  tympanic  cavity,  with  perforation  only 
in  the  membrana  flaccida,  the  dry  treatment  can- 
not be  relied  upon,  because  of  the  smallness  of 
such  perforations,  and  the  consequent  inability  of 
the  surgeon  to  blow  the  jjovvder  into  the  diseased 
cavity.  In  these  cases  the  treatment  consists  in 
the  application  of  solutions  to  the  attic,  through 
the  perforation,  by  means  of  the  tympanic  syringe. 
The  long  slender  nozzle,  si.x  centimetres  long  by 
one  millimetre  in  diameter,  must  be  conveyed 
under  illumination  by  the  forehead  mirror  down 
the  auditory  canal  to  the  seat  of  disease.  I  have 
found  the  best  results  to  follow  the  use  of  injec- 
tions of  a  three  per  cent,  so  ution  of  carbolic  acid 
by  this  means,  into  the  attic  cavity  of  the  tympa- 
num after  thorough  cleansing  of  the  attic  by  injec- 
tions of  liydrogen  dioxide,  which  thoroughly  re- 
moves all  pus.  They  do  not  tolerate  nitrate  of  silver. 
It  is  well  to  follow  these  applications  by  insuffla- 
tions of  boric  acid  into  the  fundus  of  the  auditory 
canal.  For,  tiiough  they  cannot  reach  the  attic 
unless  the  perforation  be  large,  they  have  an  anti- 
septic effect  about  the  perforation  and  the  rest  of 
outer  surface  of  the  membrana  tympani  and  the 
fundus  of  the  canal. 

Cases  of  chionic  purulent  disease  in  the  attic 
are  difficult  to  treat,  on  account  of  the  bad  drain- 
age from  those  parts  above  the  ossicles,and  because 
of  the  small  perforation  usually  found  in  the 
membrana  flaccida.  They  are  also  dangerous  to 
the  life  of  the  patient,  because  the  disease  lies  near 
the  tegmen  tympani,  directly  beneath  the  brain. 
Natural  deficiencies  in  the  bone  at  this  point  exist 
so  frequently  that  the  meninges  and  the  mucous 
membrane  of  the  roof  of  the  drum  cavity  are  often 
in  apposition. 

In  order  to  facilitate  better  drainage  of  purulent 
secretions  from  the  attic  in  chronic  disease,  and 
more  efficient  medication,  especially  by  the  insuffla- 
tion of  powders,  Dr.  Sexton  has  suggested,  and 
frequently  perfoimed,  when  the  membrana  is  large- 
ly destroyed,  an  operation  for  its  removal,  and 
then  that  of  the  malleus  and  incus,  or  their  rem- 
nants. The  fundus  is  then  treated  with  a  powder 
of  salicylic  acid  and  boric  acid,  until  a  dermoid  cica- 
trization ensues.  This  operation  is  applicable  to 
chronic  attic  disease,  unthout  perforation  of  the 
membrana  faccida,  but  with  large  destruction  of 
the  membrana  vibrans,  in  which  the  diseased 
malleus  and  incus  interfere  with  drainage  of  the 
attic,  downward  in  to  the  atrium. 

In  any  case  of  chronic  purulent  otorrhcea,  so 
long  as  we  can  detect  no  lesion  beyond  impaired 
vibration  in  the  ossicles,  with  defective  hearing,  as 
a  consequence  of  the  chronic  disease  in  the  mucous 
membrane,   the  cure  of  the  affection  may  be    con- 


sidered as  probable,  excepting  in  tubercular  cases 
far  advanced  in  pulmonary  disease.  By  curing  the 
jnirulent  disease  of  the  mucous  membrane,  the 
growth  of  granulations  and  polypi,  and  the  occur- 
rence of  necrosis  and  caries  of  the  adjacent  bone, 
are  prevented. 

If,  however,  the  ear  has  not  been  treated,  or 
improperly  treated,  granulations  and  polypi  may 
be  found,  with  impairment  of  the  hearing.  The 
granulations  are  best  removed  by  touching  them, 
and  only  them,  with  chromic  acid,  carefully  con- 
veyed to  their  surfaces  on  a  small  cotton  tuft,  not 
more  than  two  millimetres  in  diameter,  on  the 
cotton  holder,  under  perfect  illumination  of  the 
canal  and  fundus  by  the  forehead  mirror. 

If  polypi,  with  distinct  pedicles,  have  grown 
from  the  mucous  surface  of  the  middle  ear,  and 
extend  into  or  from  the  perforation  in  the  mem- 
brane, they  must  be  extracted  with  the  polypus 
snare,  and  their  pedicles  touched  every  day  or 
two,  until  they  disappear.  These  are  entirely  cur- 
able, and  the  discharge  from  the  ear  usually  ceases 
after  the  removal  of  the  polypus  and  the  destruc- 
tion of  its  roots,  and  the  hearing  improves.  The 
removal  of  the  polypus,  without  subsequent  treat- 
ment and  destruction  of  its  pedicle,  is  useless. 

Instead  of  this  conservative,  hypertrophic  action 
on  the  jjart  of  the  mucous  membrane,  in  may 
slough,  leaving  a  subjacent  bone  bare.  The 
latter  then  dies,  either  superficially  or  in  its 
profounder  parts,  and  some  of  the  evils  I  have 
sketclied  are  experienced  by  the  patient. 
In  some  cases  of  profound  inflammation  and 
ulceration  of  the  mucous  membrane  of  the  drum 
cavity,  denuded  bone  can  be  felt  with  a  probe,  and 
crumbs  of  bone  are  thrown  off  with  the  aural  dis- 
charge. But  with  the  improvement  in  the  condi- 
tion of  the  ear,  these  particles  of  dead  bone  cease 
to  appear,  and  denuded  bone  can  no  longer  be 
felt.  In  such  cases  the  ear  should  be  syringed 
once  daily,  by  the  surgeon,  with  tepid  water,  in 
which  salt  or  potassium  permanganate  may  be 
placed.  Or  the  ear  may  be  syringed  with  weak 
solution  of  corrosive  sublimate,  i  :  looo,  carbolic 
acid  five  per  cent.,  or  with  undiluted  hydrogen 
dioxide  (Lehn  &  Fink's,  or  Schiefifleins).  This 
drug  has  the  great  advantage  in  breaking  up  and 
removing  all  pus,  and  of  informing  the  surgeon 
when  this  is  accomplished,  by  the  cessation  of 
foaming,  which  ensues  as  soon  as  there  is  no  more 
pus,  with  which  it  makes  the  frothy  reaction. 
Thereafter,  the  ear  is  to  be  dressed  with  the  pow- 
der of  boric  acid  already  named.  Cleanliness  and 
antiseptics,  with  attention  to  tlie  general  condition, 
form  the  guiding  motives  in  the  treatment. 

If  sequestra  form,  they  should  be  removed,  if 
possible. 

In  many  cases,  indeed,  I  am  inclined  to  say  in 
most  cases,  of  necrosis  of  the  temporal  bone  from 
chronic  aural  purulency,  operative  interference  is 
well-nigh  useless.  Unless  it  be  the  mastoid  cor- 
tex, all  other  parts  of  the  auro-temporal  surface  are 
extremely  difficult  to  operate  upon,  and  surgical 


THE   CANADA    MEDICAL   RECORD. 


153 


interference  becomes  a  dangerous  undertaking. 
Again,  when  the  surgeon  is  consulted  in  cases  of 
intracranial  disease,  or  systemic  septicemia,  aris- 
ing from  chronic  purulent  disease  and  necrosis  in 
or  aliout  the  ear,  the  patient  is  beyond  aid.  To 
trephine  for  cerebral  abscess,  which  has  resulted 
from  chronic  aural  disease,  is  to  operate  on  a  mori- 
bund patient,  and  to  hasten  surely  the  fatal  issue. 
'l"he  time  to  aid  such  a  sufferer  was  when  the 
chronic  purulent  otorrhoea  could  have  been  check- 
ed, and  ijefore  it  had  induced  necrosis  of  bone,  or 
embolism.  In  my  opinion,  there  never  is  a  moment, 
after  the  cerebral  abscess  is  formed,  that  an  opera- 
tion for  its  relief  is  justifiable,  excepting,  perhaps, 
in  those  instances  in  which  a  sinus  can  be  found 
leading  to  it  from  the  mastoid  or  squama.  In  re- 
gard to  mastoid  trephining,  for  so-called  mastoiditis 
and  periphlebitis  of  the  lateral  sinus,  my  opinion  is 
much  the  .'-ame. 

A  chronic  purulency  in  the  tympanic  cavity  may 
gradually  and  painlessly  affect  the  mastoid  antrum, 
its  cells,  and  its  outer  cortical  as  well  as  its  inner 
wall,  the  latter  being  the  outer  wall  of  the  lateral 
sinus.  I'his  diseased  state  in  the  furrow  of  the 
lateral  sinus  is  of  the  most  serious  import,  but  an 
operation  on  the  mastoid  cortex  cannot  arrest  its 
progress  or  remedy  its  effects.  Too  often,  when 
pain  in  the  region  of  the  mastoid  is  felt,  and  other 
well-known  symptoms  of  so-called  mastoiditis  arise, 
the  pain  is  really  due  to  inflammation  in  the  lateral 
sinus,  or  deeper  parts  from  such  chronic  d  sease 
in  the  bone,  and  not  to  matter  pent  up  in  the  mas- 
toid cells,  which  a  perforation  in  the  mastoid  can 
relieve.  I  am  forced  to  such  conch  sons,  bxause 
fluid  matter  from  the  drum  cavity  and  mastoid 
antrum  can  escape,  in  most  cases,  from  the  external 
ear.  Also,  because  in  many  cases  of  pain  in  and 
about  the  mastoid,  with  symptoms  which  are  sup- 
posed to  justify  trephining  its  outer  corte-x,  the 
cavity  has  not  been  found  filled  with  fluid  matter 
seeking  an  escape,  but  with  some  inspissated  pus 
at  most ;  while  periphlebitis  in  the  lateral  sinus  has 
been  discovered,  having  its  origin  from  the  neglect- 
ed tympanic  disease,  which  trephining  is  powerless 
to  cure. 

Even  if  the  mastoid  cortex  and  cavity  are 
found  diseased,  an  operation  upon  them  will  do 
no  good  if  the  lateral  sinus  is  diseased,  and  perhaps 
the  seat  of  a  clot. 

In  many  cases  of  tumefaction  behind  the  ear, 
in  painful  acute  inflammation  in  chronic  cases, 
Wilde's  incision  does  give  great  relief.  And  in 
some  such  cases  where  this  incision  has  been  follow- 
ed by  perforation  of  the  bone,  relief  and  apparent 
cure  have  followed,  it  has  been  because  there  was 
no  disease  in  the  inner  mastoid  wall  and  the  lateral 
sinus.  In  such  cases  the  local  depletion  gave  the 
relief,  and  mastoid  perforation  was  purely  gratui- 
tous. Hence,  in  acute  cases  of  otitis  media, 
great  care  should  be  taken  not  to  resort  precipitately 
to  mastoid  trepanation.  In  chronic  cases  it  is  of 
value  in  very  few  instances,  and  the  indications 
for   its    employment   are    not    well    defined.     In 


many  cases  the  mastoid  becomes  cedcmatous, 
brawny,  shining,  sensitive  to  both  deep  and  super- 
ficial pressure,  and  painful  to  the  patient.  These 
are  often  relieved  by  poulticing  and  leeching, 
without  even  Wildcls  incision.  Sometimes,  if  let 
alone,  they  undergo  speedy  resolution.  If  the 
lateral  sinus  has  not  been  invaded,  there  is  no  need 
of  haste.  If  has  been  attacked,  mastoid  trephin- 
ing will  certainly  not  check  it. 

It  must  not  be  forgotten  that  many  instances  of 
pain  and  swelling  about  the  mastoid  are  due  to 
congestion  and  swelling  in  its  mucous  lining,  and  in 
that  of  the  middle  ear  and  mastoid  antrum.  The  cir- 
culation both  within  and  without  the  mastoid  is 
then  impeded,  and  swelling,  oedema,  and  tender- 
ness of  its  outer  surface  are  the  result.  Hence  the 
relief  obtained  sometimes  by  spontaneous  resolu- 
tion, or  by  artificial  depletion  over  the  cortex  of 
the  mastoid. — f/iil.  Polyclinic. 


TREATMENT  OF 

PNEUMONIA  IN   THE  NEW   YORK    HOS- 

PITALS. 

•  Bellevue  Hospital. 

Immediately  upon  admission  every  patient  un- 
der the  charge  of  Prof.  Alfred  L.  Loomis  under- 
goes an  examination  for  the  determination  of  the 
following  points  : 

1.  The  extent  and  location  of  pulmonary  con- 
solidation and  amount  of  complicating  pleu- 
risy. 

2.  The  temperature  and  condition  of  the  heart 
as  indicated  by  its  rhythm,  force,  and  amount  of 
muscular  element  in  the  first  sound. 

3.  The  condition  of  the  kidneys. 

When  the  patient  is  admitted  during  the  initial 
shock,  full  doses  of  morphia  are  administered 
hypodermically,  and  repeated  with  sufficient 
frequency  to  relieve  pain,  during  the  first 
three  or  four  days,  or  imtil  the  consolidation  is 
complete. 

Every  patient  is  placed  in  bed,  clothed  in  an 
oil-silk,  flannel-lined  jacket,  which  is  made  to 
come  close  up  aroimd  the  neck  and  to  extend  well 
down  on  to  the  trunk,  and  is  put  upon  a  diet  of  milk, 
vichy,  chicken  soup,  and  beef-tea,  the  selection  of 
food  being  somewhat  affected  by  the  limits  of 
hospital  dietary.     This  much  is  routine. 

When  consolidation  is  confined  to  a  lower  lobe, 
the  cough,  expectoration,  and  pain  moderate,  the 
temperature  below  104°  F.,  while  the  pulse  is 
regular  with  a  strong  first  sound  of  the  heart,  and 
the  urine  is  normal,  nothing  further  is  done  beyond 
keeping  the  bowels  freely  open  by  some  mild 
cathartic,  as  pulv.  glyc.  co. 

The  general  treatment  is  then  purely  expectant. 
The  temperature  and  pulse,  however,  are  taken 
every  four  hours  and  the  urine  examined 
daily. 

When  the  temperature  reaches  104°  F.,  or 
more,  fifteen  to  twenty  grains  of  quinine  are  given 


154 


THE   CANADA   MEDICAL   RECORD. 


at  a  single  dose.  If  at  the  end  of  six  hours  no 
reduction  of  temperature  is  produced,  twenty 
grains  are  given  in  divided  doses  within  an  hour. 
As  the  drug  used  is  "  hospital  quinine,  "  these 
doses  are  possibly  slightly  larger  than  would  be 
required  in  general  practice.  When  they  fail  to 
reduce  temperature  equal  parts  of  quinine  and 
antipyrin  are  employed,  but  always  in  combination 
with  some  form  of  cardiac  stimulant,  as  alcohol  or 
caffeine.  If  the  temperature  is  not  affected  by  the 
second  dose  its  use  is  not  continued. 

Indication  for  stimulants  are  found  principally 
in  the  cardiac  condition.  Patients  with  consoli- 
dation at  the  apex,  however,  and  alcoholic  sub- 
jects are  put  upon  stimulants  from  the  first. 

The  cardiac  stimulants  used  are  alcohol,  caffe- 
ine, digitalis,  and  ammonia,  the  first  two  being 
given  with  about  equal  frequency  and  for  prolong- 
ed effect,  while  the  others  are  used  more  for  emer- 
gencies in  the  latter  stages. 

An  irregular,  uneven,  intermittent  pulse,  or 
weak  or  absent  first  sound  are  indications  for 
stimulants  to  be  given  p.  r.  n. 

It  is  seldom  found  necessary  to  employ  measures 
directed  especially  to  the  cough.  "When  this 
is  distressing,  with  little  expectoration  in  the 
earlier  stages,  opium  is  employed  to  mitigate  its 
severity  but  not  co  check  it  entirely  ;  later  in  the 
stage  of  resolution  opium  is  avoided  and  carbonate 
of  ammonia  given  in  connection  with  infusion  of 
serpentaria  or  wild  cherry. 

Pain  is  controlled  early  by  opium  and  large  Jiot 
poultices,  later  by  poultices  alone,  if  possi- 
ble. 

The  earliest  indications  of  renal  complications 
are  met  by  the  ethers,  infusion  of  digitalis,  and 
nitroglycerine. 

Sleeplessness  is  relieved  by  bromide  and  chlo- 
ral (alone  in  robust  patients),  and  with  the  addi- 
tion of  cardiac  stimulants  in  alcoholic  sub- 
jects. 

OEdema  is  treated  by  dry  cups  freely  applied 
over  the  entire  chest,  atropia  hypodermatically, 
whiskey  and  digitalis  internally,  and  the  free  in- 
halation of  oxygen. 

St.  Luke's  Hospital. 

The  treatment  of  pneumonia  in  Dr.  Kinnicutt's 
wards  in  St.  Luke's  Hospital,  during  the  past  five 
years,  has  been  wholly  an  expectant  one.  Abso- 
lute rest  in  bed  in  a  strictly  horizontal  position, 
not  only  until  defervescence  occurs,  but  for  seve- 
ral subsequent  days,  is  a  rule  which  is  carefully 
observed  in  his  service.  The  patients  are  rarely 
permitted  to  assume  a  sitting  posture,  even  for 
the  purpose  of  an  examination.  Several  instan- 
ces of  sudden  death  from  heart  failure,  in  the 
period  immediately  following  defervescence,  on 
the  patient  attempting  to  rise,  have  ccnvinced  him 
of  the  wisdom  of  a  routine  rule  of  this  kind.  Light 
flaxseed  poultices  or  a  layer  of  cotton-wool  cover- 
ed with  oiled  silk,  applied  over  the  affected  area, 
have  been  found  serviceable  in  promoting  the 
comfort  of  the  patient. 


During  the  developing  stage  of  the  pneumonic 
process  (the  first  three  or  four  days),  opium  in 
small  doses  (morphine  one-sixteenth  to  one-eighth 
grain  given  by  the  mouth  or  hypodermatically, 
two  or  three  time  in  twenty-four  hours)  has  pro- 
ved of  great  service  in  contrbliing  the  symptoms  of 
nervous  shock  which  so  frequently  obtain  at  this 
stage  of  the  disease,  and  in  aff"ording  relief  to  the 
suffering  of  the  patient.  It  has  also  seemed  to 
combat,  in  a  measure,  the  tendency  to  heart 
failure. 

The  employment  of  alcohol  has  been  governed 
by  the  symptoms  in  individual  cases.  With  tlie 
first  indication  of  cardiac  weakness,  it  has  been 
the  rule  to  institute  i:s  use  in  small  doses  and  to 
watch  carefully  its  effect.  The  pulse,  the  tongue, 
and  the  mental  condition  are  accepted  as  guides 
for  its  continued  use  and  for  the  amount  to  be 
given.  Many  cases  have  convalesced  satisfac- 
torily without  its  employment  at  any  stage  of  the 
disease  ;  again,  twelve  or  more  ounces  of  brandy 
have  been  given  in  the  twenty-four  hours,  with 
marked  benefit  and  recovery.  Its  use  in  dimin- 
ished doses  during  the  first  days  of  convalescence 
has  often  been  found  advisable. 

Caffeine  and  digitalis  have  been  used  very  uni- 
formly as  heart  tonics,  and  Dr.  Kinnicutt  believes 
with  benefit.  During  the  past  several  months, 
strophanthus,  in  the  form  of  the  tincture  (five 
drops,  three  or  four  times  in  the  twenty-four  hours), 
has  been  employed  with  excellent  results.  He 
now  prefers  it  to  all  other  cardiac  tonics  in  this 
disease.  Antipyretics  have  seldom  been  em- 
ployed. 

On  the  temperature  reaching  105  °  ,  a  single 
small  dose  of  antipyrine,  eight  to  twelve  grains  by 
the  rectum,  has  been  given  and  repeated  if  neces- 
sary. 

Aside  from  his  disbelief  in  the  necessity  of  the 
general  use  of  antipyretics  in  pneumonia,  Dr. 
Kinnicutt  is  convinced  of  the  intolerance  of  large 
doses  of  the  group  of  carbon  compounds  in  this 
disease. 

I'inally,  the  alimentation  of  the  patient  has 
received  very  careful  attention ;  the  food  has  con- 
sisted of  milk,  in  its  raw  state,  or  peptonized.  Tlie 
hospital  records  show  the  following  satisfactory 
results  under  the  above  method  of  treat- 
ment. 

P'orty  cases  of  acute  labor  pneumonia  were 
treated  in  the  wards  from  December  r,  1884,  to, 
December  i,  18S6.  There  were  six  deaths,  15  per 
cent,  (excluding  one  which  fairly  should  be  disre- 
garded, death  occurring  twelve  hours  after 
admission  to  hospital  on  the  fifth  day  of  the 
disease),  all  in  complicated  cases  j  the  complica- 
tion being  :  (i)  amyloid  spleen,  liver, 
and  acute  nephritis;  (2)  chronic  nephritis; 
the  disease),  all  in  complicated  cases  ;  the 
(3)  endocardial  aneurism,  mitral  stenosis,  chronic 
nephritis ;  (4)  alcoholism  ;  (5)  urethral  stricture 
with  retention  of  urine ;  (6)  uraemia  and  chronic 
nephritis.     Serious  complications  existed  in  ten  of 


•the  CANADA   MEDICAL  RECOtlD, 


155 


the  cases  which    recovered.     Double   pneumonia 
was  present  in  three  of  these. 

If  tiie  nature  of  tlie  symptoms  ))oints  strongly 
toward  the  development  of  pneumonia,  altliough 
it  is  not  yet  perfectly  evident,  J)r.  Beverley  Ro- 
binson avoids  the  use  of  arterial  sedatives  like 
aconite,  and  prefers  to  order  a  few  doses  of  am- 
monia, a  small  amount  of  opium  (Dover's  powder 
preferably),  and  a  flaxseed  poultice  over  the  affect- 
ed side.  When  the  pneumonia  can  be  clearly 
recognized  by  physical  exploration  of  the  lungs, 
moderate  doses  of  digitalis  f'H.  extr.  (Jijj,  and  from 
two  to  four  ounces  of  brandy  or  whiskey  in  the 
twenty-four  hours,  are  i)rescribed. 

A  sufficient  quantity  of  milk  given  regularly 
every  hour,  with  an  egg-nog,  or  beef  extract,  morn- 
ing and  evening,  is  allowed.  Flaxseed  poultices, 
containing  a  small  proportion  of  mustard,  are  con- 
tinued as  a  local  application,  and  are  renewed 
once  every  three  hours.  To  retain  their  heat  and 
moisture,  they  are  covered  externally  with  gutta- 
percha tissue  or  oiled  silk. 

If  the  bowels  are  constipated  at  the  beginning 
of  tlie  attack,  or  subsequently,  a  dose  of  calomel 
is  ordered  (5  grs.),  followed  in  a  few  hours  by  a 
saline  aperient  (3  ss- 3  J  of  Epsom  salts).  When- 
ever the  patient  is  much  prostrated,  and  the  bowels 
remain  torpid,  a  laxative  enema  is  preferred.  In 
cases  where  the  bodily  temperature  rises  above 
103  °  Fah.  in  the  axilla,  five  to  ten  grains  of  the 
phosphate  of  quinine  by  the  mouth,  every  four 
hours,  during  the  continuance  of  the  period  of 
active  hyperpyrexia,  are  ordered.  Whenever  the 
heart  shows  symptoms  of  failure,  either  by  extreme 
frequency,  weakness,  or  irregularity  of  its  beats, 
the  amount  of  brandy  or  whiskey  to  be  given  is 
rapidly  increased,  and  strong,  black  coffee  is  also 
ordered. 

In  a  very  grave  case  of  double  pneumonia 
treated  during  the  past  winter,  and  in  which  a 
cure  followed,  the  disease  was  combated  during 
the  acute  stage  almost  entirely  with  brandy  and 
black  coffee,  a  half  ounce  of  one  or  the  other 
being  given  alternately  every  half  hour.  (The 
brandy  should  be  old  and  pure.)  Later,  dry 
champagne  was  substituted  for  the  brandy. 

Some  years  ago,  Kerms  mineral  (oxsulphuret  of 
antimony),  in  a  vehicle  of  syrup  of  gum  with 
water,  was  frequently  ordered  by  Dr.  Robinson 
every  two  or  three  hours,  in  order  to  promote 
expectoration.  Although  excellent  results  were 
obtained  from  the  use  of  this  drug,  for  no  sufficient 
reasons  it  was  abandoned,  and  never  since  re- 
sumed. 

It  the  heart  action  remains  feeble  during  the 
stage  of  resolution,  although  the  fever  has  disap- 
peared during  several  days,  he  has  found  conval- 
laria  majalis  an  excellent  substitute  for  digitalis. 
It  agrees  with  the  stomach  better  than  the  latter 
drug,  and  often  acts  quite  as  well  as  a  heart 
tonic. 

In  the  convalescent  period,  when  the  lung  re- 
mains impervious     to  air  during  a   considerable 


time,  he  has  foiuid  repeated  lly-blisters  over  the 
affected  side  extremely  beneficial  in  clearing  up 
the  local  intra-pulmonary  condition.  At  the  same 
time  that  blisters  are  applied  he  orders  small  doses 
of  belladonna,  strychnine,  and  carbonate  of  am- 
monium in  infusion  of  cinchona,  repeated  several 
times  daily,  so  as  to  strengthen  the  heart's  action, 
and  tone  up  the  general  system.  Whenever  deli- 
rium is  present,  it  is  allayed  with  ice-bag  to  the 
head,  or  by  the  internal  use  of  ether  (in  perles),  or 
of  the  bromides.  Venesection  for  the  asjjhyxia 
accompanying  a  dilated  and  over-burdened  right 
heart,  is  occasionally  advisable,  and  when  perform- 
ed under  favorable  circumstances,  has  been 
found  useful.  In  his  experience,  however,  the 
evident  indications  for  this  little  operation  have 
rarely  occurred.  The  main  source  of  danger  in 
pneumonia,  as  a  rule,  seems  to  pertain  to  rapid  or 
sudden  heart  failure.  This  accident  may  be  pre- 
vented in  many  instances  by  the  internal  adminis- 
tration of  repeated  and  considerable  doses  of  black 
coffee  and  alcoholic  stimulants. — JV.  V.  Medical 
Record. 


THE    TREATMENT   OF   PNEUMONIA  IN 
THE  PHILADELPHIA  HOSPITALS. 


Hospital     of     the     University     of     Pekn- 

sylvania- 

Dr.  Pei)per  reduces  the  initial  high  fever  in  cases 
of  pneumonia  in  his  wards  (if,  as  unfortunatlye 
rarely  happerns,  the  case  has  been  admitted  just 
after  the  onset)  by  antipyrin  or  by  the  external 
use  of  cold  water.  It  was  for  this,  accompanied 
with  severe  pain,  that  venesection  was  formerly 
used ;  and  he  still  advises  its  use  at  this  earliest 
stage  if  high  fever  returns  promptly  after  reduction 
by  the  above  remedies.  They  will  often  produce 
a  favorable  impression,  however,  with  less  risk. 
Throughout  the  disease  the  fever  must  be  carefully 
watched  and  often  requires  to  be  promptly  redu- 
ced. Sometimes  large  doses  of  quinia — as  thirty 
or  forty  grains  given  in  two  doses  at  intervals  of 
four  hours — will  do  this  ;  but  antipyrin  is  so  much 
more  prompt  and  certain  that  he  prefers  using  one 
of  them,  and  especially  antipyrin,  for  the  occa- 
sional control  of  the  hyperpyrexia,while  giving  con- 
tinuously a  moderate  amount  of  quinia,  say  ten  or 
twelve  grains  daily.  Quinia  meets  several  indi- 
cations in  pneumonia,  and  he  nearly  always  gives 
it,  adapting  the  dose  to  the  grade  of  disease  and 
special  conditions  of  the  patient.  As  the  stomach 
must  be  very  carefully  guarded  in  pneumonia  and 
everything  avoided  that  might  irritate  it,  it  is  often 
better  to  give  quinia  by  the  rectum. 

He  is  more  in  the  habit  of  using  aconite  than 
veratrum,  but  one  or  the  other  of  these  powerful 
and  reliiflle  arterial  sedatives  should  be  used 
during  the  early  days  of  the  attack,  given  in  fre- 
quent and  moderate  doses  so  as  to  produce  safely 
their  physiological  effect  by  lowering  the  pulse 
rate,  relaxing  the  system  and  aiding  in  reduction 


166 


THE   CANADA   MEDICAL  RECORD. 


of  fever.  Later,  if  the  pulse  loses  force  or  after 
the  area  of  the  disease  has  become  defined,  the 
indication  for  arterial  sedatives  has  usually  pas- 
sed. 

Not  only  must  care  be  taken  to  avoid  irritation 
of  the  stomach,  but  in  many  cases,  especially  in 
the  early  stage  there  is  much  gastro-hepatic  con- 
gestion and  irritation  present,  and  here  it  is 
important  to  limit  ourselves  to  relieving  this  by 
short  courses  of  small  doses  of  calomel  with  or 
without  soda,  using  meanwhile  quinia  by  the  rec- 
tum to  control  fever.  It  is  especially  in  these 
cases  that  aconite  is  preferable  to  veratrum  on 
account  of  its  tendency  to  irritate  the  stomach. 
After  the  disease  is  developed,  ammonium  car- 
bonate is  preferred  to  stimulate  respiration  and 
favor  resolution.  It  is  usually  given  in  simple 
emulsion,  and  in  doses  of  five  grains  every  two  or 
three  hours  for  an  adult. 

The  diet  must  be  adapted  carefully  to  the  state 
of  the  stomach  It  should  be  liguid  tliroughout  and 
for  the  first  two  or  thiee  days  should  be  restricted, 
but  after  that  may  be  more  free  and  concentrated 
if  well  received.  It  is  extremely  important  that 
the  patient  be  not  allowed  to  make  any  exertion. 
Regid  rest  must,  indeed,  be  insisted  upon,  for 
pneumonia  is  one  of  the  diseases  in  which  sudden 
death  is  apt  to  occur  from  any  improper  effort,  as 
even  of  rising  to  sit  upon  a  commode  by  the 
bedside. 

Tlie  indications  for  alcoholic  stimulants  are 
drawn  from  the  state  of  the  circulation  and  nervous 
system.  Many  cases  do  well  without  any  stimu- 
lus from  the  beginning  to  end ;  but  on  the  other 
hand  the  signs  of  cardiac  failure  or  of  failure  of 
nervous  force  call  for  alcohol,  which  may  be  re- 
quired to  be  given  freely.  Of  course,  it  is  to  be 
adapted,  as  to  amount  and  mode  of  administration, 
to  the  state  of  the  stomach.  In  general,  a  layer 
of  cotton  or  wool  batting  stitched  inside  of  the 
merino  undershirt ,  over  the  outside  of  which  a 
layer  of  oiled  silk  is  placed,  is  preferable  to  poul- 
tices. The  latter  must  be  made  skilfully  to  be 
pleasant;  they  must  be  changed  frequently,  and 
unless  this  changing  is  done  with  great  care, 
there  are  both  fatigue  and  risk  involved.  Of 
course,  the  above  remarks  apply  solely  to  crou- 
pous pneumonia. 

Dr.  Osier,  in  hospital  practice,  recognizes  two 
groups  of  pneumonic  patients — the  alcoholic  and 
the  temperate.  A  majority  of  the  former  die  in 
spite  of  all  treatment  ;  a  majority  of  the  latter  get 
well  with  any  or  with  no  treatment.  That  the 
mortality  from  pneumonia  in  the  large  general 
hospitals  uniformly  above  twenty-five  per  cent,  is 
due  to  the  fact  that  to  them  are  admitted  the 
debilitated  paupers  of  the  community,  with  systems 
undermined  by  exposere  and  drink,  and  in  no 
state  to  combat  an  acute  disease.  Alcoholics 
with  renal  inadequacy  rarely  survive  pneu- 
monia. 

When  the  disease  is  limited,  the  fever  moderate 
and  the  pulse  good,  a  dilute  acid  mixture  es  given 


with  Dover's  powder  to  allay  the  pain  and  the 
cough.  Cotton  wadding  or,  if  the  patient  prefer, 
light  poultices  are  applied  to  the  affected  side. 
Blisters  are  never  used. 

At  the  disease  can  neither  be  cut  short  nor 
essentially  modified  by  arty  remedies  we  at  pres- 
ent possess,  in  severe  cases  we  have  to  watch  and 
meet  the  tendencies  to  death. 

First.  Heart  failure  from  engorgement  of  the 
right  chambers,  and  the  lesser  circulation,  indica- 
ted by  cyanosis  and  urgent  dyspnea.  Free 
venesection  can  alone  meet  this  danger,  and 
should  be  performed  on  the  first  signs  of  cyanosis, 
with  failing  heart.  Good  results  have  followed 
the  removal  of  from  eighteen  to  twenty-five  ounces 
of  blood.  It  is  often  left  too  late,  and  to  be 
efficacious  should  be  dnne  early.  It  is  not 
always  successful.  Two  cases  bled  this  season 
died. 

Second.  The  fever,  against  which  quinine, 
antipyrin,  and  antefebrin  are  employed  ;  but  the 
action  of  antipyretics  in  pneumonia  is  more  un- 
certain than  in  other  acute  fevers.  Cold  sponging 
and  the  cold  ]iack  are  more  effectual  when  the 
temperature  becomes  dangerously  high. 

Third.  The  increasing  debility,  systemic  as 
well  as  cardiac,  demands  stimulation  and  careful 
feeding.  A  majority  of  the  fatal  cases  die  of 
progressive  heart  failure,  against  which  alcohol  is 
given  freely.  Digitalis  is  also  employed,  but  the 
full  tonic  action  of  this  medicine  is  rarely  seen  in 
the  weak  heart  of  fever.  Camphor  and  strychnine- 
are  useful  in  this  condition. 

Of  medicines,  carbonate  of  ammonium  is  freely 
given.  Opium  is  used  to  allay  the  early  pain  and 
to  quiet  the  cough.  Extensive  bronchitis  with 
liquid  expectoration  is  a  contraindication.  Arte- 
rial sodatives  are  not  much  employed,  but  when 
the  cases  are  seen  early,  aconite  is  sometimes 
given.  In  the  mild  cases  they  are  not  often 
needed,  while  in  the  more  severe  ones  they  may 
be  positively  injurious.  Expectorants  are  rarely 
called  for,  and  when  used  the  ammonia  and  nux 
vomica  fulfill  the  indications.  A  milk  diet  is  given, 
varied  as  occasion  arises. — Phil.  Med.  News. 


INTUBATION    OF    THE     LARYNX     FOR 
OBSTRUCTIONS  ARISING  FROM  INFLAM- 
MATORY CONDITIONS. 

Our  readers  are  all,  to  some  extent,  familiar 
with  the  new  device  invented  by  Dr.  Joseph 
O'Dwyer,  of  New- York,-  of  introducing  a  metallic 
tube  into  the  larynx  and  leaving  it  there  to  be  self- 
sustaining  any  length  of  time  necessary  for  the 
obstructive  condition  to  subside. 

Failures  in  tracheotomy  led  Dr.  O'Dwyer  to 
make  a  study  of  the  possibility  of  introducing  a 
tube  in  extreme  cases,  instead  of  opening  the 
trachea  below  the  seat  of  obstruction.  Having  a 
position  in  the  N.  Y.  Foundling  Hospital,  which 
contains  a  large  number  of  children,  and  affords  fre- 
quent opportunity  for  examining  the  anatomy  of 


THt  CANADA   MEDICAL  EECOBD. 


157 


the  larynx,  and  (after  some  progress  in  the  cons- 
truction of  a  tube  for  trying  it  in  tiic  living  patient) 
he  gradually  worked  out  a  practical  instrument. 

Five  years  ago,  Dr.  McKwen,  of  Glasgow, 
Scotland,  was  working  upon  a  rubber  tube  to  take 
the  place  of  tracheotomy,  but  in  his  endeavor,  the 
tube  was  not  self-sustaining  in  the  larynx,  and 
would  not  permit  the  epiglottis  to  close  down.  A 
quarter  of  a  century  ago.  M.  Bouchiit,  of  Paris, 
made  a  tube  of  metal  which  was  employed  in  seven 
cases,  but  they  all  died.  The  Paris  Academy  of 
Medecine,  under  the  lead  of  Trousseau,  con- 
demned the  use  of  the  tube  and  Bouchut,  dis- 
couraged, discontinued  his  endeavors  to  perfect 
the  instrument,  and  it  went  out  of  notice  and  out 
of  memory  until  revived  in  connection  with  the 
discussion  of  O  Dwyer's  tubes. 

As  at  present  put  up  by  the  instrument  makers, 
there  are  live  tubes,  adapted  to  different  ages 
from  one  year  to  twelve  years  of  age.  Larger 
tubes  must  be  made  to  special  order.  There  is  in 
the  case,  a  gag  of  new  construction,  an  instru- 
ment for  introducing  the  tube,  and  another  for  its 
extraction. 

The  manipulations  are  said  to  be  easy  and 
quick  after  practice,  but  difficult  in  unpractised 
hands.  Dr.  Jennings,  of  Detroit,  is  reported  (in 
the  N.  Y.  Medical  Record  for  Nov.  nth,  1886, 
p.  645)  to  have  failed  altogether  to  get  the  tube 
into  the  larynx.  It  is  doubtless  a  question  of 
practice  and  manual  skill.  The  successes  reported 
are  far  in  advance  of  anything  ever  experienced  in 
tracheotomy.  There  are  two  obvious  reasons  for 
this.  The  first  is  that  the  parents  of  sick  children 
will  consent  to  the  measure  as  soon  as  there  are 
alarming  symptoms ;  and  the  second  is  that  the 
shock  of  a  surgical  operation  is  avoided.  The 
age  of  the  patient  and  his  exhaustion,  through 
long  suffering  and  insufficient  oxidation  of  the 
blood,  render  him  especially  susceptible  to  surgical 
shock. 

The  use  of  the  instrument  is  being  rapidly 
introduced ;  Dr.  Waxham,  of  Chicago,  having 
become  early  enthusiastic  over  his  success,  as 
published  in  the  Chicago  Atedical  Journal  and 
Examiner  and  Dr.  Cheatham,  of  Louisville,  as 
published  in  the  American  Practitioner  and  News 
for  Nov.  13,  1886  has  also  become  enthusiastic  in 
praise  of  the  instrument. 

Dr.  David  Prince,  of  Jacksonville,  Illinois, 
sends  us,  and  permits  us  to  quote  two  successful 
cases  of  intubation  occurring  in  his  practice. 

The  first,  on  November  25th,  ult.,  in  a  three- 
year-old  boy,  a  patient  of  Dr.  Malone,  suffering  from 
diphteria  for  several  days,  the  patch  of  vegetation 
being  visible  on  the  palate  and  in  the  pharynx.  The 
difficulty  of  breathing  had  become  alarming,  but 
manipulation  (under  ether)  dislodged  a  large  quan- 
tity of  exudation,  iinproving  the  respiration.  The 
final  introduction  of  the  tube  rendered  the  respi- 
ration easy.  In  a  short  time  the  tube  was  coughed 
out  and  held  from  being  swallowed  by  the  string 
which  had  not  been  detach.ed.     No  further  alarm- 


ing dyspnoea  occurred,  and  the  tube  was  not  re- 
turned. Under  the  use  of  calomel  in  minute  doses, 
quinine  and  alkaline  vaporization,  the  child  made 
a  slow  recovery,  though  the  diphtheritic  vegetation 
continued  several  days.  The  lungs  escaped  inva- 
sion. The  case  was  on  December  9th  ;  one  of 
membranous  croup,  there  being  no  diphtheritic 
vegetation  in  sight. 

A  seven-year-old  boy,  a  patient  of  Dr.  Halsted, 
exhibited  a  gradually  increasing  dyspnoea,  until 
breathing  was  labored  and  the  vermilion  border  of 
the  lips  dusky.  The  introduction  of  the  tube 
(under  chloroform)  afforded  comjilete  and  perma- 
nent relief.  The  tube  remained  in  place  one 
hundred  and  six  hours  and  at  the  expiration  of 
this  time  it  was  removed  (under  chloroform) 
without  return  of  dyspnoea. 

The  child  could  whisper,  and  could  swallow 
both  liquids  and  solids  while  the  tube  remained 
in  the  larynx 

Dr.  Prince  thinks  that  operators  who  have  not 
become  skilled  through  practice,  should  always 
make  the  attempt  to  intubate  with  the  patient  in  a 
state  of  anaesthesia.  Fright  is  avoided  in  this  way  ; 
all  struggling  and  consequent  alarm  of  the  patient's 
friends  are  also  avoided.  The  operator  himself  is 
likely  to  be  more  deliberate,  and  to  have  less  to 
distract  him  than  with  the  child  in  the  waking  state. 

Dr.  Prince  counts  his  tracheotomies  for  inflam- 
matory obstructions  by  the  number  of  his  thumbs 
and  fingers,  and  his  failures  in  the  same  way. 
Some  of  the  cases  have  died  of  shock,  some  have 
been  relieved  for  a  day,  but  all  died  within  four 
days  from  the  time  of  the  operation. 

It  is  generally  conceded  that  in  those  cases  in 
which  the  small  bronchial  tubes  and  the  alveoli 
become  invaded,  death  is  inevitable.  In  these 
cases,  intubation,  relieving  the  laryngeal  dyspnoea 
will  produce  temporary  relief  and  prolong  life, 
but  the  subsequent  invasion  of  the  lungs  will 
produce  a  secondary  pulmonary  dyspnoea  beyond 
the  reach  of  any  remedy.  The  case  is  the  same 
with  tracheotomy. 

Among  the  references  to  the  literature  of  the 
subject  are  the  following  : 

O'Dwyer.  Intubation  of  the  larynx.  Medical 
Record.     Vol.  XXIX,  No.  23,  p.  641. 

O'Dwyer.     Ditto.  Vol.  XXIX,  No.  15,  p.  410. 

M.  Bouchut,  1858.  A  paper  read  before  the 
Paris  Academy  of  Medicine. 

Dr.   Cheetham.     American    Practitioner   and 
Neicis,  Nov.  13,  1886,  page  321. 

Dr.  Waxham.  Chicago  Medical  Journal  and 
Examiner,  March,  1886,  p.  193. 

Abstract  of  the  same  papers  in  Pediatrics  April, 
1886,  p.  215. 

Dr.  J.  Lewis  Smith.  American  Journal  of 
the  Medical  Sciences,  Oct.,  1886,  p.  409. 

Dr.  Northrup.  Medical  Record,  Vol.  XXX, 
No.  24,  p.  645. 

Dr.  Fletcher  Inglas.  Journal  of  t/ie  American 
Medical  Association,  July  19,  1886. — St.  Louis 
Med.  and  Sur.  Journal, 

Feb.  1887. 


158 


THE  CANADA  MEDICAL  RECORD. 


PRECOCIOUS  CHILDREN. 

SOME  HINTS  ON  THEIR  TRAINING  AND  EDUCATION. 

The  care  and  training  of  a  precocious  child  are 
among  the  most  vital  duties  that  fall  to  parental 
oversight.  It  might  be  said  that  undue  precocity 
in  a  child  is  a  misfortune,  not  only  to  the  parents, 
but  more  especially  to  the  child,  whose  very 
brilliancy  is  often  a  cause  for  keen  suffering. 
What  is  a  precocious  child  ?  We  should  say  that 
he  is  one  whose  mental  activities  are  prematurely 
developed,  whose  nervous  susceptibilities  are  so 
sensitive,  that  the  slightest  mental  excitement 
finds  expression  in  language  that  surprises  us, 
whose  sayipgs  and  doings  leap  far  ahead  of  the 
average  child,  and  whose  conclusions  are  reached 
without  the  ordinary  exercise  of  mental  strain 
or  systematic  application. 

The  precocious  child  is  constantly  saying  things 
so  epigrammatic  and  brilliant  as  to  call  out  the 
wonder  of  admiring  parents  and  relations;  and 
oftentimes  these  strange  unnatural  utterances  arc 
made  the  subject  of  remark  in  the  presence  of  the 
child,  and  some  newpapers  often  devote  a  column 
to  this  bright  and  abnormal  child-talk.  Nothing 
could  be  more  harmful  than  such  encouragement 
of  a  condition  that  is  out  of  all  harmony  with 
healthful  mental  and  physical  growth. 

As  a  rule,  the  precocious  child  is  of  a  strumous 
or  scrofulous  diathesis,  with  a  fair,  brilliant  com- 
plexion, blue  eyes,  and  golden  hair,  beautiful  to 
look  upon  according  to  popular  standards.  He  is 
delicately  sensitive  to  mental  impressions,  and 
alive  to  the  conversation  of  persons  much  older 
than  he.  He  generally  goes  on  in  his  unique 
career,  outstripping  his  brothers  and  sisters,  as 
well  as  his  schoolmates,  in  the  committing  of  tasks 
at  school,  as  well  as  in  the  reading  of  books  far 
beyond  their  comprehension. 

This  generally  goes  on  until  the  age  of  puberty, 
when  he  begins  to  falter.  The  hectic  flush  is  seen 
upon  the  fair  cheek,  the  eye  becomes  more  brilliant, 
and  the  finer  and  the  spiritual  elements  come 
out  with  almost  supernatural  intensity.  By  and 
by  a  slight  cough  arrests  the  attention  ;  and,  before 
the  fond  parent  is  aware,  phthisis  tuberculosis  has 
laid  the  foundation  for  premature  death. 

Now,  what  shall  be  done  to  save  such  children, 
and  make  them  develop  into  healthy  men  and 
women  ? 

First,  we  would  say,  Let  them  severely  alone. 
By  this  we  mean,  do  not  encourage  the  precocious 
development  by  pushing  the  child  ahead,  and 
showing  the  foolish  weakness  of  exhibiting  the  child 
to  visitors,  or  displaying  him  at  the  performances 
pi  Sunday-school  concerts  or  public-school  exhibi- 
tions. We  always  pity  the  poor  victims  of  such 
scenes,  who  come  before  audiences,  and  recite 
standard  poems  or  sing  cavatinas,  to  astonished 
crowds  in  heated  rooms,  amid  the  glare  of  gas- 
lights, and  dressed  in  tawdry  finery,  irrespective 
of  the  climate  or  weather. 

We  say  we  pity  such  children ;  and,  when  we 


look  upon  their  pale  faces  and  attenuated  legs,  we 
wish  we  had  the  power  to  send  them  home  and 
put  them  to  bed. 

Second,  be  simple  with  such  children  ;  keep 
tliem  young,  and  encourage  them  to  talk  child-talk, 
to  read  child-books,  and  to  play  with  other 
children.  Do  not  let  them  remain  in  the  house  in 
company  with  the  older  folk,  when  the  bright  sun 
is  shining,  and  the  other  children  are  romping 
upon  the  green  with  all  the  glorious  freedom  of 
childhood. 

We  recall  the  case  of  a  little  boy  who,  at  eight 
years  of  age,  would  crawl  behind  the  sofa  or  under 
the  table,  and  read  Paradise  Lost  and  the  Waver- 
ley  novels.  T4:e  fond  mother  told  of  the  incident 
with  maternal  pride.  Alas  !  the  dear  boy  was 
under  the  sod  at  twelve.  The  precocious  child, 
whose  brain  is  in  a  state  of "  super-excitation," 
must  not  be  subjected  to  the  discipline  of  the 
public  school.  Such  children  do  not  work  well  in 
a  system  so  full  of  curbs  and  checks,  so  beset  with 
"  marking,"  and  with  rewards  and  punishments. 
The  conscience  of  these  children  is  usually  morbid- 
ly acute,  and  the  suffering  occasioned  by  the 
exactions  of  marking  and  other  tests  for  promotion 
is  often  painfully  injurious.  A  private  instructor 
or  a  select  school,  where  there  can  be  more  elasti- 
city in  the  working  of  the  machinery,  and  where 
the  child  can  be  dealt  with  as  an  individual,  is  far 
better. 

Of  paramount  importance  is  the  physical  train- 
ing of  the  precocious  child.  From  the  very  nature 
of  the  case,  all  undue  excitement  must  be  avoided. 
The  full  quota  of  sleep  must  be  insisted  upon. 
No  late  hours  should  be  allowed,  full  of  the 
amusements  that  are  such  a  strain  upon  the  nervous 
system.  We  have  heard  of  a  little  precocious  miss 
of  eight  summers,  who,  besides  attending  the 
public  school,"  takes  lessons "  upon  the  piano, 
goes  to  a  dancing  school,  gives  and  attends 
children's  parties,  and  who  very  often  is  not  in  her 
bed  until  ten  o'clock  at  night.  What  a  foundation 
for  that  child's  future  is  being  laid  I  The  diet 
should  be  of  the  simplest  character,  consisting 
of  food  containing  all  the  elements  of  nutrition, 
like  milk,  bread,  and  soups.  Confections,  condi- 
ments, and  fancy  dishes  should  never  be  set  before 
children.  Give  fresh  air  in  abundance,  and  insure 
the  child  to  go  out  of  doors  in  all  kinds  of  weather. 
By  following  the  general  plan  which  has  been 
outlined,  we  think  the  precocious  child  can  be 
carried  safely  over  the  critical  line  that  marks 
the  beginning  of  manhood  and  womanhood,  and 
secure  a  healthful  development  that  will  serve 
a  long  lifetime. 

We  have  not  time  here  to  touch  upon  the  form 
of  precocity  found  in  the  gamins  of  our  great  cities. 
This  class  of  humanity  is  an  enigma  to  the  philan- 
thropist and  the  maturity  and  adroitness  of  the 
wickedness  attained  by  the  newsboys,  the  boot- 
blacks, and  the  vagabonds,  are  indeed  a  study. 
Our  suggestions  have  reference  to  the  precocious 
child  as  found  in  good  families,  and  under  favor- 
ing circumstances. — Popular  Science  News, 


TUE  CANADA  MEDICAL  RECORD. 


159 


CONGENITAL  HEREDITARY  ATONIC 
DYSPEPSIA. 

During  a  practice  of  twenty  years,  I  have  pres 
cribed  Lactopcptine  to  patients  of  all  ages,  and 
have  never  been  disapjjointed  in  its  action  when 
indicated.  But  I  desire  to  speak  in  particular  of  its 
action  in  a  case  of  congenital  hereditary  atonic 
dys])epsia  in  an  infimt,  to  whom  I  began  to  ad- 
minister this  remedy  on  the  third  day  after  birth. 
Mrs.  H.  L.  S.,  Langside,  Miss.,  was  delivered  of 
a  male  child,  in  whom  there  were  manifested  well 
marked  symptoms  of  atonic  dyspepsia.  The  moth- 
er had  been  a  victim  of  dyspepsia  from  girlhood, 
and  had  inherited  the  malady  from  her  mother. 

The  infant  was  put  to  the  breast  a  few  hours 
after  birth,  and  nursed  readily;  but  almost  imme- 
diately rejected  the  milk.  Repeated  trials  all  re- 
sulted in  vomiting,  followed  by  exhaustion.  Other 
articles  of  food  were  tried,  including  cow's  milk, 
etc.,  without  improvement.  The  child  was  in 
great  danger  of  starvation.  On  the  third  day,  I 
began  the  administration  of  Lactopeptine.  The  ef- 
fect was  immediate  and  almost  miraculous.  I 
ordered  one-sixteenth  of  the  adult  dose  to  be  dis- 
solved in  about  two  ounces  of  breast  milk  (drawn 
from  a  robust,  healthy  wet-nurse)  and  administered 
every  two  and  a  half  hours.  There  was  no  more 
rejection  of  milk — except  the  usual  vomiting  of 
curdled  milk,  to  relieve  the  crowded  state  of  the 
stomach,  which  occurred  occasionally,  after  the  first 
ten  days.  Condensed  milk  cow's  milk  (properly 
diluted  and  sweetened),  Mellin's  food,  boiled 
bread  (pap),  were,  after  a  while,  substituted  for 
breast  milk,  but  always  with  Lactopeptine.  A 
steady  improvement  was  manifest  from  the  begin- 
ning, and  kept  up  during  the  first  dentition,  which 
process  was  gone  through  with  in  a  most  satisfac- 
tory manner.  No  untoward  diarrhcea  or  intestinal 
disturbance  characterize  this  period,  and,  at  ten 
months,  the.  child  was  virtually  cured  of  its  dys- 
pepsia, and  could  eat  and  digest  ordinary  food, 
such  as  children  of  that  age  may  do  in  good  health. 

The  parents  of  the  child  believe  firmly  (as  I  do) 
that  Lactopeptine  saved  their  infant.  In  cholera 
infantum,  in  diarrhoea,  and  in  all  of  the  disturb- 
ances of  the  alimentary  canal,  during  dentition 
and  early  infant  life,  I  find  Lactopeptine  an  ever- 
effective  and  reliable  remedy.  In  adult  dyspepsia 
all  are  now  familiar  with  its  beneficial  effects  ;  but 
I  should  be  glad  if  the  profession  would  be  induc- 
ed to  try  it  in  the  vomitings,  diarrhoeas  and  dys- 
pepsias of  infancy.  I  recall  several  babies  whose 
lives  I  believe  I  could  have  saved,  had  I  known, 
ten  years  ago,  what  I  do  now  of  the  ready  adapta- 
bility of  Lactopeptine  to  infants)  ailments. — R. 
Walkers  Beers,  M.  D.  ,  in  the  Medical  Brief. 

Angola,  La. 

WARTS. 
It  is  now  fairly  established  that  the  common 
wart,  which  is  so  unsightly  and  often  proliferous 
on  the  hands  and  face,  can  be  easily  removed  by 


small  doses  of  sulphate  magnesia  taken  internally. 
M.  Colrat,  of  Lyons,  has  drawn  attention  to  this 
extraordinary  fact.  Several  children  treated  with 
three-grain  doses  of  Epsom  salts,  morning  and 
evening,  were  promptly  cured.  M.  .Vubers  cites 
the  case  of  a  woman  whose  face  was  disfigured  by 
these  excrescences,  and  who  was  cured  in  a 
month  by  a  dram  and  a  half  of  magnesia  taken 
daily.  Another  medical  man  reports  a  case  of 
very  large  warts,  which  disapjjcared  in  a  fortnight, 
from  the  daily  administration  of  ten  grains  of  the 
salts. —  Tlie  Medical  Press. 


A  NEW  TREATMENT  OF  G0>  ORRHCEA. 

Castallan,  of  St.  Mandrier  Hospital,  starting  with 
the  view,  now  popularly  entertained,  that  gonor- 
rhoea! urethitis  is  a  parasitic  disease,  and  being 
led  by  observation  to  believe  that  the  microbe  can 
only  live  in  an  acid  medium;  finding,  moreover, 
that  in  this  disease  the  discharge  is,  as  a  rule,  acid, 
proposes  to  treat  gonorrhoea  in  the  acute  stages  by 
urethral  injections  of  sodic  bicarbonate,  three  or 
four  injections  being  made  daily  of  a  one  per  cent, 
solution.  For  this  treatment,  which  is  but  a  logical 
interference  from  the  i)remises,  he  claims  remark- 
able success,  although  the  cases  on  which  it  has 
been  tried  in  St.  Mandrier,  as  yet,  number  only  a 
dozen.  The  injections  of  bicarbonate  sodium  are 
commenced  as  soon  as  the  discharge  appears,  or  the 
patient  comes  under  observation  ;  the  urethal 
secretion  is  tested  every  day  with  litmus-paper,  and 
the  injection  is  kept  up  till  the  discharge  becomes 
alkaline  or  neutral.  For  internal  treatment  the 
patient  is  given  flaxseed  tea,  with  occasional  doses 
of  bromide,  if  there  seems  to  be  any  indication  for 
the  sedative  effects  of  this  salt.  His  conclusions 
are  as  follows : 

1.  The  urethral  pus  in  the  first  stages  of  the 
disease  is  generally,  if  not  invariably,  acid ;  this 
acidity  is  quite  pronounced. 

2.  The  treatment  by  bicarborate  of  sodium  rapid- 
ly lessens  the  discharge  ;  it  also  rapidly  diminish- 
es or  removes  the  pain  in  micturition. 

3.  In  old  urethrites,  and  those  which  have  been 
treated  by  the  usual  injections,  it  speedily  brings 
about  a  cure. — Boston  Medical  and  Surgical  Jour- 
nal. 


THE  TREATMENT  OF  RHEUMATISM  IN 
THE  HOSPITAL  OF  THE  UNIVERSITY 
OF  PENNSYLVANIA. 

Dr.  Osier  employs  in  mild  cases,  with  only  one 
or  two  joints  involved,  and  the  temperature  not 
above  102  °  F.,  the  citrate  of  potash  in  3  ss  doses 
every  four  hours.  If  there  is  much  pain  and  the 
patient  is  restless,  Dover's  powder  grs .  x  at  night. 
In  more  severe  attacks,  with  polyarthritis,  and 
fever  above  103  °  ,  he  orders  salicylate  of  sodium 
grs.  XV  every  two  hours,  with  a  similar  quantity  of 
citrate  of  potash.     The  important  influence  of  the 


160 


THE   CANADA   MEDICAL   RECORD. 


salicylate  is  believed  to  be  in  the  reduction  of  the 
pain  and  fever.  It  is  not  thought  to  have  much 
influence  in  lessening  the  duration  of  disease  ;  and, 
on  the  other  hand,  when  pushed  for  many  days 
and  in  large  doses,  it  is  thought  directly  to  favor 
the  occurrence  of  relapse.  Hence,  as  soon  as  the 
pain  is  relieved,  the  amount  of  the  salt  is  reduced, 
and  it  is  stopped  as  soon  as  possible.  It  does  not 
probably  influence,  one  way  or  the  other,  the  occur- 
rence of  endocarditis.  When  the  temperature  is 
above  103.  5°  antipy:in,  grs.  xx,  is  ordered. 
With  fever  of  105°  the  cold  pack  is  employed. 
Lemonade  and  carbonated  waters  are  allowed 
freely.  An  unstimulating  liquid  diet  is  given. 
Blankets  are  preferred  for  the  bedding  of  the 
patient.  Special  care  is  enjoined  in  changing  the 
clothing,  and  a  wad  of  cotton-wool  is  placed  over 
the  front  of, the  chest,  The  joints  are  wrapped  in 
cotton-wool,  or  when  very  painful  in  spongiopiline, 
or  flannel,  soaked  in  Fuller's  lotion  (hot)  (Liquor 
Opii  Sedativus,  5  j;  Potass.  Bicarb.,  3  iv;  Gly- 
cerin., 3  ij ;  Aquae,  1  ix).  If  the  salicylate  and  the 
local  application  fail,  as  they  sometimes  do,  to 
relieve  pain,  opium  is  freely  given.  During  con- 
valescence iron  and  tonic  doses  of  quinine  are 
ordered. — Medical  News. 


WHAT  CAUSES  WEAK  AND  TIRED 
EYES. 

Eyes  are  made  to  see  with,  and  they  are  so  con- 
structed naturally  that  they  perform  this  function 
without  effort  and  without  labor.  In  its  passive 
or  quiescent  state  the  eye  is  an  instrument,  as  the 
opticians  say  of  their  lenses,  "  corrected  and 
adjusted  for  distance,  "  and  it  consequently  images 
to  the  brain  all  that  is  within  the  field  of  vision 
without  strain  or  effort.  When  a  person  fixes  his 
eyes  upon  a  distant  object,  and  looks  steadily  at  it 
for  any  great  length  of  time,  the  organ  itself  does 
not  tire  of  seeing,  but  the  muscles  which  control 
their  movements  and  hold  the  balls  fixed  tire  of 
the  strain  thus  imposed,  just  as  any  other  volun- 
tary muscle  tires  of  being  held  rigidly  in  one  position 
or  engaged  in  one  act  for  any  considerable  period. 
The  visual  apparatus  would  continue  to  see  and  re- 
port to  the  brain  for  an  indefinite  time,  did  these 
directing  agents  not  tire  of  their  task. 

But  while  this  is  true  of  vision  at  a  distance,  it 
does  not  hold  good  of  objects  held  very  close  to  the 
eyes.  In  this  case  the  muscles  are  again  the  seat 
of  weariness,  but  from  another  cause.  The  balls 
must  not  be  converged,  and  the  focusing  apparatus 
continuously  readjusted  for  near  distances.  All 
this  must  be  accomplished  by  muscular  action.  A 
person  cannot  hold  his  arm  straight  out  from  his 
body  lor  an  indefinite  time  ;  it  will  go  down  in  spite 
of  his  will,  after  the  expiration  of  a  certain  period, 
varying  according  to  strength,  practice,  etc.  So  it 
is  with  the  muscles  which  perform  the  complicated 
action  of  adjusting  the  focal  distance  of  the  eyes  in 
the  observation  of  very  near  objects.  They  per- 
form the  functions  when  ordered,  and  maintain  their 


action  for  a  certain  limited  space  of  time,  but  they 
soon  weary  and  demand  rest,  which  they  get  by 
relaxing.  The  moment  that  relaxation  occurs  the 
proper  visual  focus  is  destroyed,  and  can  only  be 
restored  by  a  readjustment,  which  means  a  fresh 
demand  upon  the  already  fatigued  focusing  muscles. 
^^'eakened  and  tired  eyes,  therefore,  result  from 
overworked  or  defective  adjusting  muscles,  and  not 
from  the  "  seeing  portion  "  of  the  apparatus,  or  the 
retina,  which  does  not  tire.  This  enables  us  to 
formulate  the  maxim  that  whenever  an  eye  sees  per- 
fectly for  one  moment  of  time,  it  is  almost  positive 
proof  that  there  is  no  organic  disease  of  the  visual 
apparatus  proper.  We  may  add  that  the  condition 
of  vision,  known  as  "  weak  "  or  "  tired  eyes,"  is  near- 
ly always  the  result  of  farsightedness,  which  neces- 
sitates constant  and  excessive  action  on  the  part  of 
the  adjusting  muscles  to  accommodate  the  organs 
to  the  vision  of  things  near  to  them.  The  treat- 
ment of  this  condition,  therefore,  must  be  addressed 
to  the  muscles,  and  in  cases  of  farsightedness  the 
selection  of  proper  glasses  is  the  only  thing  to  do. 
— St.  Louis  Med.  and  Sur.  Journal. 


ECZEMATOUS  ULCERATION  OF  THE 
CORNEA;  ECZEMA  OF  EAR  AND 
SCALP;  DIAGNOSIS  AND  TREATMENT. 

Children  are  particularly  liable  to  acute  and 
chronic  eczema  of  the  face,  scalp  and  ears,  and  the 
eruption  on  the  surrounding  skin  is  almost  certain 
to  excite  ulceration  of  the  cornea  of  one  or  both 
eyes.  The  conjunctiva,  being  continuous  with  the 
skin,  sympathizes  very  intimately  with  any  irri- 
tation thereof,  and  is  consequently  subject  to  the 
same  eruptions.  Thus  when  an  eczematous  erup- 
tion reaches  close  to  the  margins  of  the  lids  the  con- 
junctiva becomes  intensely  red,  and  is  soon  itself 
invaded  by  the  eczema,  and  the  appearance  of  the 
disease  m  that  part  of  the  conjunctiva  which  covers 
the  cornea  is  immediately  followed  by  ulceration  of 
the  latter.  These  ulcers  are  frequently  multiple  and 
are  always  the  cause  of  great  suffering,  being  at- 
tended wnth  profuse  lachrymation  and  extreme 
photophobia.  When  the  lids  are  forcibly  separated 
tears  gush  out,  and  the  little  patient  screams  with 
agony  caused  by  light.  This  condition  is  called 
eczematous  keratitis  or  eczematous  ulceration  of 
the  cornea.  It  is  frequently  most  persistent  and 
diflicult  to  manage,  but  the  prognosis  is  always 
favorable. 

Eczema  of  the  scalp  is  quite  common,  particularly 
in  the  neighborhood  of  the  auricles,  and  often  ex- 
tends to  them,  covering  one  or  both  ears.  The 
disease,  while  painful  and  unsightly,  is  by  no 
means  dangerous,  except  in  its  relation  to  the  eyes, 
as  explained  above. 

In  the  treatment  the  only  thing  to  be  used  in  the 
eye  is  a  solution  of  atropine,  from  i  to  4  grains  to 
the  ounce  of  water,  according  to  the  age  of  the 
patient.  It  should  be  dropped  into  the  eye  from 
three  to  five  times  a  day,  and  to  have  any  effect, 


'Ttit   CANADA   MEDICAL   RECORD. 


161 


must  be  gotten  well  into  it.     The  child's  head  must 

lie  firmly  held,  and  the  lids  forcibly  seiniratcd  be- 
lore  the  allcnipt  to  apply  tlie  remedy  is  made. 

The  treatment  of  the  surrounding  skin,  or  of 
the  disease  itself,  is  not  so  simple  a  matter.  The 
nature  of  eczema  is  to  extend  in  one  direction  while 
drying  up  in  another,  thus  giving  at  one  and  the 
same  time  fresh  and  old  eruptions,  the  first  being 
covered  with  moisture  and  the  latter  with  scabs  or 
scales.  The  condition  determines  the  treatment  of 
the  jiart.  The  first  thing  to  be  done  is  to 
thoroughly  clean  the  whole  surface.  Where  the 
eruption  has  extended  to  the  scalp  the  hair  must  be 
closely  cut  away.  All  dry  crusts  that  can,  without 
using  too  much  force  and  e.\citing  too  much  pain 
and  bleeding,  must  be  removed.  The  whole  surface 
must  be  brushed  over  with  a  strong  solution  of 
nitrate  of  silver  (from  20  to  40  grains  to  the  ounce 
of  water).  'I'he  silver  solution  must  be  applied  free- 
ly, the  brush  being  carried  several  times  over  every 
portion  of  the  surface.  The  caustic  is  more  parti- 
cularly indicated  in  the  moist  or  fresh  stage,  but  the 
areas  of  moisture  and  dryness  are  so  interwoven 
that  it  is  best  to  go  over  the  entire  affected  surface. 
The  caustic  application  must  be  followed  by  one  of 
oxide  of  zinc  ointment  (made  with  vaselin),  which 
should  be  gently  but  thoroughly  aj)plied  and  rubbed 
in.  The  caustic  should  be  applied  but  once  daily, 
but  the  ointment  should  be  repeated  at  least  thrice 
within  the  same  period.  If  properly  applied  the 
latter  soon  saturates  the  crusts  which  it  was  impossi- 
ble to  remove  at  first,  softens  them  up  and  loosens 
them,  so  that  they  will  separate  and  drop  off  spon- 
taneously, and  will  not  reform.  When  the  moisture 
has  disapi)eared  the  caustic  application  must  be 
discontinued,  but  the  ointment  must  be  kept  up 
until  the  skin  is  entirely  healed.  As  the  disease 
leaves  the  skin  the  ulcerations  on  the  cornea  dis- 
appear. When  this  occurs  the  use  of  the  atropine 
solution  should,  of  course,  cease.  If  there  be  any 
otorrhcea  it  must  be  treated  in  the  usual  way,  and 
due  attention  must  be  paid  to  the  nourishment  of  the 
patient  under  all  circumstances.  The  diseased 
skin  must  not  be  covered.  It  should  be  left  open 
to  the  free  contact  of  the  air  at  all  points.  So  far 
as  I  can  now  remember  this  method  of  treatment 
has  been  uniformly  and  invariably  successful  in  my 
hands. — St.  Louis  Med.  and  Sur.  Jounral 


SOME  SURGICAL  HINTS. 

Prof.  John  Chiene,  in  an  admirable  series  of 
practical  notes  on  every  day  surgery,  makes  the 
following  suggestions  in  the  Edinhurgh  Medical 
Journal: 

In  wounds  of  the  face  the  best  stitch  to  make  is 
horse  hair.  Unless  the  wound  is  of  considerable 
size  no  form  of  drainage  is  necessary.  The  best 
dressing  is  the  pad  ot  salicylic  cotton  wool  or 
corrosive  wool,  fixed  in  position  with  flexible  col- 
lodion. The  introduction  of  the  sharp  spoon 
into  the  surgical  practice  has  greatly  simplified  the 
treatment  of  lupus.    In  the  use  ot  the  sharp  spoon 


special  care  must  be  taken  to  scrape  away  the 
raised  edges  of  the  lupoid  ulcer,  as  it  is  here  that  the 
pathological  change  is  advancing.  This  is  best 
done  by  scraping  from  the  sound  skin  toward 
the  centre  of  the  ulcer.  After  the  new  formation  is 
completely  removed,  the  best  application  is  a 
powder,  which  has  been  introduced  into  the 
surgical  practice  by  Dr.  Lucas  Championnier,  of 
Paris.  It  consists  of  light  carbonate  of  magnesia, 
which  has  been  impregnated  with  vapor  of 
eucalyptus,  powdered  benzoin  and  iodoform  in 
equal  cpiantities. 

In  a  reduction  of  a  dislocation  of  the  lower  jaw, 
the  patient  should  be  seated  on  a  low  stool  before 
the  surgeon.  In  this  way  the  surgeon  gets  suffi- 
cient leverage,  standing  above  the  patient,  and  the 
reduction  of  the  dislocation  is  simplified. 

In  the  division  of  a  tight  frajnum  of  the  tongue, 
when  the  child  is  tongue-tied,  care  must  be  taken 
not  to  use  the  scissors  too  freely.  All  that  is 
necessary  is,  standmg  behind  the  patient,  to  nick 
the  anterior  edge  of  the  fra^num  with  the  scissors, 
and  to  tear  with  the  finger  nail  the  remainder  of 
the  band.  In  this  way  hemorrhage  which  is  apt  to 
be  troublesome  is  prevented.  In  the  removal  of 
an  elongated  uvula  after  you  have  grasped  the 
apex  of  the  uvula  it  is  to  be  drawn  forward  and, 
rendered  tense  before  division.  If  it  is  simply 
grasped  and  attempt  mide  to  divide  it  in  its  normal 
position,  it  is  not  an  easy  matter  to  effect  the 
object  desired.  When  it  is  rendered  tense,  the 
oijeration  is  a  very  simple  one. — New  Eng.  Medi- 
cal Monthly. 


Dr.  Livezey  writes  :  "  While  wintering  in 
Florida  1  met  with  my  annual  patient,  a  young 
lady  of  twenty-eight,  from  Chicago,  who  was  sent 
hither  three  or  four  years  ago  in  order  to  pass  out 
into  the  "  spirit  land  "  comfortably,  who  now  being 
troubled  with  poor  appetite,  a  slight  but  distressing 
nausea,  great  debility,  irregular  menstruation,  ex- 
cessive cardiac  action  on  the  least  exertion,  etc. 
I  ordered  i  oz.  bottle  of  Lactopeptine  of  the  N.Y. 
Pharmacal  Association's  manufacture,  and  she  im- 
proved at  once.  Soon  after  she  met  a  lady  friend, 
who  told  her  she  ought  to  take  Lactopeptine,  stat- 
ing what  wonders  it  had  done  her,  who  was 
troubled  "just  the  same  way"  (of  course).  "  Why 
bless  me,"  said  my  patient,  "  that  is  just  what  my 
doctor  prescribed  for  me,  I  am  doing  nicely."  By 
the  time  she  finished  the  small  vial  she  declared 
she  never  felt  better  in  her  life,  her  appetite  being 
regular,  and  everything  O.K. 

N.B. — She  has  taken  since  Lactopeptine,  Elixir 
Calisaya,  Iron  and  Bismuth,  with  excellent  results, 
—  The  Medical  Summary. 


CONIUM  FOR  SLEEPLESSNESS. 
Drachm  doses  of  fluid  extract  of  conium  allay 
and   often    cure  sleeplessness,   and  are  useful  in 
chorea,    spasm  of  paralyzed  limbs,    and   general 
irritation. — Medical  World. 


u^ 


tHE   CANADA   MEDICAL    RfiCORfi. 


PSOAS  ABSCESS;  WHEN  AND  HOW  TO 
OPEN  IT. 

At  a  recent  meeting  of  the  British  Medical 
Association,  Mr.  Edmund  Owen  read  a  paper 
on  the  above  subject.  Mr.  Owen  said  there  was 
no  disease  the  treatment  of  whicii  had  derived  a 
greater  impetus  from  the  introduction  of  antisep- 
tics than  psoas  abscess.  By  antiseptics  he  did 
not  mean  the  use  of  the  spray.  The  spray  was 
now  coohng  down  in  more  senses  than  one,  and 
the  surgeon  did  not  now  have  to  look  through  a 
cloud  01  carbolic  vapor  at  his  patient.  By  the 
use  of  antiseptics  he  meant  antiseptics  as  used  by 
the  great  masters  in  surgery,  whether  by  Tait, 
Gamgee,  Savory,  or  Lister.  Twenty  years  ago 
every  surgeon  preferred  to  leave  a  psoas  abscess 
alone,  so  long  as  it  remained  unopened.  Stanley, 
writing  forty  years  ago,  said  psoas  abscess  might 
disappear.  Could  it?  Mr.  Owen  said  that  in  an 
extensive  out-patient  e.xperience,  extending  over 
years,  he  had  only  seen  one  case  in  which,  after  a 
fusiform  tumor  had  been  detected  ascending  along 
the  iliac  fossa,  he  had  seen  it  disappear.  Aspira- 
tion was  useless,  for  it  refilled.  When  evacuation 
of  the  abscess  was  performed,  it  should  be  done 
thoroughly,  and  no  useless  temporizing  measures 
made  use  of.  During  delay  the  pus  would  be 
burrowing  out  for  itself  an  extensive  ramifying 
cavity.  A  free  anterior  and  posterior  opening 
should  be  made,  and  the  wound  thoroughly  drain- 
ed. Tlie  sac  should  be  washed  out  with  a  warm 
antiseptic  lotion,  and  a  drainage  tube  the  size  of 
a  cedar  pencil  ])assed  througli.  The  wound  should 
be  covered  with  sublimate  gauze,  then  some  oakum 
placed  over  it,  and  the  dressings  changed  as  sel- 
dom as  possible.  He  had  employed  as  the  antisep- 
tic lotion  a  warm  solution  of  corrosive  sublimate 
(I  in  i,ooo).  He  should,  however,  in  future, 
discard  the  use  of  the  sublimate,  as  he  had  had 
a  case  which  died  in  four  hours  with  black  urine, 
due,  he  believed,  to  the  absorption  of  the  subli- 
mate. Mr.  Owen,  in  concluding,  summed  up  his 
conclusions  as  follows  : 

1.  Spontaneous  absorption  of  psoas  abscess  is 
impracticable.  Sooner  or  later  it  must  be  evacu- 
ated, either  by  nature  or  art,  and  the  advantage 
is  on  the  side  of  art. 

2.  The  sac  t^hould  be  opened  both  in  front  and 
at  the  back,  and  irrigated.  For  a  small  abscess  a 
single  opening  at  the  back  might  suffice. 

3.  Antiseptics  should  be  employed. 

4.  The  operator  should  bear  in  mind  that  pus 
might  collect  on  the  opposite  side  after  evacuation 
of  the  abscess.  If  any  rise  of  temperature  take 
place,  a  second  abscess  should  be  suspected,  and 
if  found,  evacuated  at  once.  Bilateral  abscesses 
should  be  attacked  simultaneously,  as  their 
cavities  frequently  communicate.  In  reply  to  a 
query  from  a  member  as  to  the  source  of  his 
method,  Mr.  Owen  replied  that  was  neither 
English,  French,  Scotch,  nor  Italian,  but  Welsh, 
thereby  signifying  that  the  idea  was  his  own,  and  that 
he  had  not  borrowed  it  from  any  one. — JVe7c> 
York  Medical  Record. 


TREATMENT    OF    ACUTE    TONSILLITIS. 

Dr.  John  Brown  states,  in  the  British  Medical 
Journal,  that  it  is  a  rare  event  for  suppuration  to 
occur  in  acute  tonsillitis,  if  treated  early  with  the 
following  mixture  :  ' 

IJ. — Sodii  salicylat 3  iss. 

Potass,  bicarb    3  iss. 

Tinct.  aconit  m  xl. 

Liq.  opii  sed  3  ss. 

Sp.  chloroform 3  ii. 

Aquae,  q.  s.  ut  ft fS  viij. — M. 

Sig. — One  to  two  ounces  every  two  or  three 
hours  for  the  first  thirty-six  hours. — Memphis 
Medical  Monthly. 

A  RAPID  METHOD  IN  THE  TREATMENT 
OF  FRACTURES. 

Dr.  VON  DoNHOFF,  of  Louisville,  thus  describes 
a  rapid  method  of  treating  fractures  : 

"  r.  Strips  of  sole  Leather  or  gutta  percha  (tin 
will  answer  also)  of  suitable  breadth  and  length 
being  at  hand,  these  are  immersed  in  hot  water 
and  adjusted,  by  means  of  a  roller,  to  the  site  of 
the  fracture,  previously  reduced  and  properly 
swathed  in  cotton  wool  ;  the  latter  should  be  se- 
cured in  position  by  a  few  turns  about  it  with 
sewing  thread.  [Anaesthesia  is  a  sine  qua  non  to 
the  proper  manifestation  and  reduction  of  frac- 
tures] 

"  2.  If  no  suggestive  incident  intervene,  such 
as  shortening,  angularity,  or  great  uneasiness  and 
pain,  ^^  first  dressing,  in  cases  of  fracture  of  the 
shaft  of  long  bones,  should  not  be  removed  until 
the  tenth  day,  but  should  never  be  permitted  to 
remain  longer  than  the  sixth  day  in  similar  injuries 
of  joints. 

"3.  On  the  fourteenth  to  the  twentieth  day, 
barring  cases  in  which  untoward  diathetic  or  local 
influences  have  been  demonstrated  to  exist,  it  will 
be  found  that  the  fragments  are  fixed,  and  that 
the  dressing  may  be  dispensed  with  altogether, 
excej)!  in  fractures  involving  joints  ;  in  these  the 
splints,  properly  stitched  together,  should  be 
readjusted  on  going  to  bed,  in  order  that  the  un- 
conscious and  possibly  violent  movements  of  the 
patient  may  not  prove  disastrous. 

"  4.  Gentle,  passive  motion  of  fractured  joints 
should  be  begun  at  least  as  early  as  the  sixth  day 
after  the  first  dressing,  and  practiced  every  second 
day  thereafter  until  the  fourteenth,  increasing  the 
degree  of  motion  as  may  be  suggested  by  the 
judgment  of  the  surgeon.  After  this  date,  the 
dressing  being  left  off,  the  matter  of  moving  the 
limb  may  be  relegated  to  the  inclination  of  the 
patient,  unless  he  be  too  timid,  when  he  may 
safely  be  encouraged  to  handle  light  objects  and 
practice  normal  motions  of  the  limb. 

"  5.  The  average  duration  of  treatment  need 
not  exceed  twenty-eight  days,  under  ordinary  cir- 
cumstances. 


I'HE  CANADA  MEDICAL   RECORD. 


16^ 


"The   above   rules    of   practice    have   proven 

equally  reliable  in  the  treatment  of  compound 
fractures  produced,  in  osteotomies  done  for  the 
correction  of  deformities  near  the  ends  or  in  the 
continuity  of  long  bones. 

"  6.  The  posture  of  the  limb  should  be  that 
best  adapted  to  muscular  equipoise — straight,  or 
in  an  obtuse  angle." — American  Medical  Digest. 


CHLOROFORM  IN  LABOR. 

At  the  last  meeting  of  the  State  Medical  Society 
of  New- York,  Dr.  Fordyce  liaiker  read  a  paper 
entitled,  "  Is  the  danger  from  iiost-jjartum  hx'mor- 
rhage  increased  by  the  use  of  anaesthetics  during 
])arturition  ?"  'I  his  subject  is  of  great  practical 
importance,  and  Dr.  Barker  has  brought  the  trea- 
sures of  a  large  and  successful  exjjerience  to  its 
elucidation.  His  pajser  is  eminently  practical, 
and  will  secure  a  wide  reading,  and  will,  we  doubt 
not,  lead  to  the  more  frequent  employment  of 
anaisthetics  in  labor.  Dr.  Barker  regards  chloro- 
form as  the  best  and  safest  anaesthetic  in  obstetrics ; 
since  1850  he  iias  not  used  ether.  He  presents 
strong  arguments  for  this  selection.  He  has 
never  been  able  to  find  any  statistical  evidence 
in  proof  of  the  statement  constantly  made  in  obs- 
tetric literature  that  anaesthetics  increase  the 
dangerofpost-partum  haemorrhage.  He  expresses 
the  firm  conviction  that  no  woman  under  the  care 
of  a  watchful,  prudent,  and  competent  obstetrician 
ever  ought  to  die  from  post-partum  haemorrhage, 
due  solely  to  uterine  inertia  or  ataxy.  He  also 
makes  the  inijjortant  statement  that  uterine  inertia, 
the  fountain  of  post-partum  haemorrhage,  is  often 
but  another  name  for  uterine  exhaustion,  and  this 
is  certainly  much  less  liable  to  occur  when  the 
nerve  force  and  vital  powers  have  been  saved  by 
the  use  of  an  anesthetic.  While  admitting  that 
chloroform,  in  some  cases,  prolongs  labor,  and 
that  uterine  exhaustion  often  is  the  result  of  pro- 
longed labor,  he  is  satisfied  that  this  apparent  objec- 
tion is  more  than  counterbalanced  by  the  good 
obtained  by  its  use.  As  the  result  of  his  expe- 
rience, he  asserts  that  chloroform  shortens  labor 
in  a  greater  proportion   of  cases  than  it  retards  it. 

"  He  is  certain  that  it  does  in  all  those  cases 
where  the  pains  are  diminished  or  suspended  by 
extreme  sensitiveness  and  fear  of  pain,  by  vivid 
moral  imi)ressions  of  hysteria,  or  by  pains  result- 
ing from  the  coincidence  of  some  malady,  either 
existing  antecedent  to,  or  appearing  during  labor, 
such  as  rheumatism  of  the  uterus  or  other  muscular 
tissues,  or  sharp  pains  in  the  back  or  abdomen 
distinct  from  the  pains  from  uterine  contractions, 
gripings  in  the  intestines,  or  the  cramps  which 
are  occasionally  produced  by  the  pressure  of  the 
child's  head  on  the  sacral  nerves;  and,  finally,  in 
all  those  cases  where  inefficient  uterine  action 
results  from  loss  of  sleep  and  extreme  exhaustion 
from  a  prolonged  first  stage  ;  and  in  many  cases 
where  the  labor  is  retarded  by  rigidity  of  the  os 
uteri  or  perineum." 

He  has  attended  a  number  of  patients  who  in 


previous  confineinents  had  alarming  post-partmn 
haemorrhages,  though  taking  no  anaesthetic,  who 
have  escaped  this  accident  in  labors  in  which 
chloroform  was  used.  A  peculiar  idiosyncrasy,  or 
former  tendency  to  haemorrhage  or  extreme  feeble- 
ness, the  reasons  given  for  withholding  an  anaes- 
thetic in  former  labors  arc  the  very  strongest 
indications  for  the  careful  administration  of  chlo- 
roform. In  jjrivate  jiractice  he  has  only  had  one 
case  of  post-jjartum  haemorrhage,  and  in  this  case 
no  anaesthetic  was  used,  as  the  child  was  born 
before  he  had  time  to  make  an  examination.  Dr. 
Barker  is  convinced  that  the  prevalent  ojiinion 
that  chloroform  is  dangerous  for  any  woman  with 
heart  disease  is  erroneous.  He  has  had  a  number 
of  cases  of  labor  dangerously  complicated  with 
organic  heart  troubles,  which  terminated  favorably, 
as  he  thinks,  solely  from  the  use  of  chloroform. 
In  an  experience  of  thirty-seven  years,  using  chlo- 
roform in  several  thousand  cases,  he  has  never  in 
a  simple  case  had  reason  to  regret  its  use.  The 
conclusions  of  Dr.  Barker,  drawn  from  such  a 
large  experience,  will  be  most  acceptable  to  the 
profession. — South  Western  Medical  Gazette. 


TO  PREVENT  MAMMARY  ABSCESS. 

Although  Dr.  Goodell  ridicules  the  idea  of  abort- 
ing mammary  abscesses,  which  he  does  not  think 
can  be  done,  yet  Mr.  Miall  {British  Medical 
Journal)  says  that  when  mammary  abscess  is  on 
the  point  of  forming,  he  has  frequently  seen  all  the 
symptoms  rapidly  disappear  in  a  few  hours,  under 
the  influence  of  fomentations  with  hot  water  and 
carbonate  of  ammonia.  He  uses  an  ounce  of  the 
carbonate  in  a  pint  of  water,  and  when  solution  is 
accomplished  the  temperature  of  the  fluid  will  be 
hardly  too  high  for  fomentation  to  be  commenced, 
with  cloths  dipped  in  the  liquid.  He  applies  them 
for  from  half  an  hour  to  two  hours,  at  the  same 
time  protecting  the  nipples.  He  has  often  had 
immediate  relief,  and  seldom  requires  to  make 
more  than  three  applications. 


A  SUGGESTED  ALTERATION  IN  THE 
COMPOUND  LIQUORICE  POWDER. 

Having  found  that  the  above  preparation  pro- 
duced very  severe  griping  in  many  instances  where 
he  had  ordered  it,  the  griping  being  particularly 
severe  in  some  of  his  younger  patients,  Dr.  Martin 
Oxley  {Lancet)  had  ordered  the  fallowing  formula 
for  some  time  past,  in  which  anise  Iruit  is  sub- 
stituted instead  of  the  fennel,  and  one-fourth  part 
of  ginger  is  added.  The  altered  formula  runs 
thus  : — senna  and  liquorice-root  of  each  2  parts ; 
anise  fruit  and  sulphur,  of  each  i  part ;  sugar,  ^yl 
parts ;  ginger,  }^  part.  This  altered  preparation 
is  quite  as  satisfactory  in  its  laxative  properties,  is 
less  liable  to  gripe,  and  is  as  pleasant  to  take  as  the 
officinal  powder,  and  he  would  suggest  its  trial  in 
cases  where  the  powder  as  now  prepared  produces 
the  disagreeable  effects  to  which  he  has  referred. 
— J'hil.  Med.  and  Surg.  Report er. 


iU 


THE   CANADA   MEDICAL   RfiCORfi. 


VARICOSE   VEINS   AND  THEIR   TREAT- 
MENT BY  OPERATION. 
By  Kenual  Franks,  M.D. 

Varicose  veins  may  result  when  the  veins  are 
no  longer  equal  to  the  pressure  of  the  blood 
within  them.  This  may  follow  from  two  causes 
— one  extrhisic,  when  from  remote  cause  an  un- 
usual amount  of  pressure  is  thrown  upon  the 
veins,  such  as  pressure  upon  the  iliac  veins,  due 
to  overloading  of  the  intestines  or  to  some  abdo- 
minal tumor,  or,  as  in  some  forms  of  heart  di- 
sease, cirrhosis  of  the  liver,  and  such  other  ob- 
structions to  the  free  course  of  the  blood  in  the 
veins.  Or  the  cause  may  be  intrinsic — that  is,  for 
some  reason  or  other,  the  veins  have  lost  their 
tone  and  their  elasticity,  and  are  no  longer  cap- 
able of  resisting  the  normal  pressure  from  within. 

Whatever  the  agency  at  work  may  be,  the  result 
is  the  same — namely,  that  the  balance  between 
the  elasticity  of  the  walls  of  the  vein  and  the  in- 
travenous pressure  is  lost,  and  gradual  dilatation 
and  distension  cf  the  veins  ensue.  This  loss  of 
balance  will  be  felt,  of  course,  wherever  the  pres- 
sure is  greatest ;  and  these  situations  are  those,  in 
the  dependent  parts  of  the  body,  where  the  column 
of  blood  is  the  longest.  If  we  take  a  long  U- 
sha])ed  tube,  and  almost  fill  it  with  water,  the 
fluid  in  one  limb  will  rise  to  the  same  height  as  in 
the  other,  but  the  pressure  of  the  fluid  on  the 
sides  of  the  tube  will  be  greater  the  nearer  we 
approach  the  base  of  the  U — that  is,  the  longer 
the  column  of  fluid  is.  So  it  is  in  the  veins. 
The  column  of  blood  in  the  veins  is  supported  by 
the  column  of  blood  in  the  arteries,  but  the  pres- 
sure in  the  veins  will  depend  on  the  length  of 
the  column  of  blood  it  has  to  support.  No  doubt 
nature  provides  a  means  of  taking  off  this  exces- 
sive pressure  by  supplying  the  veins  with  valves, 
so  that  under  normal  circumstances  the  vein  has 
only  to  support  the  column  of  blood  that  lies 
between  two  pairs  of  valves.  But  nature  has 
also  endowed  the  veins  with  the  power  of  dis- 
tending, so  as  to  be  able  to  accommodate  an  in- 
creased quantity  of  blood,  should  there  arise  any 
temporary  obstruction  to  its  onward  flow  through 
the  heart.  Now,  when  the  veins  so  dilate,  the 
valves  within  them  are  drawn  apart,  and  so  allow 
of  regurgitation.  This  temporary  distension  of 
the  veins  and  insufficiency  of  the  valves  is  quite 
a  normal  process.  But  suppose  that  the  ob- 
struction to  the  onward  flow  of  the  blood,  due  to 
one  of  the  extrinsic  causes,  is  permanent,  or  that 
the  condition  of  the  vein  walls  is  such  that  after 
distension  their  elasticity  has  become  so  impair- 
ed as  to  prevent  them  returning  to  their  usual 
size,  then  the  valves  remain  permanently  apart, 
and  are  no  longer  capable  of  supporting  the 
column  of  the  blood.  This  throws  an  extra 
weight  on  the  valves  below,  and  these  again 
yielding,  the  functions  of  (he  veins  become  more 
and  more  impaired.  Now,  in  obedience  to  the 
general  law  in  the  body,  that  when  a  part  loses 
its  function  it  gradually  wastes,  so  in  the  veins  we 


find  that  tlie  valves,  being  unable  to  accomplish 
their  purposes,  gradually  atrophy,  and  may  ulti- 
mately either  disappear  altogether,  or  their  for- 
mer existence  be  only  recognized  by  thin  fibrous 
bands  on  the  inside  of  {he  vein.  Hence  it  is,  as 
Gay  says,  that  "  as  a  rule,  veins  that  become 
varicose  are  destitute  of  valves." 

Thus  it  happens  that  veins  below  the  original 
site  of  lesion  have  a  permanently  increased  pres- 
sure of  blood  thrown  upon  them,  and  this  alone 
will  eventually  cause  them  to  become  varicose, 
even  though  they  were  themselves  originally 
healthy,  and  although  the  original  cause  of  the 
obstruction  to  the  circulation  may  have  disap- 
peared. Let  me  here  give  an  illustration  of 
what  I  mean.  Suppose  that  the  original  cause 
of  increased  pressure  in  the  veins  of  a  limb  has 
been  due  to  constipation,  and  the  pressure  of  in- 
testinal accumulation  upon  the  iliac  veins — sup- 
])0se  that  this  has  continued  long  enough  to  cause 
varicosity  in  some  of  the  veins  of  a  leg,  say  below 
the  knee  ;  after  a  time  the  valves  in  these  vems 
have  became  atrophied,  and  the  veins  ]:)ermanent- 
ly  dilated — now,  suppose  that  under  proper 
treatment  the  constipation  has  been  cured,  will 
this  allow  the  veins  to  resume  their  normal  condi- 
tion ?  No  ;  on  the  contrary,  this  very  destruction 
of  the  valves  has  thrown  a  permanently  increased 
pressure  on  the  veins  below  them,  and  this  alone 
will  cause  them  to  undergo  the  same  process, 
unless  means  be  adopted  to  relieve  them  of  the 
unusual  pressure. 

Now,  to  the  sequel  of  events  following  on  a 
vein  in  the  leg  becoming  varicose.  The  circifla- 
tion  in  the  part  is  checked,  the  nourishment  of 
the  part  is,  therefore,  seriou>ily  interfered  with. 
The  skin  first  becomes  discolored  and  suffers  from 
a  form  of  eczma.  Finally,  the  skin  supply  is  so 
deficient  that  the  part  sloughs,  and  we  have,  as  a 
consequence,  an  ulcer.  Added  to  this,  that  the 
vein  wall  may  suffer,  and  terrible  haemorrhage  may 
ensue,  not  only  from  the  lower  radicals  but  from 
the  trunk,  in  which  there  are  no  valves  to  check 
the  backward  flow.  Now,  under  these  varying 
circumstances,  what  treatment  should  we  adopt? 
In  the  early  stage,  when  as  yet  the  vein  is  to  a 
limited  extent  involved,  but  before  the  skin  has 
suffered  in  any  way,  there  can  be  no  question 
that  palliative  measures  should  be  adopted,  and 
of  these,  in  my  opinion,  the  best  is  the  elastic 
bandage.  Its  object  is  to  yield  that  support  to 
the  veins,  which  their  walls  are  unable  to  afford ; 
and  by  such  means,  provided  the  offending  cause 
be  removed,  and  provided  that  the  valves  have 
not  been  destroyed,  we  may  even  hope  for  a  cure 
ultimately.  I  will  go  further  and  say  that  in  old 
and  very  debilitated  subjects,  such  palliative 
measures  are  preferable  to  operation,  uuder  all 
circumstances.  Again,  if  the  varicosity  of  the 
veins  in  the  legs  be  due  to  an  irremediable  ex- 
trinsic cause,  operation  is  obviously  excluded ;  as, 
for  instance,  if  the  condition  be  due  to  pregnancy, 
to    pressure  of  an  abdominal  tumor  on  the  iliac 


THE   CANADA   MEDICAL   UECOKD. 


165 


veins,  to  disease  of  tlic  heart,  to  cirrhosis  of  the 
liver,  and  so  fortli.  Therefore,  in  ail  cases  before 
operative  measures  be  adopted,  it  will  be  neces- 
sary to  satisfy  ourselves  first  that  such  causes  do 
not  exist.  From  these  exceptions  we  may  de- 
duce the  cases  in  which  J  believe  ojieration  is 
advisable.  Firstly,  the  varices  must  be  due  to 
intrinsic  causes,  or  to  remediable  extrinsic  causes, 
such  as  constipation,  the  pressure  of  an  ill-fittting 
truss,  tight-garters,  or  too  long  standing.  In 
these  latter  cases  the  cause  must  be  removed. 
Then,  again,  the  patients  should  be  young,  or 
healthy  adults  ;  and  let  me  here  say  tiiat,  in  my 
opinion,  comparatively  slight  varicosity  may  in- 
duce us  to  operate  in  a  young  subject,  which  in  an 
advanced  adult  would  not  justify  us. 

Subject  to  tiie  conditions  already  laid  down,  if, 
in  a  healthy  adult,  we  find  a  varicose  condition  of 
the  veins  accompanied  by  an  ulcer,  or  with  a 
brawny  condition  of  the  skin,  or  with  eczma,  if 
it  be  sufficiently  extensive  to  give  rise  to  pain  or 
discomfort,  I  think  operation  is  the  best  treatment. 

[The  writer  describes  various  methods  of  opera- 
ting, which  have  not  proved  very  satisfactory,  and 
continues]  : 

I  have  full  notes  of  i8  cases  which  I  have  treated 
by  antiseptic  excision,  several  cases  the  notes  of 
which  I  have  not  preserved.  In  no  case,  have  I 
seen  "  phlebitis,  erysijielas,  or  pyaemia  "  follow  as 
a  result.  The  patient  being  placed  under  ether,  I 
begin  by  shaving  the  parts  where  I  purpose  to 
make  the  incisions.  The  skin  is  then  carefully 
washed  with  corrosive  sublimate  solution  ,  some- 
times oil  of  eucalyptus  is  also  used.  I  then  usual- 
ly fasten  a  band  round  the  limb,  immediately 
above  the  knee  so  as  to  distend  the  veins  suffici- 
ently to  be  able  to  trace  them  accurately.  If  the 
veins  are  extensively  varicose,  it  is  much  better 
practice  to  excise  the  chief  radicals  at  intervals, 
removing  two  or  three  inches  at  each  ])lace,  than 
to  attempt  to  excise  a  long  piece  of  vein.  Noth- 
ing is  gained  by  the  more  extensive  incision. 
Having  selected  the  place  for  incision,  a  clean  cut 
is  made  through  the  skin,  and  almost  immediately 
the  swollen  vein  appears.  The  subcutaneous 
tissue  over  it  is  divided  on  a  director.  Should  the 
vein  be  cut,  it  is  at  once  seized  with  Spencer 
Wells'  forceps.  A  strong  cat-gut  ligature  is  passed 
round  the  vein  at  its  lower  end.  The  vein  above 
this  is  seized  with  the  forceps  and  ligature.  It  can 
then  be  easily  pulled  out  of  its  bed.  Any  radical 
going  into  it  are  ligatured  and  ciU  off;  finally,  the 
vein  is  tied  at  the  upper  angle  of  the  wound  and 
the  piece  excised.  When  the  veins  are  tough 
with  hypertrophied  coats  the  proceeding  is  very 
simple;  but  when  the  veins  are  thin,  esiiecially  if 
adhering  to  the  skin,  a  good  deal  of  care  and 
patience  are  required.  The  wound  is  irrigated 
\yith  corrosive  sublimate  solution,  i  in  2,000,  a 
little  iodoform  dusted  over  it,  and  the  edges 
brought  together.  In  my  earlier  cases,  I  used  to 
insert  a  drainage  tube,  but  I  now  think  it  is  quite 
unnecessary.     The  wound  is  then  enveloped  in 


some  of  the  antisejjlic  dressing,  whilst  a 
second  and  a  third  piece  of  the  vein  is  treat- 
ed in  the  same  way,  if  necessary.  If  both 
legs  are  involved,  the  second  leg  is  treated  at 
the  .same  time.  Both  legs -are  then  bandaged  from 
the  toes  to  above  the  knee.  As  a  rule,  the  dress- 
ings are  left  undisturbed  for  eight  or  ten  days,  and 
when  removed  we  generally  find  the  wounds  healed 
by  first  intention.  In  a  few  cases  some  su])i)ura- 
tion  occurred,  but  this  was  generally  traced  to  some 
deficiency  in  the  dressings,  at  a  time  when  the 
dressings  were  improperly  pre])ared.  This  only 
delayed  the  process  of  healing,  but  in  every  case 
the  asepsis  of  the  wound  had  been  sufficient  to 
protect  the  veins  from  contamination. 

The  beneficial  effects  have  been  in  many  cases 
as  marked  as  to  dispel  all  doubts  as  to  the  effi- 
ciency of  the  cure.  A  man,  aet.  36,  perennially 
on  inmate  of  the  A.delaide  Hospital  for  varicose 
ulcers,  refused  several  times  to  have  an  operation 
performed.  Two  years  ago  he  presented  himself 
again,  with  the  ulcer  as  bad  as  ever,  the  skin 
brawny  and  discolored,  the  edges  of  the  ulcer  hard, 
elevated,  and  inflamed.  He  consented  to  an 
operation  for  the  cure  of  the  veins.  I  kept  him 
in  bed  for  several  weeks,  and  treated  the  ulcer  until 
it  was  about  the  size  of  a  florin,  and  was  quite 
healthy.  I  then  had  him  placed  under  ether,  and 
excised  portions  of  those  veins  which  seemed  to 
be  chiefly  connected  with  the  ulcer.  All  the  veins 
operated  on  were  above  the  ulcer — that  is,  on  the 
side  nearest  the  heart.  The  operation  was  per- 
formed as  usual,  and  the  dressings  applied  were 
not  disturbed  for  a  fortnight.  They  included  the 
ulcer.  When  they  were  removed,  the  ulcer  was 
found  to  be  perfectly  healed  beneath  them,  and 
all  the  incisions — three  in  number — had  healed  by 
first  intention.  I  allude  to  this  case  because  it 
goes  to  prove  that  these  ulcers  are  caused  by  the 
pressure  in  their  efferent  veins. 

Early  in  November  last,  I  operated  on  a  young 
gentleman,  set.  25,  the  subject  of  extensive  vari- 
cose veins  in  the  right  leg.  The  saphena  vein  at 
the  bend  of  the  knee  was  very  large.  He  had 
previously  been  operated  on  by  a  surgeon  in  Dub- 
lin twice  by  the  subcutaneous  needle  method,  for 
the  obliteration  of  the  saphena  vein  at  the 
knee.  On  each  occasion  three  needles  were  pass- 
ed beneath  it  at  intervals  of  half  an  inch,  and  yet 
when  I  saw  him  this  vein  was  as  patent  and  as 
varicose  as  if  it  had  never  been  touched,  though 
the  skin  over  it  showed  marks  of  where  it  had 
been  constricted.  I  excised  portions  of  the 
three  most  aggravated  varices  I  could  find.  The 
wounds  all  healed  by  first  intention.  I  saw  this 
patient  to-day.  The  veins  operated  on  are  all 
obliterated.  He  told  me  he  had  lost  the 
bursting  feeling  in  his  leg  from  which  he  used 
to  suffer,  and  that  he  had  discarded  the 
elastic  stocking.  The  veins  unoperated  on  re- 
main varicose,  neither  better  nor  worse  than 
when  I  saw  him  in  November  and  is  he  so  pleased 
with  the  former  operation  that  he  wishes  all  the 


166 


THE   CANADA    MEDICAL   RECORD. 


veins  to  be  treated  in  a  similiar  manner.  This 
case  illustrates  the  suj^eriority  of  excision  over 
the  constriction  method. 

Let  me  say  a  few  words  as  to  the  permanency 
of  the  cure.  If  the  varicose  condition  of  the  veins 
is  due  to  a  cause  which  we  cannot  hope  to  rectify 
— an  e.xtrinsic  cause  —we  cannot  expect  the  opera- 
tion to  be  successful.  But  when  we  can  remove  the 
cause,  and  when,  at  the  same  time,  we  treat  the 
effect,  I  consider  that  we  have  just  grounds  for 
assuming  that  the  cure  will  be  radical.  Two  years 
ago  I  operated  on  a  young  man,  jet.  26,  for  exten- 
sive varices  of  one  leg.  A  year  and  a  half  later 
he  wrote  to  me  to  express  his  great  delight  at  the 
permanency  of  the  cure  ;  that  since  the  operation 
had  been  performed  he  had  been  able  to  take 
long  walks,  to  stand  the  greater  portion  of  the 
day  without  the  slightest  inconvenience,  or  without 
any  sign  of  fresh  varices  appearing.  I  could  point 
to  many  similiar  cases. — Dublin  Journal  Medical 
Science,  May,  1886. 

The  Canada  Medical  Record. 

A  Monthly  Journal  of  Medicine  and  Surgery- 

EDITORS  : 

FRANCIS  W.  CAMPBELL,   M.A.,  M.D.,  L.K.C.F.  LOUD 

K<litor  and  Proprietor. 

K.  A.  KENNEDY,  M.A.,  M.D.,  M.iiiaging  Editor. 
ASSISTANT  EDITORS: 
CASEY  A.  WOOD,  CM.,  MD. 
GEORGE  E,  ARMSTRONG,  CM.,  M.D. 

SUBSCRIPTION    TWO    DOLLAUS    PER   ANNDM. 

All  comiimnicii lions  and  Kxchangfs  must  be  addressed  to 
the  JSdttors,  Oraioer356,  Post   Office,  Montreal. 

MONTREAL,  APRIL,  1887. 

ANNUAL  CONVOCATION  OF  THE  MEDI- 
CAL FACULTY  OF  BISHOP'S  COLLEGE. 

The  annual  convocation  of  Bishop's  college,  for 
conferring  degrees  in  medicine,  took  place  on  the 
31st  March,  in  the  Synod  hall,  Montreal.  There 
was  a  very  large  attendance  of  the  students  and 
their  friends,  among  whom  the  ladies  were  in  the 
larger  proportion."  An  interesting  feature  of  the 
convocation  was  the  conferring  of  a  degree  on  a 
colored  student  from  the  West  Indies — a  fine,  in- 
tellectual looking  young  man — the  son  of  a  wealthy 
merchant,  who  jiassed  through  the  college  with 
honors. 

Mr.  R.  W.  Heneker,  chancellor  of  the  college, 
presided.'  Among  those  present  on  the  platform 
were  Rev.  Canon  Norman,  vice-chancellor  ;  Dr.  F. 
W.  Campbell,  dean  of  the  faculty  of  medicine  in 
college ;  Professors  McConnell,  Saunders,  Tren- 
holme,  Wood,  Baker  Edwards,  Lapthorn  Smith 
(acting  registrar,  in  place  of  Dr.  Kennedy,  who  was 


absent  in  Colorado),  Reddy,  Rowell,  G.  T.  Ross, 
Proudfoot ;  Rev.  Principal  Adams,  of  BishoiVs 
college  school,  Lennoxville ;  Rev.  Rural  Dean 
Lindsay,    Mr.    Ed.    Chapman,    M.A. 

REPORT    OK    SESSION    1 886-87. 

Dr.  Campbell,  dean  of  the  Faculty,  read  the  re- 
port, which  was  as  follows  : 

The  number  of  matriculated  students  for  the 
session  1886-7  was  31,  being  an  increase  of  8  over 
last  year's  attendance.  Of  these,  i  comes  from  the 
United  Slates,  6  from  Ontario,  16  from  Quebec,  2 
from  the  West  Indies,  i  from  British  Guiana,  3  from 
England,  i  from  Italy,  and  i  from  India.  Sixteen 
of  our  students  are  residents  of  Montreal. 

The  following  are  the  results  of  the  examina- 
tions : 

Botany — F.  E.  Bertrand,  Prescott,  Ont.  ;  F. 
Coote,  Quebec;  D.  H.  Judd,  Mallorytown  ;  W.  N. 
Smiley,  St.  Lambert ;  J.  M.  Jack,  Montreal ;  G.  J. 
Tait,  Jamaica,  W.  I.  ;  H.  N.  Spooner,  Highgate, 
Vt.  ;  D.  Macrae,  Montreal. 

Practical  Chemistry — J.  M.  Jack,  Montreal  ;  C. 
A.  Lauchlan,  Montreal  ;  C.  E.  Vidal,  St.  John  ;  L. 
M.Clark,  Kingston,  Jamaica  ;  T.  S.  Nichol,  Mon- 
treal. 

Practical  Anatomy — T.  S.  Nichol,  L.  M.  Clark, 
Frederick  Taylor. 

Anatomy— First  class  honors  :  L.  M.  Clarke,  T. 
S.  Nichol ;  second  class  honors  :  F.  Taylor,  Shan- 
nonville,  Ont. 

Physiology— C.  E.  Vidal  and  L.  M.  Clark,  first 
class  honors  ;  C.  A.  Lauchlan,  second  class  honors; 
passed  T.  S.  Nichol,  J.  M.  Jack,  F.  Taylor,  J. 
Rohlehr  (New  Amsterdam,  E.G.). 

Materia  Medica  and  Therapeutics — Messrs. 
Vidal  and  Clark,  first  class  honors  ;  passed,  Mr. 
Tait  (Jamaica,  W.  I.). 

Chemistry — First  class  honors,  Messrs.  Clark, 
Lauchlan,  Vidal,  Nichol ;  second  class  honors, 
Messrs.  Taylor  and  Jack. 

Hygiene — First  class  honors,  Mr.  Jack  ;  Messrs. 
Laurie  (Quebec),  Coote  (Quebec),  Judd,  Vidal, 
Clark,  Taylor,  Smiley,  Bertrand,  Nichol,  Elliott 
(Quebec) ;  passed,  Messrs.  Tait,  Macrae  and 
Spooner. 

Medical  Jurisprudence — Mr.  Pickel  (Sweets- 
burg,  P.Q.),  first  class  honors. 

Mr.  L.  M.  Clark  has  passed  the  primary  ex- 
amination, consisting  of  anatomy,  physiology, 
materia  medica  and  therapeutics,  chemistry, 
hygiene,  practical  anatomy  and  practical  chemis- 


THK   CANADA    MKDICAL   RECORD. 


107 


try,  .and  is  entitled  to  the  David  scholarship,  having 
obtained  the  iiighest  number  of  marks  in  ail  prim- 
ary subjects. 

The  foiknving  gentlemen  have  passed  their  final 
examination  for  the  degrees  of  C.  M.,  M.  1).,  con- 
sisting of  practice  of  medicine,  surgery,  obstetrics, 
and  the  diseases  of  children,  gynecology, ])athology 
medical  jurisprudence,  and  clinical  medicine  and 
clinical  surgery  : — 

Mr.  W.  E.  Fairfield,  of  Clarenceville,  Que. — 
First  class  honors  and  Wood  gold  medal,  awarded 
to  the  student  who  has  attended  two  six  months' 
session  at  Bishop's  college,  and  has  attained  the 
highest  aggregate  marks  in  primary  and  final  ex- 
aminations. 

The  Robert  Nelson  gold  medal  for  special  ex- 
cellence in  surgery  is  awarded  to  Mr.  W.  E. 
Fairfield.  The  contest  for  this  medal  was  very 
keen  between  Mr.  Fairfield  and  Mr.  R.  Camp- 
bell, the  successful  candidate  winning  it  by 
only  fifteen  marks.  This  medal  was  founded 
by  Dr.  C.  E.  Nelson,  of  New  York,  and  is 
awarded  annually  to  the  student  standing  first 
in  a  special  examination  in  surgery,  written 
and  practical.  No  one  is  allowed  to  compete 
unless,  he  has  attended  at  least  two  sessions  at 
Bishop's  college,  and  has  attained  first  class  honors 
in  primary  and  final  examinations. 

Mr.  Rollo  Campbell,  of  Montreal,  has  won 
the  Chancellor's  prize  for  the  best  final  exam- 
ination, the  Wood  gold  medallist  not  being  al- 
lowed to  compete,  and  has  passed  with  first  class 
honors. 

Mr.  A.  E.  Phelan,  of  Montreal,  first  class 
honors. 

Mr.  A.  P.  Scott,  of  Montreal,  first  class  ho- 
nors. 

Mr.  Rohlehr,  of  New  Amsterdam,  British 
Guiana. 

In  order  to  pass  in  any  subject,  a  candidate 
must  obtain  at  least  50  per  cent,  of  the  maxi- 
mum marks  ;  second  class  honors  require  at 
least  60  per  cent.  ;  first  class  honors  at  least  75  per 
cent, 

PRIZE    LIST. 

Wood  gold  medal  and  Robert  Nelson  gold 
medal,  Mr.  W.  E.  Fairfield,  of  Clarenceville,  Que. 

Chancellor's  prize  for  best  examination  in 
final  subjects,  Mr.  Rollo  Campbell,  of  Mont- 
real. 

David  scholarship,  Mr.  L.  M.  Clark,  of  Jamaica. 


Practical  anatomy,  senior  prize,  Mr.  T.  S. 
Nichol ;  junior  jirize,  Mr.  C.  E.  I'^Uiolt. 

Botany  prize,  Mr.   F.  Bertrand. 

■iHi;  ch.vncki.lok's  adi-kess. 

Chancellor  Heneker,  in  the  course  of  his  ad- 
dress, said  : — The  work  of  Lennoxville,  comprising 
the  .\rts  and  Divinity  Faculties,  is  very  satisfac- 
tory. The  number  of  students,  alihough  not  so 
large  as  could  be  desired,  is  still  large  enough  for 
satisfactory  work,  and  jjcrhaps  as  1  irge  as  may  be 
reasonably  ex])ected  in  a  new  country,  where  l)Ut 
few  men  use  the  advantages  offered  of  high  class 
education,  for  the  mental  training  it  affords,  inde- 
pendent of  any  special  jnirsuit  in  life. 

CONl'ERRING   DEGREES. 

The  graduates  were  then  called  before  the 
chancellor,  and,  after  having  been  duly  sworn  in 
by  the  dean,  they  received  their  diplomas.  The 
])rize  winners  were  heartily  apjilauded  as  they 
advanced  to  the  platform. 

THE    VALEDICTORY. 

Dr.  A.  E.  Phelan,  of  Montreal,  was  called 
upon  by  the  chancellor  to  read  the  valedictory 
address  on  behalf  of  the  graduates.  The  address 
was  well  composed,  and  Dr.  Phelan  was  frequently 
interrupted  by  applause — demonstrative  if  not 
boisterous — from  his  fellows  initiated  into  the  deep 
secrets  of  the  medical  profession.  In  the  course 
of  his  address  he  bore  testimony  on  behalf  of  the 
class  of  '87  to  the  pains  which  the  professors 
took  with  the  students,  and  to  their  zeal  and  their 
able  instruction.  The  professors  were  ever  ready 
to  remove  ob.stacles  from  the  paths  of  the  students, 
while  at  the  same  time  they  were  foremost  in 
advancing  medical  education  in  Canada.  Dr. 
Phelan,  in  conclusion,  told  of  the  pleasures  of 
their  college  life  in  Montreal,  and  was  greeted 
with  applause  at  the  conclusion  of  his  valedictory. 

FAREWELL  FROM  THE  PROFESSORS. 

Professor  Rowell  delivered  the  farewell  address 
to  the  graduates.  After  complimenting  the  members 
of  the  class  of '87  on  their  industry  and  zeal  in 
pursuit  of  their  studies,  he  said  that  the  medical 
graduates  of  to-day  were  better  fitted  to  enter  on 
their  career  in  the  profession  than  the  graduates 
of  thirty  or  forty  years  ago.  A  more  extensive 
examination  was  now  required  in  the  evergrowing 
knowledge  of  the  profession,  and  a  four  years' 
course  in  a  medical  college  was  now  a  necessity. 
The  professors  of  liishop's  college  have  not  been 
backward     in      keeping    pace    with     the    limes. 


168 


THE   CANADA    MEDICAL    RECORD. 


During  the  winter  sessions  they  applied  themselves 
to  their  special  departments,  and  during  the  sum- 
mer months  many  of  them  went  abroad  to  seek 
instruction  and  experience  in  the  older  schools 
and  hospitals  of  the  continent.  The  students  of 
Bishop's  college  had  reason  to  congratulate  them- 
selves for  the  facilities  of  hospital  inspection  placed 
within  their  reach,  and  which  were  perhaps  better 
than  those  of  any  other  college.  Not  only  had 
they  the  Montreal  General  hospital,  but  the  Hotel 
Dieu  and  the  Western  Hospital.  He  asked 
graduates  to  remember  their  alma  mater,  and  to 
do  all  in  their  power  to  reflect  honor  on    it. 

THE  REV.  CANON  NORMAN, 

vice-chancellor,  then  addressed  the  convocation. 
To  their  worthy  chancellor,  whose  absence  they 
missed  last  year,  was  to  be  attributed  a  large 
degree  of  the  success  of  Bishop's  college,  and  the 
speaker  wished  to  bear  testimony  to  the  help 
which  Chancellor  Heneker  was  to  the  cause  of 
true  education  in  the  province  of  Quebec.  He 
congratulated  the  college  on  the  increase  in  the 
number  of  students,  and  he  could  personally  bear 
testimony  to  the  unequalled  courage  and  the  manly 
endurance  displayed  by  the  professors  of  the 
faculty  of  medicine  in  the  face  of  great  difficulties. 
They  knew  that  Bishop's  college  would  have  an 
up-hilK  fight  when  it  was  founded,  but  they  had 
managed  to  surmount  the  difficulties,  audit  would 
be  hard  to  find  a  body  of  men  with  such  zeal  and 
devotion  as  the  professors  in  medicine.  (Ap- 
plause.) He  was  quiet  satisfied  that  they  would 
have  a  larger  number  of  students  next  year,  and 
he  congratulated  the  college  on  having  such  a 
remarkably  intelligent  and  clever  class  of  freshmen. 
He  was  glad  to  see  that  a  number  of  the  graduates 
in  medicine  were  also  graduates  in  arts  at 
Lennoxville. 

In  conclusion  he  trusted  that  the  benevolence 
of  the  friends  of  the  institution  would  soon  ena- 
ble them  to  build  a  hall  of  their  own  for  the  medi- 
cal faculty,  so  that  the  money  now  expended  on 
rent  might  be  devoted  to  the  cause  of  science. 
(Applause.) 

The  Rev.  Principal  Adams  delivered  an  elo- 
quent address. 

Dr.  Leo.  H.  Davidson,  in  an  admirable  ad- 
dress, spoke  of  the  advantages  conferred  by 
the  college  and  its  success  in  the  cause  of  educa- 
tion. He  wished  the  graduates  "  God  speed"  in 
their  new  life. 


The  company  then  sang  the  national  anthem, 
and  the  convocation  was  brought  to  a  close  with 
prayer. 

the  students  at  dinner. 

In  the  evening  about  fifty  of  the  students  and 
their  friends  sat  down  to  dinner  in  the  Richelieu 
hotel,  which  vvas  done  up  in  Durocher's  best  style. 
Mr.  F.  Taylor  presided,  and  among  those  present 
were  Drs.  Armstrong,  Perrigo,  England,  Longeway 
and  others.  The  following  toasts  were  proposed, 
and  duly  honored,  "  The  Queen,  "  "  President  of 
the  United  States, ''  "  The  Governor  General,  " 
''  Our  Alma  Mater,  ""  Trade  and  Commerce  of 
Montreal.  "  Appropriate  speeches  were  delivered 
by  the  chairman  and  several  of  the  graduates.  The 
majority  of  the  latter,  in  the  course  of  their 
remarks,  wished  their  confreres  all  success  in  their 
journey  through  life.  Songs  were  also  sung  by 
several  of  those  present.  The  evening  passed  off 
most  successfully.  The  students  deserve  all  credit 
for  the  manner  in  which  they  conducted  the  pro- 
ceedings. 


INTERNATIONAL    CONGRESS    ON 
INEBRIETY. 

The  Council  of  the  English  Society  for  the  study 
and  cure  of  Inebriety  have  completed  arrange- 
ments for  an  International  Medical  Congress,  to 
be  held  at  Westminster  Hall,  London,  July  ith 
and  (tth,  18S7.  The  object  of  this  Congress  is  to 
present  and  discuss  the  problems  of  Inebriety 
medically,  and  from  a  purely  scientific  standpoint, 
by  the  best  authorities,  thus  laying  the  foundation 
for  a  broader  and  more  exact  study  of  this  subject. 
Papers  and  addresses  are  promised  from  a  large 
number  of  tlie  most  distinguished  physicians. 


PERSONAL. 

Dr.  Kannon  (M.D.  Bishops  College,  1879),  who 
removed  last  winter  from  Montreal  to  Los  Angelos, 
California,  has  been  appointed  assistant  health 
officer  of  that  thriving  town. 

The  honorary  degree  of  M.D.  has  been  conferred 
by  the  University  of  New  York  on  Mr.  Lawson 
Tait,  F.  R.  S.,  of  Birmingham,  England. 

Dr.  John  Macleod  (^LD.,  Bishops,  1877),  has 
just  returned  to  Canada  from  Australia,  where  he 
was  engaged  for  the  past  ten  years  in  practice.  He 
has  accumulated  a  competency,  and  is  now  en  route 
to  ScotlandjWhere  he  intends  to  locate  permanently. 


THE  CANADA  MEDICAL  RECORD. 


SOCIETY  PROCEEDINGS. 

ftUidico-Cliirurgical  SociuLy  of  Mont- 
rual 

f*oi{ui:si''>Ni)i:x<'K 

PROGRESS  OF  SCIENCE. 

KvM  lor  I'aintul  Kyes,  is  this  Advioo 
ulways  Good? 


Neura-itliunta 1^0 

How  "  llri({lit'8  Disease  "  Comes  About  K'S 

"''J    Diet  ill  Uio  Tioiilment  of  Kpilopsy 185 

"•'    Trcalriiciil  of  Uheumatisin  in  tlie  Jef- 

fei-rion  College  Hospital 1S7 

riiiiailelpliiaCIiiiieai  Society.  — 187 

Tliorapeutics  of  Female  Sterility 188 


EDITORIAL. 

College  of  Pliy.sieiiiim   ami  Surgeons, 

IM'oviiH'.e  of  t^uobec 1**" 

Obituary ^^ 

Peisonal '■'" 

Review '■'" 

Salol 192 


MEDICO-CHI RURGICAL  SOCIETY  OF 
MONTREAL. 
Stated  Meeting,  Feb.  25///,  1SS7. 
J.  C.  Cameron,  M.D.,  Presii..ent,  in  thic  cilmk. 

Heredity. — Dr.  \V.  G.  Johnston  read  a  sliort 
paper  on  "  Heredity  of  Acquired  Peculiarities," 
which  a|)pcared  in  full  in  the  April  number  of  this 
Journal. 

Discussion. — Dr.  Shepherd  stated  that  those 
anatomical  peculiarities  which  are  characteristic  of 
inferior  animals  are  often  transmitted  for  many- 
generations  ;  for  instance,  he  had  traced  for  two 
generations  a  well-marked  supra-condyloid  pro- 
cess. Deformities  in  the  fingers  and  toes  were 
often  transmitted  from  one  generation  to  another. 
He  cited  an  instance  where  he  had  performed 
tenotomy  for  a  peculiar  formation  of  the  toes  in 
two  generations.  He  knew  of  a  f;xmily,  each 
member  of  which  was  characterized  for  three  gen- 
erations by  a  preternaturally  long  first  toe,  possess- 
ing preliensile  power. 

Dr.  Mills  said  that  Darwin  did  not  seem  to 
have  been  strongly  given  to  speculation,  and  did 
not  strive  after  a _/?// (7/ explanation  of  his  hypothe- 
sis. His  Pangenesis,  as  an  explanation  of  the 
facts  of  organic  evolution,  was  by  many  biologists 
regarded  as  weak  and  unworthy  of  him.  Brooks 
had  attempted  to  show  that  the  male  generative 
element  was  concerned  in  originating  variations, 
the  female  in  preserving  the  existing  fonn.  If 
this  were  true,  important  conclusions  followed. 
Medical  men  might  throw  some  lii;ht  on   tliis  and 


kindred  matters.  Dr.Hughlings  Jackson  had  applied 
evolution  to  the  discussion  of  diseases  of  the  ner- 
vous system  in  his  usual  masterly  manner.  Inas- 
mucli  as  morphological  explanations  never  can  be 
final,  it  was  remarkable  that  physiological  solutions 
had  not  been  invoked  prior  to  this  time.  Dr.  Mills 
believed  the  solution  must  eventually  come  through 
physiology  :  in  fact,  quite  recently  Dr.  Romanes 
had  introduced  "  physiological  selection"  as  sup- 
plementary to  "  natural  selection,"  etc.  Certainly 
at  the  present  time  the  most  thoughtful  biologists 
feel  the  need  of  something  additional  to  the  Dar- 
winian factors  to  give  a  complete  explanation  of 
organic  evolution,  which  might  now  be  considered, 
as  Huxley  called  it,  a  "  demonstiation."  Dr. 
Mills  thought  the  tiine  had  now  come  for  medical 
societies  to  discuss  such  broad  generalizations  ot 
science  in  their  bearing  on  their  own  science  and 
profession.  The  question  of  the  heredity  or  non- 
heredity  of  acquired  peculiarities  was  especially 
within  the  scope  of  physicians,  and  one  they  could 
do  much  towards  settling.  He  hoped  to  be  able 
to  lay  before  the  Society  some  views  of  his  own 
on  the  subject  of  organic  evolution,  in  some  of  its 
aspects,  at  a  future  time. 

Dr.  Trenholme,  referring  to  Brooks',  theory, 
stated  that  he  had  noticed  several  cases  where  the 
permanence  was  on  the  male  side.  He  had  in  one 
case  traced  polydactylism  through  three  genera- 
tions on  the  male  side,  and  in  another  case  the 
male  members  of  a  fiimily  were  for  several  genera- 
tions characterized  by  peculiar  teeth. 

Dr.  HiNGSTON  referred  to  the  fact  that  the 
practice  of  flatheaded  Indians  of  flattening  the 
frontal  bone  of  their  infants  for  many  generaticns 


170 


THE   CANADA   MEDICAL   RECORD. 


had  not  produced  any  permanent  change  in  the 
shape  of  their  heads.  Infants  were  born  still  with 
perfectly  round  heads. 

"  Some  of  the  Present  ^spec/s  of  Siayeri/." — Dr. 
Kingston  then  read  the  following  paper  on  this 
subject : 

The  aspects  of  a  science  or  of  an  art  are  as  the  as- 
pects of  a  country;  not  being  always  objective  are 
not  always  the  same— for  the  subject,  seeing,  has 
views  of  his  own,  habits  of  vision  as  it  were,  and 
these,  unconsciously  to  himself,  perhaps,  change 
and  color  the  prospective.  I  am  as  one,  and  only 
one,  of  those  observers,  and  the  field  of  observation 
— chiefly  ultra  mare — is  the  scene  of  former  and 
more  lengthened  residence.  During  my  recent 
visit  to  Europe,  after  an  interval  of  nineteen  years, 
I  perceived,  or  fancied  I  perceived,  among  indivi- 
duals in  the  higher  walks  of  the  profession,  whetiier 
met  with  in  society  or  at  their  own  homes,  a 
greater  seriousness — a  greater  earnestness  than  on 
former  occasions.  Or  was  it  that  those  interven- 
ing years  had  changed  the  mode  of  vision  in  the 
observer  ?  The  friction  of  mind  against  mind  is 
seemingly  incessant.  The  struggle  for  position  is 
unremitting — rendered  the  more  necessary  by  the 
increased  and  steadily  increasing  cost  of  living, 
and  almost  pari  ^j((.ssi(,  the  steadily  increasing 
number  of  votaries  to  the  healing  art.  The  large 
incomes  enjoyed — not  always  enjoyed,  but  always 
slaved  for — by  a  limited  few,  have  caused  recruits 
innumerable,  each  one  hoping  to  achieve  distinc- 
tion, as  in  the  time  of  Napoleon  the  humblest  sol- 
dier was  animated  with  a  hope  of  one  day  ex- 
changing his  musket  for  the  baton  of  the  marshal. 
Although  great  courtesy  characterizes  the  rela- 
tionship of  members  of  the  profession  with  one 
another,  there  are  few  who  are  not  keenly  alive  to 
the  necessity  of  continued  effort  for  supremacy,  as 
well  as  for  its  recognition ;  and  self-assertion, 
though  clothed  with  becoming  modesty,  is  not  al- 
ways absent  from  the  highest  and  most  conserva- 
tive ranks  of  the  profession.  F3ut  plain,  honest 
thought — most  markedly  in  Great  Britian — 
finds  plain,  honest  expression  at  all  the  meetings  of 
societies  1  attended.  Vague  statements  are  un- 
heeded; and  if  imagination  is  suspected  as  a  pos- 
sible source  of  stated  fact,  a  clapping  of  hands  is 
an  indication  of  that  fact  having  been  duly  noted. 
The  most  imaginative  could  not  devise  a  readier 
method  of  expression  than  the  clapping,  graduated 
on  a  crescendo  scale,  which  marks  distrust  or  dis- 
approval ;  and  tediousness  or  irrelevancy  receives 
a  quietus  in  the  same  way. 


The  vast  strides  in  the  study  of  minute  and 
morbid  anatomy,  and  in  special  and  general  patho- 
logy, have  opened  up  newer  and,  it  is  said,  more 
profitable  fields  of  professional  labor.  The  growth 
and  multiplication  of  specialties  are  prodigious. 
The  three  divisions  of  physician,  surgeon  and 
accoucheur;  the  subdivisionof  eye  and  ear  surgery 
and  afterwards  the  further  separation  of  the  two 
latter,  are  no  longer  adequate  to  express  the 
numerous  subsections  of  professional  work.  On 
former  visits  I  usually  spent  an  hour  or  two  a  day 
with  Sichel,  Desmarres,  or  Graefe  over  the  eye  ; 
with  Wilde  or  Toynbee  in  studying  the  ear ;  while 
a  Stokes,  a  Graves,  a  Trousseau  or  a  Schonlein 
was,  in  our  then  benighted  condition,  deemed  fit 
to  teach  the  practice  of  medicine  in  general ;  and 
a  Syme,  a  Velpeau  or  a  Langenbeck  was  supposed 
to  be  quite  abreast  of  general  surgery.  Now,  all 
is  changed,  and  perched  on  every  barleycorn  of 
vantage  ground  the  specialist  works  in  a  narrower, 
a  more  restricted  sphere,  seeing  clearer,  no  doubt, 
what  he  does  see,  but  with  less  acquaintance,  it  is 
said,  with  the  ailments  of  other  organs  with  which 
his  own  may  be  intimately  connected.  Yet  the 
labors  of  the  specialist — each  in  his  own  depart- 
ment— have  gready  advanced  the  general  stock  of 
knowledge.  The  all-round  man  is  becoming  a 
rara  avis;  yet  when  a  Jonathan  Hutchinson  ap 
pears,  going  to  and  from  the  meetings  of  the  Bri- 
tish Medical  Association,he  is  greeted  by  physician 
and  surgeon  alike  as  one  who,  in  his  day,  has 
touched  many  things  pertaining  to  both  medicine 
and  surgery,  yet  of  whom  it  may  be  said,  nee  tetiget 
quo  J  von  ornavit.  It  is  men  such  as  he  who  show 
us  how  the  various  branches  of  our  art  are  mutually 
dependent,  and  how  they  correct,  reform  and  re- 
claim each  other.  The  newer  and  more  inviting 
fields  of  special  work  are,  in  Great  Britain,  draw- 
ing into  their  ranks,  at  a  rapid  rate,  men  who  will 
be  competitors  in  those  ranks.  There  must  soon 
be  a  limit  to  subdivision.  The  story  told  a  few 
years  ago  of  a  lady  in  London  who  had  given  her 
lungs  to  one  physician,  her  liver  to  a  second,  her 
heart  to  a  third,  her  womb  to  a  fourth,  and  so  on, 
would  now  be  strange  in  the  atmosphere  of  refined 
life,  were  she  so  incautious  and  so  ill-informed  as 
to  confide  the  whole  of  any  organ  %o  a  single  indi- 
vidual. 

Now  and  then,  as  you  are  aware,  efforts  are- 
made  in  the  direction  of  synthetizing  diseases. 
Thus  Erasmus  Wilson,  in  his  old  age — and  it  was 
a  richer  legacy  than  that  represented  by  his  Cleo- 


TllK   CANADA    MEDICAL    RECORD. 


17 


palra's  needle, — reduced,  forlherai)eiilic  purposes, 
diseases  of  tlie  skin  to  fo)ir  clearly  and  easily 
understood  heads.  'I'lie  whole  was  contained  in  a 
few  duodecimo  pages.  Kc/xnia  was  grouped 
naturally  under  one  of  them,  and  I  uuich  doubt  if 
any  of  the  octavo  vohmies  on  that  disease  alone 
have  contained  more  matter  for  the  practising 
physician  than  the  few  lines  in  question.  No  one 
is  siill  doing  more  to  harmonize  medicine  and  sur- 
gery than  Sir  James  Paget,  who  draws  from  patho- 
logical anatomy  and  from  clinical  pathology, 
whether  for  the  use  of  the  experimentalist,  the 
chemist,  or  the  microscopist. 

Great  advances  have  been  made  in  the  diagnosis 
of  diseases  of  the  different  cavities  of  the  body; 
but  in  the  exploration  of  mucous  inlets,  as  the 
nose,  larynx,  trachea,  urethra,  bladder  or  vagina,  I 
failed  to  notice  any  advantages  not  within  the 
porlic  of  practitioners  twenty  years  ago. 

The  principles  of  treatment  are  not  now  much 
better  understood,  although  diagnosin  may  have 
outstripped  its  former  self  by  many  a  stride.  With 
the  greatly  increased  facilities  for  the  investigation 
of  disease,  with  the  improvements  in  the  methods 
of  diagnosis,  and  with  the  application  of  direct 
methods  of  treatment,  initiation  is  sometimes 
shrouded  in  well-intentioned  mystery.  For  in- 
stance, in  a  specular  examination  of  one  of  the 
mucous  inlets,  there  was  an  arrangement  of  mirrors, 
which  reflected  the  electric  light  funr  times  before 
it  reached  the  mucous  membrane.  The  green 
baized  drapery  completed  the  illusion  ;  and  the  fee 
was  larger,  possibly,  than  if  the  examination  had 
been  gone  through  with  direct  light  or  with  light 
once  reflected. 

The  separation  of  medicine,  as  a  whole,  from 
surgery,  as  a  whole,  seemed  destined  to  be  com- 
plete and  irreparable.  But  it  is  not  so.  Hand- 
maids of  each  other  they  must  ever  remain  ;  again 
a  tendency  is  noticeable  of  an  ajijyrochement,  and 
this  time  by  the  invasion  by  the  surgeon  of  the 
domain  of  medicine. 

The  lines  which  separate  specialties  are,  as  I  have 
said,  narrow,  short,  yet  well  defined.  They  are 
steadily  becoming  narrower,  shorter,  and  still  more 
defined  as  between  specialties,  and  especially  sur- 
gical specialties.  That  the  public  is  a  gainer  is 
much  doubted.  But  while  the  lines  which  confine 
specialism  within  steadily  narrowing  limits  are  be- 
coming more  defined,  the  lines  which  separate 
medicine,  as  a  whole,  from  surgery,  as  a  whole, — 
even  in  those  departments  in  wliich,   till   recently. 


the  physician  tolerated  not  the  aid  or  intervention 
of  the  surgeon, — the  latter  has  dared  to  enter, 
and  with  advantage,  the  domain  of  the  physician. 
Not  many  years  ago,  for  instance,  in  all  affections 
of  the  chest  or  abdomen  requiring  manual  inter- 
ference, the  surgeon  was  sent  for,  and  the  opera- 
tion was  performed  at  the  request  and  under  the 
guidance  and  direction  of  the  physician  whose 
diagnosis  was  followed,  and  who  had  called  in  the 
surgeon  to  do  that  which  required  a  cooler  nerve 
or  a  more  dexterous  hand  than  that  possessed  by 
himself.  How  is  it  now?  The  surgeon's  know- 
ledge of  internal  derangements  within  the  skull, 
chest  or  abdomen  requires  to  be  so  precise  that 
skill  in  operating  must  wait  upon,  and  be  preceded 
by  great  accuracy  in  diagnosis.  The  surgeon  who 
trephines  the  skull,  cuts  through  its  membranes, 
and  removes  a  tumor  from  the  brain  ;  or  who 
sends  a  bistoury  through  its  substance  to  an  abscess, 
does  that  which  requires  no  extraordinary  manual 
skill  or  dexterity — a  butcher  or  a  butcher's  boy 
could  do  it  as  well.  But  the  exact, the  precise  localiz- 
ing of  disease  within  the  brain,  by  the  correct  inter- 
pretation of  disturbance  of  function  (U  a  diaUince, 
is  one  of  the  greatest  triumphs  of  modern  surgery, 
and  is  a  step  towards  its  recognition  as  a  science 
as  well  as  an  art.  I'he  domain  of  the  surgeon  is, 
therefore,  steadily  extending,  and  fractures,  dislo- 
cations and  excisions  of  tumois  no  longer  limit 
the  field  of  his  labors. 

It  would  be  inconsistent  with  the  time  at  my 
disposal  to  traverse  the  field  of  practical  surgery, 
to  point  out  what  might  be  considered  encroach- 
ments upon  the  territory  of  the  physician.  I  shall 
only  allude  to  those  instances  where,  till  recently, 
medicine,  and  medicine  alone,  was  relied  upon  for 
relief. 

In  chest  affections  requiring  surgical  interfer- 
ence, diagnosis  must  be  clear  and  precise.  In 
empyema,  for  instance,  not  alone  must  the  quan- 
tity and  situation,  but  even  the  quality  of  the  fluid 
be  made  out  before  proceeding  to  operation.  In 
bronchiectasis  of  the  lung,  where  the  difficulty  of 
diagnosis  is  admittedly  great,  it  must  be  precise 
before  resorting  to  any  operative  procedure. 
Here,  again,  the  surgeon,  although  he  may  receive 
aid  in  determining  the  exact  site  and  nature  of  the 
disease,  must  rely  upon  his  own  diagnosis  chiefly, 
if  not  entirely. 

In  local  peritonitis,  what  could  be  more  daring', 
more  surprising,  and  yet  more  satisfactory,  than 
Mr.  Lawson  Tail's   thrusliim  a  bistourv    irto  the 


172 


THE  CANADA  MEDICAL   RECORD. 


groin  of  a  woman  laboring  under  all  the  symptoms 
of  puerperal  fever,  where  he  suspected  pus  by  the 
symptoms  alone,  but  where,  as  he  told  me,  there 
were  no  outward  signs  of  its  presence,  no  swelling, 
and  no  local  tenderness.  From  a  condition 
almost  of  collapse,  recovery  took  place.  The  opera- 
tion was  not,  'tis  true,  a  difficult  one.  Anyone 
could  have  performed  it ;  but  the  diagnosis  was 
prophetic. 

The  case  of  Dr.  Leslie  Phillips,  operated  upon 
by  John  W.  Taylor,  F.R.C.S.,  is  of  like  character  ; 
and  now  that  attention  has  been  directed  to  the 
subject,  and  that  surgery  has  taught  a  means  of 
escape,  deaths  from  supposed  puerperal  fever  will, 
it  is  hoped,  be  less  frequent  than  formerly.  Here, 
as  you  will  see,  surgery  comes  to  the  relief  of  the 
obstetric  physician  in  cases  which  are  peculiarly 
within  the  province  of  the  latter. 

In  diseases  of  the  abdominal  organs,  how  much 
has  lately  been  done  by  surgery.  Hepatitis,  with 
all  its  train  of  sufferings,  was  claimed  by  medicine 
as  its  own  ;  but  surgery  of  the  liver  has  suddenly 
leaped  into  importance  lately.  A  painful,  inflamed 
and  enlarged  liver  is  now  relieved  by  Harley  and 
others,  and  the  patient  cured  by  the  insertion  into 
it,  at  its  upper  and  convex  part,  of  a  long  trocar, 
and  by  the  drawing  directly  therefrom  as  large  a 
quantity  of  blood  as  was  considered  prudent  to  be 
taken  from  the  arm  in  the  days  of  venesection. 
Operation  for  draining  hepatic  abscesses  or  remov- 
ing hepatic  cysts ;  cholecystotomy  for  crushing  or 
taking  calculi  from  the  gall-bladder  ;  laparotomy 
for  purulent  or  persistent  peritonitis  ;  abdominal 
sections  for  internal  hemorrhage,  etc.,  are  all  of 
recent  date,  and  open  a  field,  not  of  brilliant  oper- 
ative procedures,  but  of  more  brilliant  diagnosis, 
and  what  is  of  greater  moment,  of  far  more  benefi- 
cial results. 

The  considerable  degree  of  immunity  from 
danger  which  has  attended  abdominal  sections  has 
led  to  the  spaying  of  females — -married  and  un- 
married— for  sometimes  real- — sometimes,  it  is  be- 
lieved, unreal  sufferings.  This  operation  has  been 
performed  for  objective  disturbances,  and  for  dis- 
turbances purely  subjective.  Prolajisus  of  the 
ovary,  a  common  affection  ;  atrophy  of  the  ovary, 
not  easily  diagnosed ;  oedematous  ovary ;  a 
pultaceous  condition  of  "the  ovary;  cirrhotic 
ovary  ;  hydrosalpinx  ;  in  pyosalpinx  pin-  ct  sim- 
pie,  often  guessed  at  by  raised  temperature 
alone  ;  in  pyosalpinx  resulting  from  gonorrhoea; 
in  that  condition    of  neurosis    whose  shapes  are 


endless  and  whose  outward  hysterical  manifesta- 
tions are  innumerable;  in  localized  peritonitis 
where  the  intestines,  omentum,  etc.,  are  glued  to- 
gether, etc. ;  in  inflammatory  conditions  after  con- 
finement, especially  in  tjie  acute  and  subacute 
stage;  in  deformity,  where  the  birth  of  a  living 
child  might  be  reasonably  expected  to  prove  fatal 
to  the  mother  ;  in  uterine  myomata,  where  the  size 
of  the  growth  is  inconvenient;  in  bleeding  myo- 
mata; in  (who  would  believe  it.')  all  cases  of 
uterine  myomata  in  patients  under  40  years  of 
age  ;  in  retroflesed  and  anteflexed  uterus  ;  in  epil- 
epsy ;  in  hystero-epilepsy  ;  in  every  case  of  insanity 
in  the  female  !  ! 

Here,  as  you  will  ]  erceive,  I  have  said  nothing 
of  those  considerable  tumors  of  the  ovary  or  tubes 
— cystic,  fibrocystic  or  malignant — which  all  agree 
may  demand  removal.  Is  it  to  be  wondered  at 
that  this  operation  should  be  resorted  to  with  a 
frequency  which  is  alarming  ?  Oophorectomy  is 
to-day  epidemic  in  many  places  on  the  other  and 
on  this  side  of  the  Atlantic.  Occasionally  an 
authority,  such  as  Thomas  More  Madden,  in 
Europe,  writes  that  the  o|)eration  of  laparotomy  is 
performed  "  too  frequently  "  and  in  unsuitable 
cases  ;  and  PLmmet,  on  this  side,  stems  the  tide 
somewhat  by  saying  that  for  a  year  he  had  seen 
but  one  case  of  disease  of  the  tubes  where  the  op- 
eration might  be  justifiable,  that  the  patient  refused 
to  be  operated  upon,  and  got  well  in  a  few  months. 
Yet  every  one  knows  Emmet's  unsurpassed  field 
of  clinical  observation.  In  one  hospital  in  Liver- 
pool, says  Dr.  Carter,  no  less  than  1 1 1  women 
had  been  deprived  of  one  or  both  ovaries  during 
the  year  1885,  said  to  be  about  one-third  of  all  the 
patients  admitted.  This  frequency  continued  in 
1886,  and  led  to  a  commission  of  enquiry.  Cana- 
da has  many  oophorectomists  and  salpingotomists. 
The  Canada  Lancet  has  denounced  the  epidemic, 
and  at  our  own  Medico-Chirurgical  Society, 
ovaries  are  sometimes  fished  up  from  the  depths 
of  the  pocket — sometimes  the  vest  pocket, — and, 
sometimes  it  has  happened  that  so  able  a  patho- 
logist as  Prof.  Osier  has,  after  close  inspection, 
declared  he  found  nothing  abnormal  in  them. 
The  fashion,  doubtless,  will  soon  change  ;  diagnosis 
of  affections  of  the  appendages  will,  in  the  mean- 
time, have  been  much  advanced  ;  and  the  question 
of  operation  will  have  been  settled  in  accordance 
with  those  general  principles  which  should  guide 
all  prudent  and  honorable  men  in  its  performance 
or  rejection.     This  question    has  a  moral   and   a 


Tnt;  CANADA   MEDICAL   IIECORU. 


173 


social  as  well  as  a  medical  aspect ;  but  I  do  not  ar- 
logatc  to  myself  any  preparedness  not  ]iossessed 
liy  others.  I  may  say,  however,  I  have  more  than 
once  prevented  the  operation,  and  I  have  been 
al'terwarijs  Ihanki-d  lor  it,  and  anollicr  tlien  unborn 
generation  has  been  advantaged  by  it.  I  admit 
tiiere  are  cases  wlierc  a  diseased  condition  of  tjie 
ovaries  or  tubes  demands  singical  interference  ;  but 
tliose  are  not  cases  where  every  objective  sign  is 
aljsent,  and  where  the  symptoms  detailed  by  a 
hysterical  women  are  the  only  guide. 

J)isi-iission. — Dr.  Tukniiolme  did  not  believe 
tiial  gyti;ecoiogy,  as  a  branch  of  surgery,  would 
ever  lose  its  importance  ;  its  utility  was  undoubted. 
With  regard  to  spaying,  the  speaker  expressed  his 
belief  tliat  it  would  be  better  if  every  insane  person 
t:otild  be  prevented  from  juopagating  Iiis  species, 
and  the  same  could  be  said  of  criminals.  He  gave 
an  account  of  a  case  where  one  noted  criminal 
marrying  another  had  given  rise  to  a  race  of  no 
fewer  than  176  noted  criminals,  male  and  female. 
With  regard  to  the  utility  of  abdominal  sections, 
he  could  only  say  that  in  his  experience  more  than 
90  per  cent,  were  cured  of  undoubted  and  often 
intense  suffering.  He  did  not  think  that  patients 
suffering  from  pyosalpinx  or  hydrosalpinx  when 
over  40  years  of  age  required  operative  measures, 
but  believed  in  operating  on  in  all  cases  where 
patient  was  28  to  30  years  old. 

Dr.  Gardner  agreed  with  Dr.  Hingston  that 
there  should  be  objective  signs  to  justify  operation, 
except  in  a  few  cases — e.g.,  cirrhotic  ovaries.  Dr. 
Bantock  gives  many  cases  of  diminution  of  ovaries 
which  produced  intense  suffering,  but  which  were 
cured  by  operation.  With  regard  to  the  removal 
of  ovaries  for  myomata,  it  is  known  that  many 
myomata  may  exist  for  life  without  producing  the 
smallest  danger  or  even  discomfort.  On  the  other 
hand,  these  tumors  may  produce  dangerous  hemor- 
rhages or  intense  pain,  and  ovariotomy,  as  a  rule, 
gives  relief.  With  regard  to  neuroses,  we  have 
still  much  to  learn  about  the  effect  of  the  ovaries 
on  the  nervous  system.  Pelvic  pain  is  often  un- 
doubtedly of  central  origin,  yet  in  many  cases  it 
is  due  to  the  ovaries.  In  selecting  proper  cases 
for  operation  in  neuroses,  we  require  experience. 
This,  however,  will  come  in  time. 

Dr.  Shepherd  remarked  that  nervous  affections 
were  now  treated  by  operations  on  the  eyes  instead 
of  ovariotomies.  Cutting  the  eye  muscles  is  a  re- 
cent mode  of  treatment  for  epilepsy  and  insanity. 
Many  cures  are  claimed  for  this  method  of  treat- 
ment. 


Dr.  Kingston,  in  rejily,  stated  tiiai  lie  did  not 
wish  to  depreciate  gynaecology,  but  he  did  wish  to 
denounce  tin's  wholesale  operation  for  subjective 
symptoms.  .Such  recognized  authorities  as.S[)encer 
Wells,  Keith  ami  Knnnet  speak  in  much  stronger 
terms  than  he.  The  /.(^//r/c// /(?//(r/ has  for  some 
time  refused  to  publish  the  |)apers  of  these  whole- 
sale ovariotomists.  He  believed  that  if  men  like 
Lawson  Tait  and  .Savage,  who  oi)erate  for  subjec- 
tive symptoms,  are  to  be  imitated  by  men  with  less 
judgment,  it  would  lead  to  unlimited  operating. 
fCvery  hysterical  girl  with  pelvic  pain  would  be  a 
fit  subject  for  ovariotomy.  With  regard  to  ovarian 
fibroma,  he  could  cite  very  many  cases  in  his  own 
practice  of  women  who  have  had  uterine  fibromata 
all  their  lives  without  causing  them  any  discomfort. 
Otis  claims  to  have  cured  neurosis  by  circumcision, 
and  contends  that  many  forms  of  epilepsy  can  be 
thus  cured.  Ovariotomy  is  the  modern  fiishion  in 
surgery,  just  as  the  now  almost  discarded  .Syme's 
external  urethrotoiuy  was  the  fashion  a  few  years 
ago. 

Paris,  8th  May,  1887. 
Dear  Record, — -In  my  last  letter  I  told  you 
that  I  would  in  my  next  endeavor  to  give  your 
readers  some  ideaof  Apostoli's  method  of  employ- 
ing electricity  in  Gynecology.  I  was  the  more  anx- 
ious to  acquaint  myself  with  his  process,  because  I 
have  always  held  the  view  that  most  of  the  dis- 
eases of  the  female  generative  organs  depended 
on  disordered  innervation,  circulation,  and  nutri- 
tition,  and  that  the  only  sure  cure  for  these  dis- 
eases would  be  found  in  a  system  of  thera- 
peutics, which  vi'ould  directly  re-establish  these 
functions.  This  then  was  the  main  object  of  my 
visit,  and  in  Dr.  Apostoli  I  found  my  wish  fully 
gratified.  After  a  pleasant  lunch  at  the  magnifi- 
cent club,  which  has  a  membership  of  eighteen 
hundred  scientific  and  literary  men,  and  where  I 
made  the  acquaintance  of  Paquelin,  and  several 
others  whose  names  are  known  to  fame.  Dr. 
Apostoli  took  me  with  him  to  his  private  clinic  at 
the  Halles,  and  introduced  me  at  once  to  his 
instruments,  which,  I  must  confess,  had  hitherto 
been  somewhat  strangers  to  me.  They  were  as 
follows  : 

I  St.  A   battery   of  sixty  Leclanche  cells,    con- 
j  nected  in  what  is  called  series  of  tension,   that  is 


1?4 


THE   CANADA  jrEDICAL   RECORD. 


the  positive  pole  of  No.  i  is  connected  with  the 
negative  of  No.  2,  and  the  positive  of  No.  2 
with  the  negative  of  No.  3,  and  so  on.  The 
wires  of  all  these  couples  are  received  by  a  very 
important  but  somewhat  complicated  machine 
called 

2nd.  A  collector,  by  means  of  which  you  can 
gradually  bring  the  strength  of  the  whole  battery 
to  bear,  one  cell  at  a  time.  The  collector  has  a 
double  index,  by  means  of  which  the  first  or  any 
worn  out  cells  can  be  thrown  out  of  the  circuit,  as 
they  would  only  hinder  the  others  from  doing 
their  work. 

3rd.  The  galvanometer,  the  most  important  of 
all,  by  means  of  which  the  dose  is  measured  out 
in  thousandths  of  amperes.  For  example,  strych- 
nine and  atropine  are  very  useful  medicines,  but 
they  would  be  likely  to  do  more  harm  than  good 
if  we  had  no  scales  with  which  to  measure  them  ; 
the  galvanometer  is  to  electricity  just  what  a  fine 
pair  of  scales  is  to  strychnine.  It  is  only  since 
electricians  have  invented  accurate  galvanometers 
that  electricity  can  be  used  effectively  and   safely. 

I  may  mention  for  the  information  of  some  of 
your  readers  that  the  ampere  is  the  measure  of  quan- 
tity, the  volt  is  the  measure  of  intensity, and  the  ohm 
the  measure  of  resistance.  To  explain  further 
these  terms,  quantity,  intensity  and  resistance,  I 
must  compare  electricity  to  water.  Now,  if  you 
have  a  large  quantity  of  water  running  over  from  a 
large  flat  basin,  you  would  have  quantity  without 
pressure  or  resistance.  On  the  other  hand,  a  much 
smaller  quantity  of  water  confined  in  a  very  fine 
but  very  high  tube  would  give  great  pressure  with- 
out quantity;  that  corresponds  with  intensity  in 
electricity.  But  if  we  have  a  current  of  water  flow- 
ing through  a  very  long  and  very  thin  pipe,  we  will 
have  friction,  which  corresponds  with  resistance  in 
electricity. 

4th.  A  Gaiffe  faradic  ma(  hine,  with  long,  fine 
wire  coil,  and  short,  thick  wire  coil  and  commuta- 
tor.    This  is  worked  by  two  Leclanche  couples. 

5th.  A  platinum  electrode,  which  can  be  con- 
verted into  a  Simpson's  sound  or  a  trocar,  at  will. 

6th.  A  set  of  uterine  and  vaginal  excitors  or 
double  electrodes. 

7  th.  A  large  abdominal  electrode,  made  of  very 
moist  potter's  clay,  on  the  upper  surface  of  which  is 
stuck  a  large,  flat  piece  of  zinc,  and  on  the  under 
surface  a  piece  of  coarse  tarletan  to  hold  it  togeth- 
er, and  through  the  meshes  of  which  the  moist  clay 
transudes. 


This  is  the  outfit;  but  I  must  explain  that  the 
positive  and  negative  poles  of  such  a  battery  have 
very  different  qualities;  the  positive  pole,  about 
which  oxygen  and  acids  accumulate,  is  like  an  acid 
caustic,  coagulating  and  astringent ;  while  the 
negative  pole,  about  which  the  bases  soda,  ammonia 
and  potash  accumulate,  is  fluiditying  and  produces 
an  action  like  the  caustic  alkalies. 

\\'ell,  then,  a  patient  mounts  the  tal.ile,  she  com- 
plains of  losing  blood  continuously  for  several 
months,  pain  and  weight  in  the  back  and  belly  ; 
the  sound  enters  4)4  inches  and  a  digital  exam- 
ination reveals  a  large  fibroid  in  the  posterior  wall 
of  the  uterus. 

Dr.  Apostoli  decides  to  employ  a  positive 
chemical  galvano  cautery  to  the  uterine  cavity. 
He  first  irrigates  the  vagina  with  i  in  a  1000  sub- 
imate  solution,  as  I  may  say  he  does  before  and 
after  every  examination  and  operation,  no  matter 
how  trivial,  and  then  introduces  the  platinum 
sound  right  up  to  the  fundus,  the  vaginal  por- 
tion of  it  being  covered  with  celluloid  tubing,  which 
is  one  of  the  best  and  cleanest  of  non  conductors. 
In  a  few  minutes,  after  gradually  increasing  the  cur- 
rent until  the  compass  needle  marks  150  or  200, 
and  even  sometimes  250  milliamperes,  the  platinum 
sound  becomes  bathed  in  acid,  which  coagulates 
the  blood  in  the  uterus  into  so  firm  a  clot,  that  it 
can  with  some  little  traction  be  withdrawn,  and  the 
hemorrhage  ceases.  Without  the  clay  electrode  on 
the  abdomen,  the  skin  there  would  have  been 
burned  with  so  strong  a  current,  and  until  Dr. 
Apostoli  thought  of  it,  no  one  could  administer 
more  than  40  or  50  milliamperes.  It  being  covered 
with  a  towel,  and  the  patient  herself  pressing  it 
down  with  both  hands,  tlie  current  enters  her 
system  by  more  than  a  thousand  doors. 

Apostoli  used  to  never  go  beyond  50  milliam- 
peres, but  he  made  the  seance  last  10  or  1 5  minutes ; 
but  now  that  he  can  go  as  high  as  250  milliamperes, 
he  only  makes  the  sitting  last  5  minutes. 

As  soon  as  the  hemorrhage  stops,  which  it  gener- 
ally does  after  two  or  three  applications  or  less,  he 
goes  for  the  fibroid,  if  it  is  in  an  accessible  position 
that  is  behind,  or  anywhere  within  reach  through 
the  vaginal  cul-de-sac,  but  not  if  it  is  in  front  and 
high  up,  owing  to  danger  of  injuring  the  bladder. 
The  way  in  which  be  goes  for  it  is  as  follows  : 

An  assistant  presses  the  uterus  backwards  from 
the  abdomen,  while  he  feels  for  the  fibroid  with  one 
finger  pushed  up  into  Douglas'  sac,  and  with  the 
right  hand  he  plunges  the  trocar  end  of  the  sound 


TIIK   CANADA   MEDICAL   IlECORD. 


/•) 


into  the  fihroid,  a  distance  of  half  or  three-quarters 
of  an  incli.  The  dose  is  very  gradually  increased 
to  I  no  or  150  inilliam])(Jrc  and  the  trocar  is  left  in 
for  5  minutes,  when  it  is  willuhawn,  and  the  wound 
dressed  with  ifxloforni  gauze.  A  large,  soft  sKuigli 
comes  away  in  a  few  days,  the  negative  pole  hav- 
ing been  used.  The  result  is  two  fold  ;  the  fibroma 
is  diminished  in  bulk  at  each  sitting  to  the  extent  of 
the  scar,  and  the  current  contracts  all  the  vessels 
of  tlie  uterus,  and  causes  alisorption  of  the  hyper- 
plasic  deposit.  The  operation  is  in  nowise  dan- 
gerous, and  though  a  little  i>ainriil  is  often  per- 
formed without  any  aiuesthetic.  Of  course  it  is 
antiseptic  as  tliat  amount  of  electricit)'  kills  all 
germs. 

He  only  continues  the  operation  until  the  tumor 
is  so  much  di  minished  in  size  and  in  nature,  that 
the  woman  no  longer  complains  of  any  symptoms, 
or,  as  he  calls  it,  until  she  is  symptomatically  cured. 

He  applies  the  same  treatment  to  cases  of 
chronic  pelvic  cellulitis,  and  I  must  say  with  remark- 
able results,  but  it  must  be  chronic.  In  a  few  sittings 
the  diseased  tissue  either  comes  away  in  slough  or 
is  re-absorbed.  But  still  more  remarkable  because 
almost  instantaneous  were  the  results  of  the  applica- 
tion of  the  faradic  current  in  cases  of  ovarian  pain 
and  hysteria.  Over  and  over  again  patients  came 
there  for  the  first  time  with  such  tender  ovaries,  that 
they  could  not  bear  the  weight  of  the  hand  on  the 
abdomen,  and  who  after  ten  or  fifteen  minutes  of 
the  intra-uterine  application  of  the  faradic  current 
with  the  long,  fine  coil,  could  bear  any  amount  of 
pressure. 

In  cases  of  relaxation  of  the  vaginal  and  uterine 
muscles  he  employs,  on  the  contrary,  the  current 
from  the  coil  of  thick,  short  wire,  which  has  a  more 
powerful  effect  in  contracting  muscular  tissue, 
while  the  long,thin  wire  acts  more  as  a  nervous  tonic. 

lu  my  opinion,  we  have  here  precisely  the  means 
we  have  been  waiting  for  for  years  to  strengthen 
the  uterine  supports.  For  example,  when  we  are 
called  upon  to  treat  a  case  of  lateral  curvature  of 
the  spine,  which  we  know  to  be  due  to  weakness  of 
the  erector  spiniB  muscle  of  one  side,  it  is  not  by 
ordering  stays  that  we  can  cure  the  case,  for  they 
will  only  make  the  muscles  weaker  and  more  lazy. 
While  good  air,  good  food,  frictions,  and  gymnas- 
tics, either  voluntary  or  artificial,  by  the  aid  of  the 
faradic  current,  will  soon  train  the  defaulting  mus- 
cles up  to  the  point  of  doing  their  duty. 

So,  for  the  same  reason,  instead  of  introducing 
pessaries  into  the  pelvis  of  a  women,  whose  uterine 


muscles  are  not  doing  their  work,  we  would  do 
much  better,  1  think,  to  put  these  defaulting  mus- 
cles through  a  course  of  electrical  gymnastics, 
until  they  have  learned  to  do  their  duty. 
A]iostoli  has  cliargecl  me  with  the  task  of  translat- 
ing his  last  work,  and  until  it  ajjpears,  I  cannot 
more  than  briefly  hint  at  the  manifold  methods  in 
which  electricity,  in  its  various  forms  and  strengths, 
can  lie  applied.  In  tedious  labour,  and  in  ante-  or 
post-partum  hemorrhage,  it  is  more  certain  than 
ergot,  much  quicker  to  act,  and  under  perfect  con- 
trol. In  subinvolution  of  the  uterus,  after  miscar- 
riage or  abnormal  labor,it  is  an  easy  and  sure  means 
of  getting  perfect  contraction,  alike  of  the  blood- 
vessels and  the  muscular  tissue.  In  extra  uterine 
fcetation  it  is  the  only  means  of  killing  the  foetus. 
In  hysteria,  hystero-epilepsy,  neuralgia  and  gastral- 
gia  one  must  see  its  effects  properly  applied,  in 
order  to  realize  what  it  can  do.  I  feel  sure  that  when 
electricity  becomes  better  understood,  spaying,now 
so  fashionable,  will  become  a  lost  art,  and  the 
death  rate  in  gynaecological  practice  will  become 
nil,  while  the  treatment  will  be  more  effective.  Even 
dyspepsia,  the  bane  of  medical  existence,  Apostoli 
believes  can  be  fought  and  triumphed  over  at  the 
point  of  the  electrodes  (on  the  pneumogastric 
nerves  in  the  neck,)  as  he  believes  that  the  disease 
depends  on  defective  innervation  of  the  digestive 
organs. 

Making  all  due  allowance  for  the  natural  enthu- 
siasm of  an  inventor,  I  think  that  we  will  all  be- 
fore long  admit  that  the  advantages  of  Apostoli's 
method  are  real,  and  that  the  method  itself  has 
come  to  stay. 

I  spent  several  hours  under  the   magic  eye   of 

Professor  Charcot ;  but  I  fear  my  letter  is  already 

too  long,  so  I  will  speak  of  him  in  my  next,  when  I 

also  intend  to  say  something  of  Berlin.     Till  then, 

I  remain,  your  truly, 

Lapthorn  Smith. 


JPm^'tedS  -af  Science. 

REST'  FOR  PAINFUL  EYES,  IS  THIS 
ADVICE  ALWAYS  GOOD? 

By  Julian  J.  Chisolm,  M.D., 
Prufessor  of  Eye  and   Ear  Diseases   in   tfie   University   of 
Maryland,  Surgeon  In  Charge  of  ttie  Presbyterian 
Eye  and  Ear  Cliarity  Hospital  of  Baltimore 
City,  etc.,  etc. 

When  the  eyes  tire  under  much  and  long 
continued  use,  relief  naturally  comes  with  rest, 
and  we  voluntarily  desist   from  work  so  that  the 


176 


THE   CANADA   MEDICAL  RECORD. 


eyes  may  regain  their  normal  condition  of  comfort : 
and  this  they  readily  do.  This  eye-weariness, 
which  comes  on  simultaneously  with  a  tired  feel- 
ing in  the  whole  body,  is  not  a  painful  condition. 
That  it  is  a  general  discomfort  which  rest  relieves 
is  familiar  to  us  all  as  individuals,  and  hence  we 
are  ever  ready  to  acquiesce  in  the  proposal  to  rest 
our  painful  eyes,  when  such  advice  comes  from 
the  physician  to  whom  we  have  appealed  for  treat- 
ment.    But  is  this  advice  always  good  ? 

To  answer  correctly  this  very  important  ques- 
tion, eye  troubles  must  be  classified  into  two  great 
dinsions : 

1.  We  have  diseased  states  of  the  eyes,  in- 
flammatory in  their  nature,  accompanied  by 
pain  with  other  evidences  of  congestion,  and  often 
associated  with  blurred  vision. 

2.  This  great  division  comprises  faults  in  eye 
construction,  defects  in  the  focusing  power,  errors 
in  refraction,  unaccompanied  by  visible  conges- 
tions, except  on  abusive  use  of  the  organ. 

In  one  or  the  other  of  these  two  great  classes 
most  eye  troubles  can  be  placed. 

When  we  see  an  eye  that  is  red,  watering,  pain- 
ful, and  in  many  instances  accompanied  with 
blurred  vision,  whether  this  trouble  be  in  one  or 
in  both  eyes,  we  naturally  and  properly  advise 
rest  from  eye  work,  while  the  inflammatory  symp- 
toms are  being  relieved  by  judicious  medication.  AVe 
even  shut  out  the  normal  retinal  stimulus,  liirht, 
by  smoked  glasses  or  darkened  rooms,  and  there- 
by add  to  the  comfort  of  the  patient. 

All  eyes,  painful  under  use,  are  not  necessarily 
inflamed  ones.  On  the  contrary,  a  very  large 
number  of  the  most  annoying  eye  troubles  are  not 
dependent  upon  diseased  conditions.  The  dis- 
comfort induced  by  the  use  of  such  eyes  is  occa- 
sioned by  faults  in  the  focusing  power,  necessitat- 
ing over-use  of  the  eye  muscles,  and  subsequent 
pain  in  the  ev'es  and  head.  Any  disturbance  of  the 
S3-stem,  which  causes  temporarily  general  mus- 
cular debility,  will  diminish  the  force  of  the  eye 
muscles,  and  increase  the  tendency  to  head  and 
eye  pains.  As  these  eye  faults  are  most  frequent- 
ly congenital,  starting  with  our  very  being,  they 
often  begin  to  show  their  injurious  effects  when 
young,  growing,  and  not  necessarily  over-strong 
eyes,  are  taxed  in  the  acquisition  of  knowledge, 
and  when  the  adWce  to  rest  these  painful  eyes  for 
months  at  a  time  is  a  serious  interference  with 
school  life  and  with  education.  In  this  classifica- 
tion is  brought  a  very  large  number  of  young  per- 
sons, whose  eyes  are  badly  shaped,  and  hence 
pain  in  them  on  use. 

A  weU  shaped  eye  should  be  nearly  a  sphere. 
In  such  a  round  eye  the  inner  or  retinal  coat  will 
receive  the  focused  image,  sharply  defined,  of 
distant  objects,  without  aid  from  muscles  of  ac- 
commodation. These  important  muscles,  within 
such  an  eye-ball,  are  called  into  use  when  the  eye 
is  viewing  near  objects.  Writing,  reading  and  sew- 
ing, are  properly  called  eye  work,  because  they 
require  the  need  of  the  accommodating  eye  mus- 


cles. Ail  other  uses  to  which  the  eyes  are  put, 
except  the  viewing  of  near  objects,  means  rest. 
This,  of  course,  is  not  rest  from  retinal  work, 
which  is  going  on  actively  as  long  as  our  eyes  are 
opened  ;  for,  as  a  rule,  the  retina  does  not  seem 
to  tire.  It  means  rest  front  intraocular  muscular 
work.  Such  a  round  eye  is  called  emmetropic, 
and  is  the  type  of  a  good  one.  This  is  the  kind 
of  eye  that  nature  should  always  supply  to  the 
human  race. 

Unfortunately,  from  this  standard  deviations, 
detrimental  to  the  comfortable  use  of  the  organs, 
are  found  in  numbers.  Many  children  are  born 
with  eyes  flattened  from  before  backwards,  so  that 
the  retina  is  brought  too  near  the  lens,  and  there- 
fore in  front  of  its  normal  focus  plane.  This  flat 
eye  is  called  over-sighted  or  hyperopic.  Such  a 
flat  eye,  when  at  rest,  does  not  see  even  a  distant 
object  sharply.  It  needs  muscular  work  for  all 
purposes,  to  enable  it  to  focus  light  from  far,  as  well 
as  from  near,  objects.  Such  an  eye  is  never  at 
rest  during  waking  hours.  As  nature  abhors  a 
vacuum,  so  badly  shaped  eyes  may  be  said  to  abhor 
badly  defined  pictures  on  the  retina.  An  effort  is 
made  involuntarily  by  the  flat  eye  to  sharpen  out- 
lines and  perfect  the  focus.  This  is  always  a  mus- 
cular effort.  When  required  for  distant  vision,  as 
is  always  the  case  with  flat  eyes,  some  of  the  mus- 
cular force  of  the  eye  is  used  up,  leaving  less  for 
the  accommodating  power  in  viewing  small  near 
objects.  If  the  eye  be  very  flat,  and  the  demand 
upon  the  muscular  apparatus  necessarily  very  great 
for  even  distant  objects,  then  the  moderate  use  of 
the  eyes  for  reading  soon  exhausts  the  rema'jiing 
muscular  power.  After  reading  for  a  short  time, 
the  natural  relaxation  of  the  over-worked  and 
tired  muscles  changes  the  focus  of  the  lens,  blurs 
the  image  upon  the  retina,  and  causes  the  letters 
of  a  page  to  run  together.  A  little  rest  enables 
the  muscles  to  resume  work,  and  the  printed  page 
to  be  again  clearly  seen,  but  a  very  few  more  min- 
utes' use  of  the  tired  muscles  again  blurs  the  page. 
If  the  effort  to  read  be  persisted  in,  pain  in  the 
eyes  and  in  the  head  ensues.  If  the  muscular 
force  be  weakened  by  any  acute  disease,  then  the 
eyes  give  out  the  sooner.  We  experience  this  in 
children  after  measles,  diphtheria,  etc.  Children 
who  could  study  with  comfort  before  the  attack, 
find  themselves  unable  to  read  for  any  length  of 
time  afterwards.  Often  months  are  required 
before  the  eye  muscles  again  become  strong. 

An  eye  may  be  so  ver)-  short  in  its  antero-poste- 
rior  diameter  that  all  the  intraocular  muscular 
power  is  required  for  viewing  distant  objects,  leav- 
ing none  for  near  work.  Children  with  such 
badly  shaped  eyes  cannot  study,  because  from 
deficiency  in  the  focusing  power  of  the  crystalline 
lens  they  cannot  distinguish  the  shape  of  the  small 
letters.  The  nervous  apparatus  of  such  an  eye  is 
good.  The  retina  and  optic  nerve  are  perfect,  but 
the  picture  thrown  upon  this  retinal  screen  is 
blurred,  solely  for  want  of  accurate  focusing  power. 
Add  to  the  lens  power,  and  perfect  vision  for  small 


THE   CANADA    MEDICAL   RECOKD. 


177 


olijccls  is  cit  oiucdljtained.  The  ;icci<IuiiUil  use  of 
tlifir  j^Mand-niotlier's  glasses  to  ;ii(l  the  crystalline 
lens  tu  focus  a  sharply  defined  image  is  a  marvel- 
lous revelation  to  such  an  eye,  and  shows  just 
what  it  refjuires  to  make  it  a  strong,  useful  organ, 
viz.,  a  ])air  of  projierly  adjusted  magnifying  si>ecta- 
cles.  ^Vith  such  scientific  aid  the  child  is  in  con- 
dition to  undertake  hard  study,  and  seeing  clearly 
becomes  easy.  Because  over-exertion  of  the  eye- 
muscles  is  no  longer  required,  when  the  child 
wears  properly  selected  glasses,  no  more  pain 
in  eyes  and  head  is  experienced  during  study 
hours. 

Although  rest  from  near  work  will  always  bring 
about  relief  from  the  pain  consequent  to  over 
muscular  exertion,  the  advice  so  often  given  to 
parents  by  the  family  jjhysician,  to  take  hyjjeropic 
children  from  school,  and  let  them  rest  their  eyes 
from  study,  for  months  at  a  time,  is  bad,  because 
it  is  founded  on  ignorance  of  die  cause  producing 
the  trouble.  At  the  end  of  six  or  twelve  months, 
the  eye  is  just  as  niis-sha])ed  as  it  was  before  the 
rest  was  taken,  and  application  for  near  work  will 
surely  bring  the  former  painful  discomfort.  This 
is  a  matter  of  every  day  observation.  Adjust 
proper  glas.ses,  correct  the  error  of  refraction,  give 
the  eye  muscles  less  work  to  do  by  allowing  the 
eye  to  do  its  work  with  spectacles  on,  and  conse- 
quently without  effort,  is  surely  the  rational  course 
to  be  pursued.  With  the  aid  of  magnifying  glasses 
for  all  uses  a  flat  eye  will  need  no  rest.  To  rest 
such  eyes  with  the  expectation  that  they  will  j 
become  strong  is  delusive,  and  is,  therefore,  bad 
advice. 

Again,  an  eye  may  be  mis-shaped  from  the  round 
standard  by  being  longer  than  it  ought  to  be.  An 
eye  long  in  its  antero-posterior  diameter  is  more 
oval  than  round,  and  is  called  near-sighted,  or 
myopic,  because  it  only  sees  near  objects  clearly. 
The  retina  is  so  far  from  the  lens  in  long  eyes  that 
a  focus  of  light  from  distant  objects  is  made  before 
the  retinal  screen  is  reached.  ^Vhen  the  picture  is 
finally  thrown  upon  the  nerve  layer,  it  is  ill  defined 
and  consequently  blurred.  Distant  objects  for 
such  eyes  are  always  befogged,  unless  the  strength 
of  the  crystalline  lens  is  weakened,  and  its  focus 
lengthened  by  the  use  of  concave  or  near-sighted 
glasses.  As  flat  eyes  were  always  congenital,  so 
long  eyes  may  be  found  at  birth.  As  a  rule,  how- 
ever, eyes  acquire  this  condition,  and  become 
mis-shaped  by  too  much  study  in  early  school  life. 
When  an  eye,  previously  good  for  seeing  distant 
objects,  changes  shape  and  becomes  nearsighted, 
the  change  indicates  a  yielding  of  the  sclerotic  or 
outer  tough  coat,  which  is  the  sustaining  wall  of 
the  eye-ball.  This  is  a  weakening  and  diseased 
condition  of  the  organ,  which  will  eventually  be  a 
serious  injury  if  it  becomes  excessive. 

When  progressive  near-sightedness  is  found  in 
school  children,  in  order  to  check  the  rapid 
deterioration  in  this  very  valuable  organ,  rest  from 
eye-work  becomes  a  very  important  factor  in  the 
treatment.     When  the  eye-ball    is  elongated,  the 


cornca  retaining  its  regular  outlines,  concave 
spherical  glasses  correct  the  defect  in  the  focusing 
power  of  the  lens  and  make  vision  better  ;  but  this 
aid  for  distant  vision  does  not  make  such  young 
and  still  growing  eyes  strong  or  capable  of  standing 
abusive  work. 

There  is  still  a  very  important  class  of  mis-sha- 
ped eyes,  also  starling  usually  with  the  beginning  of 
life.  It  is  to  call  attention  to  the  headaches  and  eye 
pains  caused  by  many  such  eyes  that  this  paper  is 
written.  In  this  large  class  of  painful  eyes  the  cause 
of  trouble  lies  in  irregularities  of  curvature  of  the 
surface  of  the  cornea.  The  curvatures  of  the 
various  meridians  differ,  as  if  the  eye-ball  had  been 
flattened  from  its  sides.  In  such  eyes  the  mis-sha- 
ped cornea  may  be  represented  by  the  crystal  of  a 
watch,  which  has  lost  its  true  spherical  form, 
from  irregular  pressure  upon  its  edges  when  the 
substance  of  the  glass  was  still  soft.  The  curva- 
tures of  the  short  diameter,  corresponding  to  the 
direction  of  pressure,  must  be  greater  than  those  of 
the  longer  ones,  and  this  must  necessarily  vary  the 
focus  of  light  passing  through  these  different  con- 
vex surfaces.  In  some  meridians  light  may  pass 
through  and  focus  correctly  upon  the  retina ;  in 
other  directions  the  focus  of  transmitted  light  will 
be  made  too  rapidly  or  too  tardily,  in  either  case 
blurring  the  retinal  image,  and  causing  defective 
vision.  Whether  the  cornea  border  be  compressed 
vertically,  horizontally,  or  obliquely  it  so  changes 
the  surfaces  of  the  cornea  for  that  direction,  that 
however  perfectly  the  other  surfaces  of  the  cornea 
may  focus,  the  faulty  curvature  acts  as  if  it  were 
a  distinct  lens  of  different  focal  power,  and  it  will 
cast  shadows  over  the  sharply  defined  picture 
made  by  the  correct  portions  of  the  cornea.  This 
error  of  refraction  is  called  astigmatism,  and  may 
be  found  in  long,  short,  or  round  eyes  ;  hence  we 
find  simple  or  mixed,  hyperopic  or  myopic  astig- 
matism. Such  irregular  corneas  are  frequently 
met  with. 

In  all  such  eyes  an  effort  is  made  automatically 
to  correct  this  fault  by  changing  the  shape  of  the 
crystalline  lens  to  correspond  with  the  irregnlarities 
in  the  cornea.  Fortunately  the  lens  in  young  ]ier- 
sons  in  so  soft  and  jelly-like,  that  very  little  action 
on  the  part  of  the  eye  muscles  corrects  the  faulty 
lines  of  refraction,  and  a  perfect  focus  is  secured. 
For  a  time  this  succeeds  well,  and  comfortable, 
clear  vision  is  enjoyed,  provided  the  application 
of  the  eyes  for  near  work  is  not  too  long  conlinned. 
But  unfortunately  the  lens  is  hardening  steadily 
with  advancing  age,  and  the  muscular  effort  has 
to  be  continually  increased  till  it  becomes  irksome 
and  finally  painful.  The  discomfort  produced 
does  not  restrict  itself  to  the  eyes  alone,  but  diffuses 
itself  over  the  brow,  forehead,  and  temples,  caus- 
ing headache  more  or  less  persistent.  In  some 
cases  the  pain  invades  the  whole  head,  back  of 
neck,  and  even  spine.  Those  headaches  can 
always  be  brought  on  by  eye-use.  To  some  very 
sensitive  astigmatic  patients  eye-use  refers  to  their 
whole    waking   life.     They  arise  in    the  morning 


178 


THE   CANADA   MEDICAL   RECORD. 


with  comfortable  heads,  but  before  they  are  dressed 
the  headache  has  been  started  by  the  necessary 
toilet  preparations,  and  it  increases  in  severity 
with  the  advancing  day.  Siuirise  and  all-day 
headaches  they  are,  with  some  of  these  very  sus- 
ceptible persons,  whose  eyes  see  differently  for 
the  different  curvatures  of  their  cornese. 

Every  object  in  nature  will  radiate  light  from 
every  exposed  surface,  and  the  eye  catches  some 
of  these  rays.  Where  the  cornea  is  regularly 
carved  light  from  any  and  all  directions  is  accur- 
ately focused  on  the  retina,  and  while  we  see  every- 
thing perfectly,  we  are  not  aware  that  we  have  eyes, 
so  painlessly  do  they  function.  To  the  abnormally 
sensitive  astigmatic  eye,  this  varied  direction  of 
light  beams  transmitted  through,  and  irregularly 
refracted  by  the  varied  curvatures  of  the  cornea, 
necessitates  nearly  a  choreic  action  of  the  ciliary 
muscles.  From  this  perpetual  changing  of  focus, 
now  for  one  part  of  the  cornea  and  then  for  another, 
fatigue  of  the  muscles  and  pain  in  the  eyes  must 
soon  be  induced,  even  to  the  extent  of  making 
simlight  annoying. 

This  irregular  shape  of  the  cornea  can  be  de- 
tected if  the  eye  views  a  drawing  similar  to  a  clock 
dial,  traversed  by  groups  of  black  radiating  lines 
of  equal  size  and  distinctness.  By  a  well  formed 
eye  these  groups  of  lines  are  seen  with  equal  sharp- 
ness of  outline  and  of  the  same  degree  of  black- 
ness. By  an  astigmatic  eye  some  of  these  groups 
of  lines  are  brought  out  much  more  boldly  than 
others.  While  some  remain  black  others  of  these 
black  lines  may  appear  gray,  and  at  times  even 
red  or  blue  ;  and  instead  of  standing  out  boldly 
in  the  group  they  run  together  as  if  they  were  one 
solid  line.  The  faulty  lines  are  always  at  right 
angles  to  those  most  clearly  seen.  With  the  clock 
dial  card,  if  the  lines  running  from  12  to  6  o'clock 
are  brightest  those  from  3  to  9  o'clock  will  be 
most  blurred.  If  those  from  10  to  4  are  the  most 
clearly  defined,  the  blurred  lines  will  be  in  the 
direction  of  i  to  7  o'clock,  and  so  on  for  any  other 
series  of  lines.  If  a  cylinder  lens  be  selected, 
which  will  make  the  dull  lines  as  bright  as  the 
clear  ones,  this  peculiar  eye-glass,  when  carefully 
set  at  the  proper  angle,  will  equalize  vision,  and 
will  remove  the  discomfort  which  the  use  of  the 
eyes  had  formerly  produced. 

The  ordinary  spectacles,  worn  by  the  masses, 
are  called  spherical  lenses,  being  sections  of  a 
sphere  or  ball.  Such  are  the  glasses  worn  by 
near-sighted  and  by  old  persons.  The  peculiar 
glasses  which  correct  irregularities  of  corneal  re- 
fraction are  called  cylinder  lenses,  because  they 
represent  a  slice  of  glass  taken  from  the  length  of 
a  round  bar  or  cylinder.  Tlie  spherical  and 
cylinder  glasses  bear  the  same  relation  to  each 
other  as  would  an  open  umbrella  to  a  wagon  top. 
The  cylinder  lens  has,  as  it  were,  a  ridge  pole  over 
which  the  curvatures  of  the  lens  are  made,  while 
the  spherical  lens  curves  in  all  directions  from  a 
central  point.  In  the  use  of  cylinder  glasses  the 
ridge  pole  or  plane  surface   is  always  set  in  the 


direction  corresponding  to  the  clearest  lines  of 
the  clock  dial,  and  the  curved  surfaces  of  the  lens 
are  put  necessarily  in  the  direction  of  the  blurred 
or  discolored  lines  of  the  dial.  Such  cylinder 
glasses  alone  can  give  rest  to  the  weary  muscles 
in  astigmatic  eyes,  for  without  them  these  irregu- 
larly curved  eyes  can  not  secure  rest  except  during 
sleep. 

A  very  useful  law  can  be  laid  down  for  the 
guidance  of  pliysicians  in  the  treatment  of  their 
eye  complaining  patients, viz.,  that  headaches  which 
come  on  with  the  use  of  the  eyes,  and  which  dis- 
appear during  the  rest  which  a  night's  sleep  brings 
to  the  weary  eyes,  do  not  usually  depend  upon 
gastric,  hepatic,  cerebral,  or  uterine  troubles,  as  is 
so  commonly  believed. 

When  school  girls  from  12  to  18  years  of  age- 
complain  of  eyes  and  head  aching,  after  hours  of 
close  application,  and  are  not  annoyed  in  this  way 
during  vacations  or  times  of  eye  rest,  inquiry  is 
yet  made  by  the  family  physician  concerning  the 
menstrual  functions.  Any  tardiness  in  the  appear- 
ance of  this  discharge,  or  any  deviation  in  its 
amount  of  frequency  from  what  the  physician  has 
established  in  his  own  mind  as  the  normal,  is 
deemed  too  often  a  sufficient  and  satisfactory  ex- 
planation for  all  the  head  and  eye  discomforts- 
According  to  their  theory  when  the  monthly  dis- 
charge becomes  regular,  the  head  and  eye  troubles 
will  disappear;  but  permanent  relief  does  not  come 
as  was  exjiected.  When  young  men  complain  of 
these  identical  symptoms  of  eye  pains  and  head- 
ache after  hours  of  study,  I  sometimes  wonder  why, 
from  professional  habit,  their  menstrual  functions 
should  not  be  also  inquired  about,  for  the  same 
explanation  might  as  truthfully  be  accepted  for 
them. 

In  this  connection  I  will  also  say  that  these  eye- 
headaches,  disappearing  after  sleep,  have  their 
origin  neither  in  malaria  nor  in  a  bilious  derange- 
ment, notwithstanding  the  fact  that  these  terms 
are  used  every  day  in  connection  with  them  by 
patients  and  physicians.  Neither  quinine,  calomel, 
morphine  nor  pessaries  will  prevent  this  kind  of 
eye  headache,  although  building  up  the  system  in 
feeble  persons  will  help  the  eye  muscles  and  relieve 
them.  The  careful  adjustment  of  proper  glasses, 
by  correcting  the  painful  muscular  effort,  alone 
will  cure  them.  Rest  is  a  very  frequent  prescrip- 
tion with  physicians  for  siich  painful  eyes.  It 
will  quiet  tem]wrarily  the  pain,  but  what  perman- 
ent good  can  it  possibly  secure?  When  upon  the 
use  of  the  eyes  the  head  aches,  and  when  painless 
heads  are  made  painful  by  reading,  with  very  few 
exceptions,  it  is  the  abnormal  curvature  of  the 
cornea  which  causes  the  eye  and  head  jiains.  How 
can  rest  bring  about  a  correction  in  these  faulty 
curvatures?  Might  as  well  expect  rest  from  walk- 
ing to  make  a  shortened  leg  grow  to  the  length  of 
the  other,  as  to  expect  a  shorter  curve  in  one 
direction  of  the  cornea  to  grow  out  in  the  dimen- 
sions of  the  other  longer  meridians  by  resting  the 
eyes  from  reading  or  sewing.     Wc  can  readily  see 


TIIK  CANADA   MEDICAL   RECORD. 


179 


the  absurdity  in  the  leg  suggestion,  and  yet  many 
physicians  do  not  see  tliat  tlic  expectations  from 
the  eye  rest  is  eeinally  prciioslcrous. 

How  ninny  thousands  in  tliis  country  to-day 
are  inipaticnily  and  uselessly  resting  eyes  that 
])ain  when  jiut  to  near  work,  when  a  jiair  of  pro- 
l)erly  adjusted  spectacles  will  correct  the  evil  ? 

Nearly  every  day  I  restore  some  restless  ])atient 
to  his  work,  wlio  had  sought  in  vain  relief  from  eye 
pains  in  rest ;  or  I  assist  some  ambitious  jicrson, 
who  having  accpiired  an  enviai)le  start  in  life,  feels 
that  his  painful  eyes  have  become  barriers  to 
further  study  and  prospective  promotion.  Daily 
by  the  use  of  properly  selected  glasses  I  cure  head- 
aches of  years'  duration,  and  which  have  resisted 
every  species  of  medication.  In  so  doing  I  have 
often  been  able  to  satisfy  anxious  patients  that 
their  brains,  stomachs,  livers,  kidneys,  or  uteri 
have  been  accused  wrongfully  of  producing  the 
headaches,  and  that  these  have  ever  been  inno- 
cent and  healthy  organs.  The  following  remarks 
1  have  frequently  heard  from  patients  to  whom  I 
had  recently  jjrescribed  astigmatic  glasses.  "  For 
one  week,  ever  since  I  put  on  the  spectacles,  I 
have  been  free  from  headache,  and  it  is  a  freedom 
that  I  have  not  had  before  for  years. 

Although  most  a  stigmatic  eyes  cause  headache 
and  eye  pains,  if  the  eyes  are  much  used  in  fine 
work,  especially  by  artificial  light,  1  find  cases  of 
faulty  refraction  from  astigmatism  in  which  head- 
ache is  not  and  has  never  been  an  annoying  symp- 
tom. 

In  some  astigmatic  persons  a  strong  muscular 
development  enaljles  them  to  conceal  the  corneal 
irregularity.  Should  any  disturbance  of  the  sys- 
tem temporarily  weaken  this  muscular  power,  the 
eye  muscles,  along  with  the  other  muscles  of  the 
body,  are  weakened  and  unable  to  keep  up  their 
work,  then  are  pains  induced.  If  it  be  a  bilious 
or  gastric  disturbance,  its  temporary  influence  over 
the  muscles  is  mistaken  for  the  actual  cause  of 
the  headache,  when  it  is  only  the  indirect  cause, 
])ermitting  the  latent  trouble  to  become  manifest. 
If  the  astigmatism  did  not  exist  in  a  concealed 
form,  there  would  be  no  headache  on  use  of  the 
eyes  during  these  general  disturbances. 

Again  in  nervous  persons,  especially  in  fem.ales, 
I  have  found  great  suffering  about  the  head  and 
eyes,  clearly  traceable  to  a  small  degree  of  irregu- 
lar refraction,  and  promptly  corrected  by  the  con- 
stant use  of  carefully  adjusted  cylinder  lenses. 

The  report  of  a  case  with  which  I  will  close  this 
paper  is  one  of  unusual  severity  in  effects, 
although  a  high  degree  of  astigmatism  did  not 
exist.  Such  extreme  discomfort  as  this  lady  suf- 
fered is  fortunately  not  often  found.  The  case  is 
also  peculiar  from  the  length  of  time  that  she 
suffered  before  her  eyes  were  suspected  of  being 
the  source  of  the  trouble.  In  this  age  of  diffusion 
of  medical  knowledge,  by  means  of  many  medical 
journals,  physicians  are  on  the  alert  to  distinguish 
eye  headaches  from  the  headaches  caused  by 
other   organic   disturbances,    and    usually   at   an 


early  day  invoke  the  aid  of  the  specialist  in  eye 
diseases  to  remedy  the  evil.  In  her  own  case, 
several  years  elapsed  in  testing  ncwsjiaper  reme- 
dies for  headache,  having  lost  faith  in  physicians 
from  her  earlier  medical  experiences,  The  case, 
however,  will  illustrate  the  efficacy  of  i)roper 
glasses  in  relieving  even  years  of  suffering. 

Mrs.  F.,  aged  38,  the  mother  of  several  chil- 
dren, has  been  a  martyr  to  headaches  since  child- 
hood and  during  the  ]iast  13  years, since  her  married 
life,  has  been  often  nearly  cra/.y  from  them.  Any 
close  eye  work,  continued  for  even  a  short  time, 
would  send  her  to  bed  with  a  raging  headache. 
On  an  average,  she  has  spent  one  day  out  of 
every  week  in  a  dark  room,  and  that  has  been 
kept  up  for  months  at  a  time.  If  she  felt  bright 
and  applied  herself  to  complete  any  piece  of 
needle  work,  so  necessary  with  a  growing  family, 
she  never  failed  to  pay  the  jjenalty  in  severe  head 
and  eye  suffering.  When  she  came  first  to  my 
office,  she  frankly  told  me  that  she  had  come  be- 
cause she  had  been  advised,  not  that  she  expecte  1 
any  benefit,  for  she  had  no  faith  in  any  curative 
agent  whatever,  having  years  since  exhausted 
them  all  without  finding  any  relief.  She  gave  me 
this  very  clear  history  of  her  case.  ''  Dr.  A.  has 
always  been  my  family  physician,  and  in  him  I 
have  every  confidence.  Having  in  my  early  mar- 
ried life  exhausted  his  skill  in  vain  attempts  at  re- 
lieving me  of  my  suffering,  he  gave  up  treating  me 
for  these  headaches  many  years  ago.  Under  his 
advice  I  had  consulted  Prof.  B,  you  know  him  to 
be  one  of  our  leading  practitioners.  He  acknow- 
ledged that  I  had  a  good  family  doctor,  but 
thouu;ht  that  something  might  have  been  overlook- 
ed, and  that  he  hoped  to  find  me  a  remedy.  He 
varied  his  medicines,  as  one  after  another  failed  to 
procure  me  relief,  and  finally  he  advised  a  visit  to 
the  seashore.  I  spent  six  weeks  at  Caiie  May, 
and  while  there  rested  my  eyes  from  all  work, 
eschewing  both  reading  and  sewing.  I  returned 
home  with  body  invigorated  by  the  salt  baths,  and 
was  free  from  pain.  As  soon  as  I  commenced 
using  my  ejes  in  sewing,  all  the  old  distressing 
symjjtoms  returned.  My  family  physician  and 
friend,  seeing  me  in  some  of  these  terrible  attacks, 
advised  me  to  consult  another  physician,  Prof.  C, 
who  you  know  has  the  reputation  of  being  a  very 
skilful  physician.  He  had  me  under  his  profes- 
sional care  all  winter  and  spring.  Summer  found 
me  no  better.  Any  use  of  the  eyes  in  sewing  or 
reading  sent  me  to  bed  with  twenty-four  hours  of 
suffering  before  me.  He  finally  advised  a  course 
of  mineral  waters,  and  sent  me  to  the  White  Sul- 
phur Springs  of  Virginia.  There  I  spent  two 
months,  wh;ch  improved  me  much  in  health.  In 
the  fall  I  returned  to  Baltimore  looking  and  feeling 
well.  A  very  few  days  of  housekeeping  showed 
me  that  the  long  rest  at  the  springs  and  the 
drinking  of  sulphur  waters  had  brought  me  to  no 
permanent  good.  My  head  at  times  ached  as 
badly  as  ever. 

"  I  now  despaired  of  ever  getting  relief,  because 


180 


fME   CANADA   MEi3lCAL   RECoW). 


I  had  sought  the  best  medical  advice  at  my  com- 
mand, and  nil  to  no  purpose.  Some  of  my  friends, 
in  their  anxiety  to  see  me  cured  of  the  daily  suffer- 
ing, advised  me  to  try  homeopathy.  I  accepted 
the  suggestion  and  sent  for  Dr.  D.  He  examined 
carefully  into  my  case,  and  said  that  he  could  cure 
me.  With  these  assurances  from  the  new  physi- 
cian, my  feeling  barometer  at  once  went  up  and 
my  future  prosjjects  brightened.  1  entered  active- 
ly into  the  course  of  medication  mapped  out  by 
him.  I  took  his  mixtures  hour  by  hour,  for  days 
and  weeks,  my  faith  growing  unfortunately  less 
and  less  with  the  monotony  of  the  dosing.  P'inally 
as  my  headaches  were  not  mitigated  even  by  the 
long  continued  treatment,  I  gave  up  all  hope,  and 
dismissed  the  homeopathic  physician. 

"I  felt  that  my  case  was  now  beyond  medical 
cure,  and  I  became  despondent  and  rash.  In  my 
anxiety  to  secure  relief  I  have  tried  anything  that 
anyone  would  suggest.  I  believe  that  during  the 
last  six  years  I  have  taken  every  quack  remedy 
warranted  to  cure  headaches  that  I  could  hear  of, 
as  published  in  the  newspapers,  and  my  many 
friends  have  kept  me  well  supplied  with  this  kind 
of  information.      Recently  I  have  heard  how  Miss 

E has  been  cured  of  constant  headaches  by 

wearing  eye  glasses,  and  my  friends  have  suggest- 
ed that  I  have  my  eye  examined.  On  the  princi- 
ple that  in  my  desire  to  escape  this  bodily  tor- 
ment, I  have  been  willing  to  try  every  treatment 
that  has  been  brought  to  my  notice,  I  have  come 
to  have  you  examine  my  painful  eyes,  but  I  must 
tell  you  candidly  that  I  expect  no  benefit,  and 
have  given  up  all  hope  of  obtaining  relief" 

Upon  examination  I  found  that  she  could  read 
the  finest  print,  but  only  for  a  few  lines.  Her 
distant  vision  was  also  acute.  Fixing  the  eyes 
upon  the  clock  dial  trial  card  for  a  short  time 
caused  pain  in  the  head  and  eyes,  and  also  induced 
a  feeling  of  nausea.  I  found  that  she  could  clear- 
ly see  the  vertical  lines  of  the  test  card,  but  only 
dimly  those  which  were  horizontally  placed.  I 
selected  from  the  trial  case  a  magnifying  lens 
which  would  make  these  blurred  lines  perfectly 
clear,  for  each  eye,  and  finding  the  corresponding 
cylinders  adjusted  them  at  the  proper  angle  in  a 
trial  frame.  These  I  ]ilaced  before  her  eyes.  To 
her  surprise  not  only  did  all  the  lines  come  out 
with  equal  boldness  of  color  and  of  definition,  but 
she  found  lierself  able  to  stare  at  them  without 
inconvenience.  After  she  had  worn  the  glasses 
for  some  minutes,  feeling  great  comfort  from  them, 
I  removed  the  frames,  when  immediately  the  nausea 
previously  experienced  came  on.  The  restoration 
of  the  glasses  brought  back  strength  of  vision  and 
comfort.  I  prescribed  for  her  the  proper  cylinder 
lenses  set  at  an  angle  of  180  ^  ,  in  spectacle  frames 
to  be  constantly  worn.  So  anxious  was  she  to 
test  these  spectacles  that  on  her  way  home  from 
my  office  she  called  at  the  optician's,  and  remained 
in  the  store  while  the  glasses  were  being  fitted  to 
the  frames  which  she  had  selected.  When  they 
were  ready,  she  put  them  on  at  once,  and  sallied 


forth.  Before  getting  home  she  found  herself 
walking  with  a  degree  of  comfort  which  she  had 
not  known  for  months. 

The  rapid  im]irovement  commenced  from  that 
hour.  Her  headache  disappeared  within  three 
weeks,  by  the  rest  which  her  eyes  enjoyed  frojn 
the  constant  wearing  of  th6  spectacles.  Now  she 
makes  lier  eyes  do  just  what  she  pleases.  Her 
constant  headaches  are  bygones,  and  are  only 
remembered  from  the  years  of  torture  through 
which  she  had  passed.  Her  face  had  be- 
come bright  and  free  from  care,  as  her 
head  is  free  from  pains.  Her  relief  by  such 
apparently  simple  means,  and  without  medicines. 
is  called  a  miracle  by  herself  and  a  marvel  to  her 
friends.  No  amount  of  rest  without  these  cylinder 
glasses  could  have  effected  this  cure  from  suffering. 
It  had  been  thoroughly  tested,  and  had  been  found 
as  useless  as  the  many  prescriptions  with  which 
during  many  years  her  body  had  been  drugged. 
Cylinder  glasses  alone  could  and  they  have  cured 
her. 


NEURASTHENIA.* 


BY   A.    B.   ARNOLD,   M.D. 


Piofcssor  of  Clinical  Merlicine  and  Diseases  of  the  Nei'vous 
System,  in  the  College  of  Physicians  and 
.Surgeons  of  Baltimore,  etc. 

The  term  "  neurasthenia"  was  first  introduced  by 
the  late  Dr.  G.  Beard,  of  New  York,  to  denote  a 
peculiar  functional  disease  of  the  nervous  system. 
One  of  the  principal  reasons  he  assigns  for  the 
neglect  of  this  nervous  disorder  by  previous  ob- 
servers is  the  great  difficulty  of  analysis  and  classifi- 
cation of  its  symptoms.  Neurasthenia,  he  main- 
tains, is  exceedingly  common  in  the  United  States, 
owing  to  the  widespread  influences  that  favor  its 
development.  Perhaps  the  frequency  of  its  occur- 
rence in  this  country  is  only  apparent,  for,  as  he 
remarks,  Americans  seek  medical  aid  for  the 
relief  of  ailments  which,  as  a  general  rule,  cause 
less  anxiety  to  European  people.  Dr.  Beard's 
first  publications  on  this  subject  encountered 
much  adverse  criticism  at  home.  Nervousness,  or 
rather  nervous  weakness,  it  was  said,  had  always 
been  recognized  as  a  morbid  condition,  giving  rise 
to  a  host  of  symptoms,  clinically  distinguished  by 
designations  in  accordance  with  their  supposed 
dependence  on  special  disturbing  causes.  Every 
one  is  familiar  with  the  phrases  such  as  cerebral 
ancemia,  spinal  irritation,  the  neuropathic  diathesis, 
irritable  weakness,  oxaluria,  etc.,  etc.  Bouchut's 
nervousisni  not  only  included  all  the  said  designa- 
tions, but  embraced  every  possible  functional 
disease  of  the  nervous  system.  The  Griffith 
brothers  had  before  him  indulged  in  analogous 
exaggeration  of  the  pathological  importance  of  the 


*  Read    before    the    Baltimore    Academy    of   Medicine, 
January  18,  1S87. 


TIIR   CANADA   MEDICAL  RECORD. 


LSI 


so-called  spinal  initalion.  Dr.  Beard  has  fallen  into 
a  similar  error  in  claiming  for  neurasthenia  .1  multi- 
plicity and  variety  of  symi)toins,  which  would 
haidiy  justify  the  attempt  to  set  up  any  other 
sjiccies  of  tiuuiioiial  iuT\'ons  disease.  Hut  tho 
meiit  can  iml  lir  iK  iiicd  lo  hun  that  he  opened  a 
ncnv  line  ot  in\esliyatioii  Icililc  of  |)ractical  lesults. 
I'Aery  liusy  |jiacliliiiner  will  admit  that  he  fre- 
iiucntjy  meets  with  obscure  and  anomalous  symp- 
toms, which  he  funis  dillicult  to  refer  to  any 
individual  disease  with  which  he  is  conversant.  If 
the  patient  he  a  female,  anil  the  morbid  phenomena 
point  to  disturbance  of  sensory  or  motor  fimctions, 
independent  of  any  tangible  alfeclion,  he  is  very 
likely  to  suspect  hysteria.  Supposing  the  patient 
is  of  the  male  se.x,  he  will  probably  be  tempted 
to  seek  for  the  cause  in  some  disorder  of  the  ner- 
vous system.  It  is  curious  to  notice  in  this  connec- 
tion the  colloquial  change  the  word  nervous  has 
undergone.  Originally  it  implied  a  vigorous 
ipiality,  and  we  still  speak  of  the  nervous  style  of 
a  writer.  We  now  signalize  a  ])erson  as  nervous 
when  he  is  easily  agitated  or  morbidly  imi)ressible. 
Experience  did  not  fail  to  teach  what  physiology 
leads  to  expect,  that  numerous  and  diversified  dis- 
orders of  the  nervous  system  are  traceable  to  the 
debilitation  influences  of  physical  over-exertion  and 
mental  strain.  The  word  nervousness  is  at  any- 
rate  an  unscientific  expression.  Dr.  Beard  deserves, 
therefore,  much  credi.  for  having  drawn  attention 
to  the  great  prevalence  of  nervous  exhaustion  and 
the  many  disguises  it  may  assume. 

Neurasthenia  belongs  to  a  group  of  neurotic 
diseases,  having  in  common  with  all  of  them 
transmissibility  and  a  tendency  to  appear  under 
different  forms,  not  only  in  different  individuals, 
but  in  the  members  of  the  same  family. 

A  recent  German  writer  *  indulges  in  some 
curious  speculation  concerning  the  important  role 
which  neurasthenia  has  played  in  shaping  the 
destinies  of  races  and  n:itions.  He  says,  ''  when 
historians  sjjeak  of  the  degeneracy  and  effeminency 
of  celebrated  people  of  the  past,  they  only  express 
in  other  terms  the  jihysical  and  mental  deterioration 
of  those  people.  That  the  nervous  system  received 
the  chief  brunt  of  the  injarions  influences  which 
brought  about  such  a  change,  may  be  inferred  from 
its  physiology.  Thus  the  decadence  of  the  Roman 
power  dated  from  the  introduction  of  luxurious 
habits  and  profligate  manners.  I'hese  causes 
undoubtedly  tend  to  undermine  the  vigor  of 
physical  and  mental  health.  Dr.  Beard  in  the  same 
strain  warns  his  countrymen  to  take  care  of  the 
nervou.)  system.  But  be  this  as  it  may,  when  we 
come  nearer  our  own  time,  we  see  many  influences 
at  work  bearing  heavily  on  the  integrity  of  the  ner- 
vous apparatus.  'I'here  is  the  mental  strain  which 
the  hot  race  for  wealth  and  distinction  imposes ; 
the  unremitting  toil  to  secure  a  competency  ;  the 
anxiety  and  worry  of  those  engaged  in  public  life  ; 
the  painful  efforts  to  keep  up  appearances  ;  the 


;);  Die  Neurastlieni.n,  by  Prof.  Rudolph  Arndt. 


vicissitudes  of  fortune  ;  the  heart-burnings,  the 
disa]i|  ointments,  and  the  numerous  penalties  we 
pay  for  our  high-pressure  civilization. 

If  neurasthenia,  as  Dr.  Beard  will  have  it,  has 
picked  out  our  country  for  its  special  visitations,  it 
can  only  be  that  the  etiological  factors  of  this 
malady  are  more  intensified  among  us  than  any- 
where else.  He  refers  to  Russia,  where  in  contrast 
with  the  United  States,  France,  England  and 
(Jermany  the  occurrence  of  neurasthenia  is  gen- 
erally believed  to  be  almost  unknown.  The 
Russian  novelist  Turgeyew  does  not  share  in  this 
opinion.  Many  of  his  life-piciures  of  the  different 
strata  of  Russian  society  give  evidences  of  physical 
deterioration  and  premature  mental  decay. 

As  neurasthenia  sometimes  rapidly  develops,  it 
must  be  assumed  that  such  an  occurrence  depends 
on  an  exciting  cause  that  suddenly  overwhelms 
the  nervous  system.  In  general,  however,  the 
disorder  comes  on  slowly,  and  is  probably  the 
final  result  of  a  combination  of  causes,  that  act  as  a 
drain  upon  the  nerve  force.  This  characterization 
of  the  pathology  of  neurasthenia  serves  to  explain 
the  absence  of  a  destructive  lesion,  the  multiplicity 
and  purely  subjective  nature  of  its  symptoms. 
Taking  for  granted  that  nervous  exhaustion  is  the 
essential  condition  underlying  the  clinical  manifes- 
tations of  neurasthenia,  it  must  necessarily  happen 
that  the  energy  of  all  the  bodily  functions  subject 
to  nervous  influence  will  be  lowered.  Such  a  state 
of  thg  general  system  labors  under  the  disadvantage 
of  losing  its  various  powers,  and  in  consequence 
that  morbid  excitability  becomes  established,  which 
goes  by  the  name  of  irritable  weakness. 

An  enfeebled,  nervous  apparatus  is  also  incapable 
of  offering  adequate  resistance  to  morbific  causes 
that  would  otherwise  exert  but  little  influence, 
hence,  the  numerous  ill-defined  ailments  of  which 
neurasthenic  patients  constantly  complain.  More- 
over, as  the  neurasthenic  diathesis  occurs  in  every 
conceivable  grade  of  intensity,  it  is  easy  to  under- 
stand why  many  of  its  symptoms  are  not  considered 
outside  the  limits  of  health.  Finally,  it  must  not 
be  forgotton,  that  the  insufficient  control  exercised 
by  the  higher  nerve  centres  leads  to  perversions 
and  aberrations  what  constitutethe  most  singular 
phenomena  of  neurasthenia. 

It  is  usual  to  make  the  division  of  cerebral  and 
spinal  neurasthenia.  As  observed  in  actual  prac- 
tice, the  symptoms  of  both  forms  of  the  disorder 
are  frecjuently  blended. 

Among  the  cerebral  symptoms  of  neurasthenia, 
none  is  more  conspicious  and  constant  than  head- 
ache. Many  instances  of  so-called  sick-headache 
are  of  a  neurasthenic  origin.  Of  greater  signifi- 
cance is  a  peculiar  distressing  sensation  of  the 
head,  which  patients  compare  to  the  feeling  ex- 
perienced when  some  heavy  body  is  pressed  on 
the  vertex.  A  young  artist  consulted  me  some 
time  ago  for  the  relief  of  just  such  a  symptom 
which  he  described  to  resemble  the  sensation  as 
if  h'n  head  were  held  in  a  vice.  He  had  aban- 
doned his  profession  on  account  of  this  complaint, 


182 


teE   CANADA   MEDICAL   RECORD. 


which  although  it  did  not  amount  to  actual  pain 
was  nevertheless  of  an  unbearable  nature.*  The 
scalp  in  neurasthenia  is  exceedingly  sensitive  to 
the  touch  so  that  the  use  of  the  comb  and  brush 
causes  pain.  Disorders  of  the  special  senses  are 
very  common,  consisting  of  flickering  before  the 
eyes,  muscK  volutantes,  asthenopia,  noises  in  the 
ears,  a  perverted  smell,  and  a  sour  pasty  t,iste  in 
the  mouth.  Sleep  is  nuich  disturbed  by  terrifying 
dreams.  Many  [lalients  declare  they  pass  vigilant 
nights  for  weeks. 

The  psychical  symptoms  of  neurasthenia  usual- 
ly partake  of  a  depressing  character.  .Sometimes 
they  amount  to  utter  despondency  or  melancholia. 
More  frequently  the  mental  irritability  shows  itself 
in  curt  answers,  in  exhibitions  of  a  morose  and 
peevish  temper,  and  not  seldom  in  a  disagreeable 
selfishness.  Probably  the  desire  of  subduing  or 
chasing  away  the  moods  and  vapors,  of  which  the 
patients  themselves  are  conscious,  is  one  of  the 
causes  that  frequently  leads  them  to  resort  to 
alcoholic  stimulants  and  narcotics.  When  such 
patients  fall  into  the  habit  of  reflecting  much  on 
their  unpleasant  feelings  they  are  sure  to  become 
confirmed  hypochondriacs. 

Morbid  fears  constitute  another  set  of  symptoms, 
which  occasionally  plague  the  neurasthenic.  Agro- 
phobia,  or  the  fear  of  open  places  is  most  frequent- 
ly observed;  claustrophobia  or  the  fear  of  narrow 
places ;  anthrophobia,  or  the  fear  of  meeting 
crowds  of  people  ;  mysojihobia,  or  the  fear  of  con- 
tamination, come  less  frequently  under  notice. 
A  variety  of  these  morbid  fears  I  have  observed  in 
one  of  my  patients,  which  I  have  not  yet  seen 
mentioned.  A  middle  aged  gentleman,  who  had 
been  unfortunate  in  stock  speculations,  and  had 
suffered  for  many  years  from  bleeding  piles,  kept 
himself  in  a  constant  state  of  misery  from  self 
reproach  because  he  blamed  the  death  of  one  of 
his  friends  to  catching  cold,  which  might  have 
been  prevented  if  he  had  not  kept  his  friend  stand- 
ing for  a  considerable  time  in  a  cold  draught  of 
air  during  an  interview.  When  my  neurasthenic 
patient  takes  a  walk,  he  constantly  looks  out  for 
some  substances  on  the  pavement  that  may  possi- 
bly cause  people  to  slip,  and  fall.  Should  he  find 
the  end  of  a  nail  sticking  out  in  the  buildings  he 
passes,  he  immediately  sets  about  to  knock  it  in. 
He  stops  to  adjust  a  loose  brick  in  the  sidewalk, 
and  he  has  been  known  to  give  notice  to  owners 
of  lumber  yards  to  remove  a  piece  of  timber  that 
happens  to  project  from  the  pile.  A  very  strange 
neurasthenic  symptom  among  patients  of  education 
and  culture  is  the  brooding  over  the  insolvable 
problems  of  the  universe,  or  some  puzzling  meta- 
physical question.  Such  unbidden  thoughts  in- 
cessantly harrass  them,  however  much  they  may 


^  Dr.  F.  Runge  published  in  the  Archiv.  fur  Psvchiairie, 
(vi  B.)  a  series  of  cases  under  the  caption  of  A^?/*/^/;;;!-^ 
(head  pressure)  which  presents  in  many  particulars  the 
clinical  features  of  neurasthenia.  In  nearly  half  of  the  cases 
the  etiology  embraced  conditions  and  circumstances  which 
are  known  to  induce  nervous  exhaustion. 


try  to  banish  them  from  their  minds.  But  the 
saddest  of  all  the  psychical  manifestations  of  the 
disorder  is  the  tendency  to  drift  into  some  debas- 
ing vice.  The  low  appetites  and  propensities 
appear  to  gain  the  mastery  over  the  diminislied 
resistence  of  the  moral  power. 

An  enormous  array  of.symptoms  is  attiibuted 
to  the  sjiinal  form  of  anaistiiesia.  This  is  due  to 
the  extent  and  variety  of  functional  disturbances 
resulting  from  an  unstable  and  irritable  condition 
of  the  spinal  nerve  centres.  'J'here  are  few  neu- 
rasthenic patients  who  do  not  sufier  from  excentric 
neuralgic  pains  and  muscular  weakness  of  the 
lower  extremities.  Real  ixiralysis  does  not  occur, 
but  there  is  a  constant  feeling  of  fatigue  and  a 
desire  for  rest.  Patients  feel  weary  and  exhausted 
after  ordinary  exertions.  Lumbar  or  sacral  pain 
seems  to  be  never  absent.  The  general  sensibility 
is  heightened.  Slight  pressure  of  superficial  nerves 
causes  tingling;  the  contact  of  gold  substances 
produces  pain.  There  is  a  sensation  of  burning 
in  the  palms  of  the  hands  and  soles  of  the  feet. 
Neurasthenic  females  complain  that  their  shoes 
press  too  tightly,  and  their  dresses  make  them 
feel  uncomfortable,  all  of  which  is  provoking  to 
trades-people,  who  despair  to  please  such  custom- 
ers. The  reflex  excitability  is  augmented.  Mic- 
turition and  defecation  may  in  consequence  be 
attended  with  much  discomfort.  Muscular  hyper- 
esthesia causes  twitching  of  muscles,  and  painful 
movement  of  the  joints.  Paraesthetic  symptoms 
are  felt  everywhere,  consisting  of  numbness  and 
the  sensations  of  pricking  and  formication.  Vaso- 
moter  disturbances  bring  on  fitful  flushings  of  the 
face  and  partial  sweatings.  I  remember  the  case 
of  a  young  shop-girl,  who  had  broken  down  in 
health,  and  became  the  victim  of  a  large  number 
of  neurasthenic  symptoms.  She  had  frequent 
attacks  of  palpitation  of  the  lieart,  and  constricting 
pain  about  the  chest.  These  attacks  were  ushered 
in  by  extreme  reddening  of  the  right  ear  and 
neighboring  part  of  the  cheek.  The  same  side  of 
the  face  broke  out  afterwards  in  a  profuse  perspira- 
tion. The  respiratory  symptoms  are  sometimes 
of  an  alarming  character,  consisting  of  embarrassed 
breathing  and  a  choking  sensation,  attended  by  a 
tumultuous  action  of  the  heart.  The  gastric  dis- 
turbance witnessed  in  neurasthenia  constitutes  the 
so-called  "  nervous  dyspepsia,''  which  is  common 
in  overworked  clerks  and  seamstresses,  and  no  less 
also  among  people  in  different  walks  of  life,  that 
impose  varied  hardships  and  the  deprivation  of 
the  required  rest  and  sleep.  Such  a  dyspepsia 
baffles  the  usual  remedies,  unless  a  change  of 
habits  and  pursuits  be  adopted. 

It  is  hardly  necessary  to  mention  that  the  diag- 
nosis of  neurasthenia  should  not  be  lightly  made. 
Chronic  and  progressive  diseases,  in  their  early 
stages,  often  give  no  other  intimation  of  their  exis- 
tence than  the  evidence  of  a  declining  state  of  the 
general  health.  The  nervous  depression,  which  is 
then  sure  to  ensue,  is  liable  to  lend  a  neurotic 
feature  to  the  ill-defined  symptoms,  depending  on 


TIIIC    CANADA    MEDICAL    KECORD. 


183 


the  undeveloped  disease,  and  the  more  so,  if  the 
[jatient  is  coiistilutionally  i)rcdis|)osed  to  nervous 
affcclions.  On  tiie  other  side  lliere  is  a  risk  to 
mistake  neurasthenic  symptoms  for  serious  organic 
irouliie.  'I'hc  experienced  jihysiciau  will  find  no 
great  difficulty  to  distinguish  neurasthenia  from 
alhed  nervous  disorders,  though  it  must  be  con- 
fessed that  tlie  pictures  ])reseiUed  by  this  ckiss  of 
makidies  are  so  frequently  confusing  by  their  vari- 
gated  coloring,  or  so  frequently  change  into  dis- 
solving views,  that  their  distinction  often  turns 
Ujion  the  choice  of  a  phrase. 

There  is  a  great  scope  for  the  display  of  tact 
and  judgment  in  the  treatment  of  neurasthenia. 
The  munber  and  complexity  of  its  symptoms, 
their  (luctuation  and  jironencss  to  relapses  after 
encouraging  improvements,  heavily  la.v  the  thera- 
peutical resources  of  the  attending  physician.  He 
would  do  well  to  lake  the  patient  into  his  confi- 
dence, should  there  exist  the  least  reason  to  be- 
lieve that  preventable  etiological  factors  are  at 
work,  which  on  being  abandoned  or  removed  will 
materially  assist  the  treatment.  The  patient  may 
either  require  absolute  rest  and  quiet,  or  to  be 
benefitted  by  exercise  that  does  not  fatigue.  The 
lecuperative  influence  of  mountain  air  or  a  visit 
to  the  sea  shore  may,  under  circumstances,  be  in- 
disjjensible.  Ur.  Beard  says  he  has  seldom  found 
general  auKmia  associated  with  neurasthenia.  My 
experience  induces  me  to  differ  from  him.  A 
judicious  cotirse  of  tonic  remedies  is  often  of  great 
value  in  long  standing  cases.  For  the  restoration 
of  the  muscular  vi^or,  as  Dr.  Beard  has  indicated 
nothing  can  surpass  the  refreshing  effects  of  general 
faradization.  After  a  number  of  trials  with  various 
remedies,  which  stand  in  repute  for  the  relief  of 
nervous  headache,  I  give  now  the  preference  in 
the  neurasthenic  variety  to  a  combination  of  ether 
and  the  tincture  of  cannabis  indica,  in  doses  of 
twenty  drops  of  the  former  and  ten  of  the  latter. 
Sometimes  these  remedies  act  better  after  a  good 
night's  rest  has  been  obtained  from  a  full  dose  of 
chloral  hydrate.  Great  caution  is  necessary  in 
the  administration  of  ojiium,  or  any  of  its  alkaloids, 
for  fear  of  inducing  a  disastrous  habit,  to  which 
neurasthenic  patients  are  particularly  inclined. 
The  practice  of  giving  now  large  and  repeated 
doses  of  the  bromides  is  open  to  much  less  objec- 
tion. In  regard  to  arsenic,  jihospliorus  and  the 
salts  of  copper  and  zinc,  which  are  emijirically 
ordered  in  neurotic  affections,  I  cannot  say  any- 
thing of  a  positive  character  concerning  their  em- 
jiloyment  in  the  treatment  of  neurasthenia. — 
Maryland  Medical  Journal. 


HOW    '^BRIGHT'S    DISEASE"    COMES 
ABOUT. 

By  J.   MiLNER  FOTHKRGILL,  M.  D.,  LOXDOX. 
riiysician  to  tlie  City  of  London  Ilospil.il  for  Diseases  of  the 
Chest  (Victoria  Park) ;  Hon.  M.D.,  Rush,  111.;  Foreign  As- 
sociate Fellow  of  the  College  of  Physicians  of  Philadelphia. 

When  the  late    Dr.  Richard   Bright,   F.   R.  S., 


stood  with  a  tablespoonful  of  urine  in  the  flame 
of  a  candle,  watching  the  albuminous  cloud  film- 
ing, he  little  surmised  what  a  new  ])athological 
(ontinent  was  thus  being  brought  to  our  know- 
ledge. He  observed  dropsy,  and  found  the  iirim; 
albuminous,  and  diagnosed  disease  of  the  kidneys. 
It  was  a  shrewd  inference. 

His  original  cases  are  of  high  interest,  and  his 
colored  plates  could  not  but  attract  attention. 
()n  studying  them,  they  give  one  the  impression 
that  the  ca.ses  were  instances  of  the  subjects  of 
chronic  Bright's  disease,  who  had  got  acute  renal 
trouble,  superimposed  upon  old  standing  mischief. 
In  such  cases  the  albuminuria  wauld  be  pronoun- 
ced. Further  researches  taught  Dr.  Bright  some- 
thing of  the  relations  of  the  kidney  trouble  to  the 
enlarged  heart  found  in  the  subjects  of  vaso-renal 
change. 

Since  then,  the  matter  has  jirogressed  in  two 
totally  opposite  directions.  It  has  undergone 
a  process  of  evolution  and  a  certain  involu- 
tion. The  facility  which  the  test-tube  offers 
for  testing  the  urine  has  been  a  temptation 
which  many  minds  have  been  unable  to 
resist.  'J'atight  at  the  hospital  to  watch  the 
reaction  of  the  urine  under  heat  and  nitric  acid 
(or  any  other  re-agent  the  teacher  chose  to  em- 
])loy)  in  cases  of  actual  renal  disease,  and  with 
the  importance  of  such  testing  thoroughly  drilled 
into  him,  in  order  to  make  a  good  appearance 
before  his  examiners,  many  a  student  has  entered 
practice  with  the  firm  conviction  that  albuminuria 
was  pathognomonic  of  renal  disease.  The  con- 
sequences were  that  many  a  person  was  made  unne- 
cessarily miserable,  including  medical  men  them- 
selves, when,  by  some  accident,  they  discovered 
albumen  in  their  urine.  Too  exclusive  reliance 
upon  one  phenomenon  in  complex  cases  is  apt 
every  now  and  again  to  be  an  ignus  fatiins. 

No  man  who  is  worthy  of  his  profession  would 
make  the  discovery  that  a  certain  patient's  urine 
contained  albumen,  without  at  once  giving  the 
case  his  best  consideration.  But  to  leap  at  one 
bound  to  the  conclusion  that  the  condition  was 
necessarily  due  to  disease  in  the  kidney,  is  a  feat 
in  saltation  of  a  rash  and  dangerous  character. 
Albeit  it  is  often  accom|ilished,  thoughtlessly, 
recklessly,  wantonly,  from  a  combination  of  haste 
and  ignorance  ;  and  possibly  at  times  from  a  con- 
stitutional timidity,  tending  only  to  see  the  dark 
side  of  everything. 

This  may  seem  putting  it  strongly.  But  is  it 
stronger  than  the  fiicts  warrant  ?  Richard  Bright 
observed  the  dropsy  first,  and  then  tested  the 
urine.  He  did  not  test  the  ui  ine,  and  then  forget 
the  dropsical  factor,  as  has  been  done  since  his 
day  over  and  over  again.  Such,  then,  is  tlie 
involution,  which  has  gone  on  in  the  matter  of  the 
diagnosis  of  Bright's  disease. 

On  the  other  hand,  great  progress  has  been  made 
by  an  innumerable  band  of  workers  in  the  new  land 
opened  up  to  us  by  Bright.  He  stood  on  the 
threshold,  and  from  thence  a  host  has  advanced. 


184 


THE   CANADA   MEDICAL    RECORD. 


which  has  ever  gathered  force.  Sir  Robert 
Christison,  M.  Solon,  Traiibe,  were  observers  who 
led  the  van.  The  associations  of  a  large  left 
ventricle  and  a  loud  aortic  second  sound  with 
chronic  kidney  disease,  were  generally  recognized. 
Then  came  a  notable  discussion  between  Prof. 
George  Johnson  on  the  one  part,  and  Sir  William 
(inll  and  Dr.  Gawen  Sutton  on  the  other  part ; 
and,  as  nothing  has  such  an  attraction  for  the 
Anglo-Saxon  mind  as  a  fight,  the  attention  of  the 
]jrofession  was  attracted  towards  the  condition  of, 
and  the  changes  in,  the  arterioles.  The  conse- 
quences of  this  again  led  to  the  utilization  of  the 
sphygmograph,  and  to  the  establishment  of  the 
fact  that  the  arterial  blood  pressure  is  raised  in  the 
condition  known  as  chronic  Bright's  disease. 
From  such  spliygmographic  evidence  the  late  Dr. 
Mahomed  proceeded  to  make  the  diagnosis  of  the 
chronic  vaso-renal  change  in  the  absence  of 
albuminuria.  He  considered  it  possible  to  estab- 
lish a  valid  diagnosis  in  cases  where  there  Was  no 
albumen  in  the  urine.  His  position  was  a  widely 
different  one  from  that  which  makes  albuminuria 
and  interstitial  nephritis  equivalent  and  convertible 
terms. 

We  now  possess  a  comparatively  wide  grasp  of 
the  widespread  change  in  heart,  artery,  and  kidney, 
which  so  commonly  ends  in  dropsy,  but  which  has  a 
large  variety  of  final  endings.  We  know  that  cases 
differ  widely.  In  one,  the  condition  of  the  kidneys 
may  be  the  most  jjrominent  matter  ;  while  in  others, 
the  kidneys  lie  latent,  and  the  interest  centres 
round  the  heart.  In  another  case,  articular  gout 
may  mask  all  else  to  the  superficial  observer. 
Yet  each  may  be  a  true  case  of  vaso-renal  change, 
presenting,  however,  different  aspects  of  that 
change. 

What  starts  the  widespread  change  which  is 
really  an  abbreviation  of  the  changes  which  occur 
as  advanced  life  passes  into  old  age  ?  It  was  due,  so 
Prof  Hayles  Walshe  declared  in  1849,  to  the  con- 
dition of  the  blood  circulating  through  the 
kidney.".  Prof  George  Johnson  held  :  "  Renal 
degeneration  is  a  consequenceof  the  long-continu- 
ed elimination  of  products  of  faulty  digestion 
through  the  kidneys  ;"  and  emphasized  the  view 
by  eniijloying  italics.  Then  Dr.  Garrod,  the 
authority  on  gont,  held  gout  to  be  due  to  "  a  loss 
ofjiowcr  (temporary  or  permanent)  in  the  uric 
acid  excreting  function  of  the  kidneys ;"  and 
"  that  gouty  inflammation  is  often  set  up  in  the 
interior  structure  of  the  kidney,  accompanied  with 
deposits,  not  merely  within  the  tubuli  uriniferi, 
but  in  the  fibrous  structure  itself " 

It  is  useless,  or  rather  needless,  to  make  further 
quotations  from  authorities.  The  view  now  held 
is  that  the  ]iresence  of  uric  acid  and  urates  in 
excess  in  the  blood  circulating  through  the  kidneys 
acts  as  an  irritant,  and  (faster  or  slower,  sooner  or 
later)  excites  in  them  a  growth  of  connective 
tissue,  which  destroys  the  other  and  higher  struct- 
ures, ultimately  crii)pling  the  organs  till  they 
become    inadequate    to   carry    on    their  function 


as  depurators  of  the  blood.  (Possibly  other  pro- 
ducts of  albumen  metamorphosis  may  play  a  part.) 
Kidneys  constructed  to  cast  out  a  fluid  urine 
cont.iining  the  highly  soluble  urea  are  irritated  and 
injured  by  the  outjiut  of  the  comparatively  insolu- 
ble uric  acid.  Interstitial  neijhiitis  is,  then,  one 
outcome  of  the  reversioiC  of  the  liver  to  the  early 
uric  acid  formation  of  the  bird  and  reptile.  We 
have  got  another  link  further  back  in  the  chain  i.f 
morbid  sequences. 

The  next  consideration  is,  what  causes  the  liver 
of  the  bimana  to  so  revert  to  the  earlier  formation  ? 

We  are  all  familiar  with  the  results  of  high 
living  in  the  production  of  gout.  We  all  know 
that  the  poison  of  gout  is  uric  acid.  The  rever- 
sion of  the  liver  to  the  uric  acid  formation  with 
the  morbid  outcomes  thereof  is  well  known  to  the 
most  of  us  as  "rich  man's  gout."  That  the 
cirrhotic  or  granular  or  gouty  kidney  is  common 
with  gout  is  evinced  by  the  term  "  gouty''  being 
applied  to  the  contracted  kidney. 

But  how  do  we  account  for  the  phenomenon 
known  as  "  poor  man's  gout,"  the  undoubted  gout 
connected  with  the  articulations,  which  is  found  in 
persons  of  spare  habit  and  most  moderate  gastron- 
omic performances,  especially  as  regards  animal 
food?  Up  to  recently  this  malady  has  been  a 
recognized  crux  ;  but  the  view  of  lithiasis  be-ng 
a  reversion  to  the  primitive  uric  acid  formation 
brought  "  poor  man's  gout"  into  the  daylight. 
Dr.  Budd  talked  of  an  "  insufticient"  liver  as 
regards  a  liver  cri|)pled  by  disease  in  it.  A 
view  indorsed  by  Dr.  Murchison,  the  well-known 
authority  on  the  liver,  who  goes  on  :  "  In  others 
the  liver  seems  only  just  capable  of  performing 
its  functions  under  the  most  favorable  conditions, 
and  it  at  once  breaks  down  under  adverse 
circumstances  of  diet,  habits,  or  climate.  This 
innate  weakness  of  the  liver  is  often  inherited." 
The  congenital  or  inherited  insufficient  liver 
reveals  its  "  innate  weakness"  upon  slight  provoca- 
tion. But  whether  it  is  a  primarily  competent 
liver  breaking  down  under  the  burden  imposed 
upon  it  by  the  palate,  or  the  congenitally  insuffi- 
cient liver,  which  is  unequal  to  its  functions,  the 
result  is  the  same,  viz.,  reversion  to  the  primitive 
uric  acid  formation.  Rich  man's  gout  and  poor 
man's  gout  alike,  then,  depend  upon  the  existence 
of  an  excess  of  uric  acid  in  the  blood,  no  matter 
how  brought  about.     It  is  there. 

The  reversion  of  the  liver  has  two  distinct  sets 
of  casual  relations.  The  first,  or  "  rich  man's 
gout,"  is  too  well  known  to  need  further  reference 
to  it. 

But  to  the  other,  the  reversion  of  the  liver  from 
injury  done  to  it,  or  "innate  weakness,"  is  a  mat- 
ter worthy  of  our  most  attentive  thought.  The 
influence  of  the  mind  upon  the  liver  was 
recognized  by  the  ancients  as  regards  jaundice, 
and  in  Germany,  at  the  present  day,  this  causal 
relation  of  jaundice  is  generally  recognized.  The 
effect  of  the  mind  upon  secreting  glands  is  seen  in 
tears ;  and  in  the  salivary  glands  by  the  Hindoo 


THK   CANADA    MKDldAL    RECORD. 


185 


lirac  ticc  of  detecting  a  thief  in  a  hotiscliold  by 
jjlacing  some  rice  in  the  niontli  of  all.  'I'iie  tliief's 
mmilh  alone  is  dry,  while  the  mouths  of  all  the 
rest  are  moist.  It  is  not  in  jaundice  merely  that 
mental  causes  of  hcijatic  disturbance  are  seen. 
I'lenly  of  )ieo|)le  know  that  mental  excitement  and 
still  more  jiertuibation  upset  their  livers.  'I'liey 
cannot  affoid  to  be  angry.  Worry  and  grief  pro- 
duce emaciation,  even  if  food  be  taken.  Irtcrus 
f.r  mota  uniiiil  is  readily  seen  from  the  altered  hue 
of  the  skin,  'i'he  other  hepatic  disturbances  are 
not  so  obvious  to  the  eye.  Still  the  wan,  worn, 
wasted  expression  of  those  who  have  undergone 
long  and  severe  mental  worry  or  distress  is  readily 
recognized  by  even  ordinary  observers.  The  late 
Dr.  VV.  H.  C'ar])enter  pointed  out  how  melancholy 
and  jealousy  had  a  malign  influence  upon  the  liver. 
Dr.  Clifford  Albut  has  told  of  ■'  the  mental  cau.ses  of 
ISright's  disease."  While  Dr.  Charles  Creighton, 
in  speaking  of  the  relation  of  the  mind  to  the 
glands,  says  :  "The  lachrymal  and  salivary  glands 
afford,  perhaps,  the  most  striking  examples.  But 
the  wave  of  emotional  disturbance  spreads  widely 
over  the  viscera,  and  certainly  does  not  exempt 
the  liver,  although  the  action  of  the  feelings  upon 
the  liver  is,  perhaps,  less  familiar  to  us  than  the 
reaction  of  the  liver  upon  the  feelings  and  temper.'' 
As  to  the  writer,  he  recently  contributed  a  series 
of  articles  to  "  health,"  entitled  "  Mind  and  I,iver," 
which  have  since  been  published  in  collected  form 
by  Lea  Brothers  of  Philadelphia.  And  the  same 
opinions  are  held  by  a  great  many  who  have  not, 
however,  published  them. 

'I'he  hard,  keen  brain-toiler  is  liable  to  derange 
his  viscera,  and  his  liver  reverts  to  the  uric  acid 
formation  as  years  roll  on.  Not  only  that,  but  he 
begets  children  with  congenitally  insufficient  livers, 
tlie  innite  vcaJcness  of  Munliison.  In  some  cases 
urates  are  seen  in  childhood,  and  vesical  calculus 
is  not  infrequent  in  babies.  More  commonly,  how- 
ever, it  begins  to  show  itself  after  |)uberty.  A 
lady  of  this  type  will  present  the  following  charac- 
teristics and  symptoms  :  She  is  a  bright,  sensitive, 
high-spirited  and  usually  high-sculed,  unselfish 
creature  ;  light  in  the  bone,  commonly  petite,  mus- 
cles not  large,  but  firm,  and  when  she  shakes  hands 
her  grip  is  that  of  decision,  as  are  the  tones  of  her 
voice ;  her  features  are  regular  and  mobile,  often 
small ;  her  susceptibilities  are  keen,  and  so  are  her 
special  senses.  She  is  capable  of  great  devotion, 
and  in  her  earnestness  is  usually  self-forgetful ;  she 
is  emotional,  but  not  demonstrative,  and  is  a  dis- 
tinct neurotic.  As  to  her  complaint,  she  has  indi- 
gestion accompanied  by  acidity  and  flatulence, 
often  alternating',  commonly  some  constipation; 
she  is  liable  to  attacks  of  hemicrania,  or  migraine, 
or  "face-ache,"  as  she  calls  it,  usually  unilateral 
and  on  the  right  side,  accompanied  by  sparks  or 
"dazzles,"  often  ending  in  vomiting ;  and  these 
migrainous  attacks  are  accompanied  by  great 
vesical  irritability,  and  constant  call  to  make  water  ; 
she  has  fits  of  palpitation,  and  at  other  times  failure 
of  the  heart's  action,  differing  from  syncope  in  that 


there  is  no  loss  of  consciousness,  and  she  feels 
unutterable  sensations,  of  which  the  cxi)ression  of 
the  eye  mutely  tells.  She  constantly  has  sedi- 
ments in  her  water,  though  a  small  eater,  and 
especially  avoiding  animal  food.  She  has  an 
insufficient  liver  which  Dame  Nature  protects  by 
a  small  fastidious  ajipetite,  and  a  dainty  palate, 
despite  which  it  reverts  to  the  uric  acid  formation. 
She  is  a  typical  instance  of  the  adage,  "The  sword 
will  wear  out  the  scabbard."  She  has  no  mercy 
upon  her  body,  and  her  complaint  is  that  it  is  very 
hard  that  she  cannot  do  as  others  do.  If  she  goes 
to  the  theatre  or  concert,  she  so  thoroughly  enjoys 
it  all  that  probably  she  is  in  bed  next  day  with 
migraine.  Her  old  nurse  speaks  of  her  as  "all 
up  and  down."  Either  volatile  and  gay,  or  irrita- 
ble and  depressed.  Somatically  these  neurotics 
of  the  Arab  type  are  the  grey-hounds  of  the 
human  race.  Light,  active,  and  nimble;  but 
pyschically  greatly  superior  to  these  canine  repre- 
sentatives. 

She  is  to  be  found  everywhere,  but  most  marked- 
ly in  towns.  She  is  a  charming  patient;  but  rare- 
ly yields  flattering  results  of  treatment.  She  is 
acute  and  capable  of  taking  care  of  any  one  but 
herself.  She  is  in  my  experience  commonly  an 
American  lady  ;  and  in  most  instances  tells  of  the 
energetic,  long-sustained,  and  usually  successful 
efforts  of  her  father.  "The  fathers  have  eaten 
sour  grapes,  and  the  children's  teeth  are  set  on 
edge."  Her  father  carried  on  severe  mental  toil 
at  the  expense  of  his  viscera  ;  his  daughter  comes 
into  the  world  framed  on  his  pattern.  In  both  we 
find  reversion  to  the  uric  acid  formation,  and,  of 
course,  with  that  the  whole  consequences  thereof. 

And  one  of  the  direct  outcomes  of  uric  acid  in 
excess  in  the  blood  is  interstitial  nephritis,  com- 
monly termed  "Chionic  Bright's  Disease." — Fkil. 
A/edical  Register. 


DIET  IN  THE  TREATMENT  OF  EPIL- 
EPSY. 
By  a.  E.  Bridges,  London,  B.  A.  and  B.  SC.  of  Pahs, 
M.  D.,  Edin. 

Epilepsy,  like  hydrophobia,  a  disorder  of  the 
nervous  system  without  pathognomonic  microsco- 
pic lesion,  has  for  many  years  possessed  a  fascina- 
tion for  the  scientific  pathologist,  who,  according 
to  his  individual  experience,  and  irrespective  of 
that  of  his  brethren,  has  sought  to  classify  the  dis- 
ease, bestowing  on  each  class  a  formidable  scien- 
tific name. 

Ignoring  such  classifications,  I  shall,  for  the  pur- 
poses of  chemical  observation,  and  more  especially 
for  that  of  treatment,  divide  epilepsy  into  the  fol- 
lowing four  great  classes  : 

I  St.  Simple  epilepsy— rare  in  women. 

2d.  Mixed  epilepsy  (hysteroepilepsy)— rare  in 
men. 

3d.  Epileptiform  seizures— result,  of  course  from 
brain  lesion,  injury  to  head,  tumor  of  cerebrum, 
etc. 


1S6 


The   CANADA  MEDICAL  RECORD. 


4th.  Reflex  epilepsy — common  in  children,  less 
frequent  in  women,  rare  in  men. 

My  observations,  as  regards  the  efTect  of  diet  in 
epilepsy,  will  refer  almost  exclusively  to  class  i, 
the  most  hopeless,  and,  therefore,  from  a  medical 
standpoint,  the  most  interesting  tbrm  of  the  disease. 
They  will,  however,  apply  in  a  sense,  restricted 
according  to  the  peculiarities  of  each  case,  to  the 
other  classes  which  I  have  enumerated. 

The  frei|u;nt  occurrence  of  the  convulsive 
seizures  which  occur  in  the  course  of  epilepsy  is 
due,  there  is  every  reason  to  suppose,  to  an  explo- 
sion of  what  we  are  compelled  to  call,  for  want  of 
a  better  term,  nerve  force. 

Now,  we  know  that  of  the  four  main  elements 
of  which  the  human  body  is  composed,  carbon, 
hydrogen,  oxygen  and  phosphorus,  nitrogen  is  the 
one  which  has  the  fewest  and  weakest  chemical 
affinities,  and  we  also  know  that  exactly,  by  reason 
of  this  chemical  peculiarit)-,  nitrogen  is  a  neces- 
sary element  in  all  the  most  powertul  explosives. 
We  have,  therefore,  just  reason  to  conclude  that 
it  plays  a  very  important  part  in  those  nerve  cxjilo- 
sions  of  which  we  have  spoken.  It  is  then  quite 
as  reasonable  to  limit  in  epilepsy  the  amount  of 
nitrogen  supplied  by  the  medium  of  our  food  stuffs 
as  it  is  to  limit  the  supply  of  articles  containing 
sugar  and  starch  in  diabetes  mellitus.  Not  only, 
however,  may  we  limit  the  actual  amount  of  nitro- 
gen taken,  but  we  may  give  it  in  that  form  in  which 
it  is  apparently  digested  and  broken  up  in  the  eas- 
iest manner.  It  is  a  fairly  well-attested  scientific 
fact,  and  one  that  accords  with  personal  experience, 
that  the  nitrogenous  compounds  which  we  use  as 
foods,  and  which  are  supplied  from  the  vegetable 
kingdom,  are  more  easily  broken  up  and  assimilated 
by  the  economy  than  tiiose  derived  from  the  animal 
kingdom.  The  reason  of  this  difference  is  one  not 
very  easily  explained.  The  best  explanation,  per- 
haps, that  can  be  offered  is  that  in  regard  to  the 
digestibility  of  foods  in  general,  it  may  be  said  that 
the  more  concentrated  a  food  is  the  more  difficult  is 
it  of  assimilation.  Eggs  and  cheese,  two  substances 
exceptionally  rich  in  nitrogen,  are  familar  proofs 
of  this.  The  same,  to  a  lesser  extent,  may  be 
said  of  meat.  I  am  well  aware  that  peas  and 
beans  contain  a  larger  percentage  of  nitrogen 
than  meat ;  but,  on  the  other  hand,  those  substan- 
ces are  mixed  with  a  far  larger  proportion  of  car- 
bon, and,  furthermore,  as  compared  with  meat,  do 
not  enter  nearly  so  largely  into  ordinary  vegetarian 
diet  as  does  the  latter  in  the  menu  of  a  mixed  feeder 
• — furthermore,  more  water  is  used  in  their  cooking, 
and  is  absorbed  by  them  and  eaten  with  them 
than  is  the  case  with  meat,  and  they  are,  therefore, 
contrary  to  what  we  might  expect  at  first  sight, 
really  more  dilute  foods  than  are  the  various 
fleshy  articles  of  diet.  The  same  applies,  but  with 
greater  force,  to  the  cereals. 

My  argument  may,  however,  seem  to  tell  against 
myself,  for  it  might  be  said :  well,  since  animal 
albuminoids  are  less  digestible  than  vegetable 
ones,  it  follows  that  less  of  the  fiist  will  be  taken 


up,  with  the  result  of  a  decreased  supply  of 
nitrogen  to  the  body  at  large.  This  conclusion, 
however,  is  incorrect.  The  result  of  the  deficient 
digestion  of  any  albuminoid  is,  partly  at  least,  that 
imperfectly  prepared  peptones  are  liable  to  be 
absorbed  into  the  system,  and  it  is  mainly  with 
the  further  conversion  of' these  that  the  liver  has 
trouble. 

I  appeal  from  theory  to  practice.  Take  a  case 
of  leeble  digestion,  due  to  general  atony,  and  not 
to  any  special  digestive  derangement,  and  give  to 
that  individual  a  meal  of  meat  and  bread,  and 
he  will  very  shortly  afterwards  develop  the  well 
known  symptoms  of  atonic  dyspepsia.  Give  to 
the  same  man  a  dish  of  Revalenta,  of  crushed- 
wheat  meal,  or  of  oatmeal  porridge  with  bread, 
and  let  such  meal  contain  exactly  the  same 
amount  of  nitrogen  as  in  the  one  composed 
mainly  of  meat,  and  he  will,  as  a  rule,  sufter  little, 
if  at  all.  This  is  the  real  secret  of  the  enormous 
sale  in  this  country  of  Revalenta  Arabica,  I 
have  at  i:)resent  many  dyspeptics  under  my 
care,  who  take  that  form  of  diet  without  the  least 
inconvenience,  and  to  whom  the  painless  digestion 
of  meat  is  apparently  impossible. 

Amongst  substances,  however,  that  are  derived 
from  animals,  and  which  contain  nitrogen,  milk  is 
the  only  one  that  is  an  exception  to  the  above 
rule,  and  this  simply  because  the  nitrogen  it  con- 
tains is  in  a  very  dilute  form. 

We,  therefore,  come  to  this  conclusion  :  In 
epilepsy  we  have  a  disease  in  which  it  is  very 
necessary  to  regulate  exactly  the  amount  of  nitro- 
gen. It  is  also  desirable  that  all  the  organs  of 
the  body,  and,  therefore,  the  stomach  and  liver, 
should  be  kept  in  as  healthy  a  state  as  is  possi- 
ble. Vegetable  nitrogenous  compounds  and  milk 
and  its  preparations  (buttermilk,  skim-milk,  kou- 
miss, etc.)  enable  us  to  obtain  both  ends,  and 
we,  therefore,  in  our  treatment  of  epilepsy,  should 
entirely,  or  almost  so,  discard  the  use  of  flesh  foods. 

Even  meat  soups  are  objectionable.  Though 
apparently  very  dilute  they  really  are  highly  con- 
centrated foods,  the  water  with  which  the  meat 
juice  is  mixed  being  absorbed  with  great  rapidity 
by  the  stomach.  I'he  result  is  that  in  a  few  min- 
utes after  swallowing,  a  thickish  meat  jelly  only  is 
left. 

Basing  my  deductions  on  the  foregoing  prem- 
ises, I  have  for  some  time  past  been  in  the  habit 
of  treating  all  cases  of  epilepsy  by  the  vegetarian 
system,  though  I  hasten  to  explain  that  I  am  no 
vegetarian  myself,  nor  do  I  recommend,  as  is  gen- 
erally done  by  gentlemen  of  that  persuasion,  that 
particular  style  of  feeding  as  a  sovereign  preventa- 
tive and  sure  remedy  for  all  the  ills  of  life. 

It  will  scarcely  be  necessary  to  give  any  exact 
dietary  whicli,  of  course,  varies  with  the  means  of 
my  patient  and  with  his  surroundings.  Epileptics 
are  of  all  people  most  anxious  to  be  ridof  their  com- 
plaint, and  will  better  follow  out,  at  least  that  is  my 
experience,  more  than  any  other  class  of  patients, 
the  rules  laid  down  for  their  guidance. 


TUr.   CANADA    MEDICAL   RECORD. 


1S7 


All  I  (ail  say  is,  thai  the  greatest  possible  bene 
fit  is  often  to  be  derived,  especially  in  those  still 
retaining  fair  stamina,  from  keeping  the  supi)ly  of 
nitrogen  down  below  that  laid  down  as  neeessary 
for  maintenance  of  health  in  the  ordinary  physio- 
logical hand-hooks.  I'his  is  especially  true  of 
those  who  take  little  exercise. 

With  regard  to  the  use  o(  drugs.  In  the  majority 
of  cases  1  use  none,  unless,  in  s])ile  of  dietetic 
treatment  and  hygienic  surroundings,  the  disease 
progresses  rapidly.  I  avoid  the  bromides.  'J'he 
apparent  benefit  derived  from  then  is  more  than 
overbalanced  by  their  disastrous  permanent  effect 
on  the  ner\ous  system. 

Iodide  of  potassium,  lo  to  20  grains,  at  bed- 
time, is  my  favorite  prescription,  even  in  cases 
where  1  do  not  suspect  syphilis. 

Belladonna  and  digitalis  I  also  find  in  certain 
cases  to  be  very  useful,  and  free  from  most  of  the 
drawbacks  which  attach  to  the  bromides. 

Stomachics — bismuth,  with  rhubarb  and  soda — 
are  often,  especially  at  the  onset  of  the  disease,  of 
great  service. 

Of  twenty-three  cases  belonging  to  class  i, 
which  I  treated  on  what  I  may  call  a  vegetarian 
and  inilk  system,  nineteen  were  markedly  benefit- 
ed. Seven  of  the  nineteen  were  apparently  cured, 
and  eight  were  able  to  resume  occupations  which 
they  had,  by  reason  of  the  frequency  of  the  fits, 
been  compelled  to  abandon.  The  other  four  of 
those  who  derived  benefit  had  a  considerable  dim- 
inution in  the  number  of  fits. 

Of  118  cases  belonging  to  classes  2,  3  and  4,' 
about  half  received  decided  benefit ;  but,  unless  I 
give  my  full  statistics,  which,  I  fear,  would  be  too 
great  a  call  on  your  space,  I  cannot  in  cases  where 
the  causation  of  the  epilepsy  varies  so  widely  as  it 
does  in  such  a  group,  draw  any  convincing  deduc- 
tions worthy  the  attention  of  your  readers. — Jour- 
nal of  Reco'istructives. 

TREATMENT  OF  RHEUiMATIS.M  IN  THE 
JEFFERSON  COLLEGE  HOSPITAL. 

Dr.  DaCosta  treats  his  cases  of  acute  rheumatic 
fever,  as  a  rule,  with  salicylic  acid,  about  a  drachm 
in  twenty-four  hours  ;  he  does  this  esjjecially  in 
the  cases  of  active,  frank  character,  in  which  the 
joint  affection  is  decided.  Where  marked  cardiac 
complication  exists,  he  greatly  prefers  the  alkaline 
plan  of  treatment ;  indeed,  has  little  fiiith  in  the  use 
of  salicylic  acid  either  to  prevent  cardiac  complica- 
tions or  to  remove  them.  Nor  does  he,  in  any 
case,  continue  salicylic  acid  or  the  salicylates  if  no 
impression  is  made  on  the  rheumatic  malady  in 
three  or  four  days.  When  the  remedy  does  good 
at  all,  his  experience  is  that  it  does  good  quickly. 

In  cases  of  acute  or  subacute  muscular  rheuma- 
tism, or  in  subacute  articular  rheumatism  with 
much  pain  and  only  moderate  swelling  of  the  joints, 
he  often  employs  bromide  of  ammonium,  or,  if  this 
fail  nitrate  of  potassium.  He  uses  opium  sparing- 
ly, and  generally  confines  it  to  a  moderate  dose  or 
two  of  Dover's  powder,  given  at  night. 


He  strongly  insists,  no  matter  what  plan  of  treat 
nient  be  ado])ted,  on  the  addition  of  quinine,  from 
twelve  to  sixteen  grains  daily,  as  .soon  as  the  more 
active  symptoms  have  subsided,  believing  that 
thereby  the  p.atient's  strength  is  sustained  and 
relapse  ])rovented. 

Formstincture  of  chloride  of  iron  he  has  seen  no 
good,  except  in  pyxmic  rheumatism  or  in  kindred- 
forms  of  rheumatism. 

Locally,  he  uses  little,  enveloping  the  swollen 
joints,  if  very  painful,  in  a  thin  layer  of  cotton- 
wool ;  where  the  joints  are  very  much  swollen  he 
envelops  themin  cloth  wrung  out  in  a  strong  solu- 
tion of  nitrate  of  potassium,  with    morphia  added. 

The  diet  is  always  blank  and  unstimulating, 
chiefly  milk,  farinaceous  substances,  and  very  mod- 
erate amounts  of  broths,  eggs,  and  fish.  Alcohol 
is  not  given, except  in  the  so  called  ''typhoid  cases," 
in  which  also  high  temperature  is  generally  found. 
— Afed.  News. 


PHILADELPHIA  CLINICAL  SOCIETY. 

Stated  Meeting,  February  25,  lSS;. 

The  President,  Dr.  James  B.  Walker,  in  the 

chair. 

The  President  introduced  the  subject  of 

ARTIFICIAL    FEEDING  OF  INFANTS. 

The  importance  of  the  subject  all  will  ad- 
mit, and  depends  upon  (i)  the  inability  of  the 
mother  to  afford  nourishment ;  (2)  the  demands 
of  the  child  for  the  materials  for  growth,  repair,  and 
heat-production  ;  and  for  protection  from  indiges- 
tion and  the  numerous  disorders  of  malnutrition. 
The  prominent  indications  of  the  non-agreement  of 
any  food  are  excessive  colic,  vomiting,  diarrhoea. 
The  results  are  seen  in  losses  of  flesh,  strength, 
vivacity,  and  color,  non-development  of  general 
body  or  of  parts,  as  of  teeth,  retardation  of  infan- 
tile accomplishments,  psychical  or  physical,  or 
even  loss  of  those  which  have  existed.  One  or 
many  of  these  conditions  may  exist  and  call  for 
attention  on  the  part  of  the  physician  to  the  impera- 
tive needs  of  the  little  patient. 

In  choosing  a  diet  there  is  no  established  law, 
save  that  the  food  shall  be  easily  digested,  non- 
irritating,  and  suitable  for  nourishment  and  heat- 
production.  If  the  infant  have  been  nursing  its 
mother,  the  quantity  may  be  alone  at  fault.  In 
all  such  cases  artificial  food  should  be  made  to 
supplement  and  not  to  substitute  the  natural  sup- 
ply. The  amount  of  artificial  food  must  vary  with 
each  case  from  every  alternate  feeding  to  two  or 
three  feedings  daily.  Should  the  quality  of  the 
mother's  milk  be  at  fault,  or  should  she  be  unable 
to  nurse  her  child  from  other  causes,  a  complete 
substitute  must  be  furnished. 

Here,  unquestionably,  the  best,  because  furnish- 
ing the  most  rational  substitute,  is  the  wet-nurse. 
But,  rational  though  it  be,  it  has  objections  which 
sometimes  are  insurmountable.  Among  these 
are  the  expense  incurred,  the  difliculty  of  getting 
one  whose  milk  is  altogether  satisfactory,  or,  this 


188 


TflE  CANADA  MEDICAL   RECORD. 


agreeing,  the  unsalisfactoriness  of  the  individual 
herself,  who,  reins  in  hand,  may,  if  inclined,  drive 
the  family  to  distraction.  Apart  from  this,  many 
mothers  object  lO  having  their  little  ones  nurse  at 
other  breasts  than  their  own,  even  when  the  sub- 
stitute is  cleanly  in  person,  cliaracter,  and  liabits, 
and  nnich  more  so  if  doubt  exist,  as  it  often  must 
upon  these  scores.  \V'liile  not  decrying  wet-nur- 
ses,— indeed,  while  claiming  that  for  some  infants 
they  are  our  only  means  of  salvation, — the  lectu- 
rer claimed  tliat  in  most  instances  tliey  are  not  in- 
dispensable. 

In  choosing  a  substitute  for  human  milk  for 
healthy  children,  the  lecturer  does  not  approve  of 
the  so-called  infant-foods  manufactured  on  a  large 
scale,  and  kept  on  the  druggist's  shelves.  These 
substances,  many  of  which  have  much  virtue,  find 
a  sphere  in  the  management  of  the  sick,  but  as  a 
rule  may  be  eschewed  in  arranging  a  food  for  the  well. 

For  most  babies  condensed  milk  answers  best, 
for  the  first  three  to  six  months  of  life.  Here 
again  a  choice  may  be  made.  There  are  several 
varieties  of  this  food,  most  of  which  are  sup|)lied 
in  quantities  to  grocers  and  druggists,  and  lie  an 
indefinite  time  on  the  shelf  or  counter,  duriug 
which  time  they  are  liable  to  deterioration.  This 
is  not  a  matter  of  theory,  but  has  been  proved  in 
more  than  one  instance  by  an  attack  of  severe  in- 
digestion and  diarrhcea  on  opening  a  new  can. 
The  brand  most  satisfactory  in  the  lecturer's  expe- 
rience is  Canfield's,  which  is  manufactured  in 
Philadelphia,  and  is  for  sale  only  at  the  manufac- 
turer's office,  where  its  freshness  and  purity  are 
guaranteed.  Or,  if  the  sweetness  of  the  condens- 
ed milk  be  an  objection  in  an  individual  case,  the 
"  Evaporated  Cream,"  a  jjartially  condensed  milk, 
prepared  by  the  same  firm,  may  be  used,  having 
it  served  fresh  every  day  or  every  alternate  day. 
Unquestionably,  condensed  milk  is  preferable  for 
the  young  infant  to  the  fresh  (?)  milk  furnished  by 
the  milkman  in  our  large  cities. 

If  a  child  taking  condensed  milk  is  constipated, 
a  small  quantity  of  Mellin's,  Horlick's,  or  Nestle's 
food  may  be  used  in  each  bottle,  and  will  usually 
be  all-sufticient. 

At  least  until  a  food  has  proved  satisfactory,  the 
infant  should  be  weighed  at  the  end  of  each  week, 
and  should  gain  from  three  or  four  ounces  to  a 
pound  weekly.  If  severe  colic,  vomiting,  or 
diarrhoea  occur  without  cause,  such  as  teething, 
exposure,  etc.,  some  change  is  indicated.  Thrs 
will  usually  be  the  case,  where  condensed  milk  is 
the  diet,  somewhere  from  the  third  to  the  eighth 
month.  The  addition  of  oatmeal  to  the  food  may 
be  all  that  is  needed.  It  should  be  thorouglily 
cooked  for  three  hours,  then  strained  through  a 
cloth,  producing  a  white,  semi-translucent  "sub- 
stance, about  the  consistency  of  starch,  as  used  by 
the  laundress.  Of  this  from  one  to  three  table- 
spoonfuls  may  be  added  to  each  bottle,  according 
to  the  age  of  the  child  and  its  power  of  digestion. 
Lime-water  is  an  important  addition  to  the  arti- 
ficial food;  and  should  be  used    continuously  for 


the  first  ten  or  twelve  months. 

In  most  instances  fresli  cow's  milk  will  liave  to 
be  substituted  for  the  condensed  milk  when  the 
latter  disagrees,  or  this,  if  obtainable  pure,  may 
be  used  from  the  first.  This  sliould  be  diluted  to 
suit  the  age,  and  have  ^dded  sugar,  lime  water, 
and  from  a  teaspoonfiil  to  two  tablespoonfuls  of 
cream  to  each  bottle,  varying  the  amount  to  suit 
the  condition  of  the  bowels.  After  the  third 
month,  or  even  before,  some  of  the  oatmeal-gruel, 
jjrepared  as  already  directed,  may  be  added.  In 
cities,  all  the  water  used  in  preparing  the  food 
should  have  been  previously  boiled.  Sometimes 
an  irritable  state  of  the  bowels,  induced  by  one  of 
many  causes,  may  be  benefited  by  the  substitution 
for  a  few  hours  of  barley-water,  arrowroot  water,  or 
gum-arabic  water,  and  on  resuming  the  milk  food 
one  of  the  above  waters  may  be  used  as  the 
diluent,  instead  ofplnin  boiled  water.  Sometimes 
the  use  of  peptonized  milk  diluted  with  barley- 
water,  or  the  addition  to  the  milk-food  of  the 
"  Peptogenic  Milk- Powder  of  Fairchilds,  Brother 
&  Foster,  may  be  required  for  a  shorter  or  longer 
period. 

In  the  artificial  feeding  of  infants,  the  plain 
nursing-bottle  with  pure  rubber  nipple  is  better 
than  spoon-feeding,  giving  exercise  to  the  masti- 
catory apparatus,  and  stimulating  to  more  rapid 
functional  development  the  salivary  function. 

The  subject  was  discussed  by  the  difterent  mem- 
bers, and  the  experience  of  each  one  proved  that 
cow's  milk  in  some  form  was  the  best  food  for  a 
'child  who  must  be  artificially  fed. 

Dr.  Anna  McAllister  spoke  of  some  interesting 
experiments,  which  had  been  tried  at  the  New 
York  Infant  Asylum,  under  the  supervision  of  Dr. 
J.  Lewis  Smith:  where,  in  several  autopsies  on 
artificially-fed  infants,  it  was  found  that  in  those 
fed  on  starc/iy  food  the  pancreas  was  very  small, 
seemingly  arrested  in  its  development;  while  in 
those  fed  upon  condensed  milk  the  organ  was 
normal  in  size. — Phil.  Med.  Tunes. 


THERAPEUTICS  OF  FEMALE  STERILITY. 
The  rational  treatment  of  female  sterility  is 
based  upon  a  knowledge  of  its  causation.  In 
anaemia,  chlorosis,  or  scrofulosis,  reconstructive 
medication  is  required.  Amenorrhoea,  if  the  gen- 
erative organs  are  normal,  may  yield  to  local  sti- 
mulating apjilications,  such  as  scarification  of  the 
cervix,  introduction  of  the  sound  or  of  stem-pessa- 
ries, vaginal  douches,  hot  foot  or  sitz-baths, 
galvanism  or  faradic  electricity ;  a^ded  by  aloes, 
apiol,  or  permanganate  of  potassium  used  inter- 
nally. In  the  amenorrhcea  of  corpulent  women, 
Kisch,  Martin  and  Rohrig  extol  the  sulphate-of- 
soda  waters,  among  which  those  of  Marienbad 
have  a  high  reputation.  In  this  country  the  waters 
of  Crab  Orchard  Springs  in  Kentucky,  Bedford 
Springs  in  Pennsylvania,  or  Ballston  Spa  in  New 
York,  would  probably  be  equally  efficacious. 

In    endometriiis,    applications   of    tincture   of 
iodine  or   of  iodinized    collodion    to  the  internal 


TUE  CANADA  MEDICAL  UECORD. 


i8f» 


surface  of  tlic  uterus  arc  often  effective.  When 
villous  endometritis  is  present,  or  the  uterus  still 
contains  remnants  of  a  ])revious  misconception, 
the  dull  curette  is  indicated.  In  peri — or  jjarame- 
tric  exudations,  hot-water  vaginal  douches  and 
iodoforniized  tampons  are  useful. 

Catarrhal  diseases  of  the  vagina  must  be  treat 
ed  with  astringents.  Kisch  reports  a  case  in 
which  there  were  ])rofuse  hyperacid  secretions. 
He  directed  injections  of  a  fifteen  ])er  cent, 
solution  of  sugar  to  which  one-tenth  \>er  cent,  of 
caustic  potassa  liad  been  added.  In  this  solution 
the  spermatozoa  remain  active  for  a  long  period. 
'I'he  woman  became  jiregnant  after  using  this 
injection  for  some  time.  Charrier  foimd  in  two 
similar  cases  tliat  the  daily  injection  of  a  solution 
containing  one  part  of  albumen,  with  fifty-nine  of 
phosphate  of  soda,  in  ten  thousand  of  water, 
removed  the  acidity  of  the  secretion,  and  the 
women  conceived  in  the  course  of  six  weeks, 
although  during  four  years  of  married  life  they  had 
been  sterile. 

Gonorrhcea  should  be  treated  with  germicide 
irrigations.  The  most  effecli\e  are  nitrate  of 
silver  (one  to  three  thousand — one  to  two  thous- 
and), .salicylate  of  sodium  (one  to  twenty), 
corrosive  sublimate  (one  to  twenty  thousand). 

In  atrophy  of  the  uterus  tlie  galvanic  and 
faradic  currents  may  be  used  with  some  hope  of 
benefit. 

Vaginismus  demands  a  careful  consideration  of 
each  case.  Recently  cocaine  in  four  per  cent, 
solution  painted  on  the  vulva  and  vagina  has  been 
found  effective.  If  this  fail,  operative  measures 
(dilatation  under  anaesthesia  and  subsequent  wear- 
ing of  a  plug)  may  be  resorted  to. 

In  cervical  stenosis  dilatation  with  tents  or 
incision  may  be  employed.  The  former  method 
is  warmly  advocated  by  Schultz.  If  rigid  instru- 
ments are  used,  the  solid  romid  dilators  of  Peas- 
lee  or  Hegar  should  be  chosen.  The  dilating 
instruments  which  act  by  a  separation  of  two  or 
more  blades  are  by  Kisch  considered  inappropriate. 
In  hypertrophy  of  the  cervi.x,  amputation  is  proper  ; 
in  laceration,  Emmet's  operation. 

Atresia  of  the  vagina  does  not  demand  treat- 
ment in  the  absence  or  defective  develo[)ment  of 
the  other  internal  generative  organs. 

Displacements  should  be  ap|iropriati'ly  treated 
by  manual  reposition  and  pessaries  or  tampons. 

The  accepted  oiiiniou  among  physiologists  is 
that  the  most  favorable  time  for  conception  is  two 
or  three  days  before  the  beginning,  or  five  or  eight 
days  after  the  cessation,  of  the  menstrual  tlow. 

Kisch  does  not  advise  attemi)ts  at  the  artificial 
impregnation  of  the  human  female,  as  ]iracticed 
by  Sims  and  some  of  his  followers.  He  closes 
his  very  interesting  monograph  with  the  caution  to 
the  physician  not  to  be  too  ready  to  give  either 
a  favorable  or  an  unfavorable  prognosis.  In  the 
former  case  he  may  be  mistaken  and  disappoint- 
ment follow  ;  in  the  latter  he  may  be  likewise  err, 
and  his  judgment  will  then  be  discredited  in  other 
things. — F/ii/.  Medical  Times. 


Till'.  Canada  Mhdical  Rmcord. 

A  Monthly  Journal  of  Medicine  and  btirgery- 

EDITORS  : 

FRANCIS  W.CAMPBELL,   MA.,  M.D.,L.K,C.P    LOND. 

I'Mil.Miiiicl  I'injiri.tor. 
K,  A,  KENNEDY,  M.A.,  M.D.,  Miin;iKiiig  r;,lit(jr. 
ASSISTANT  EDITORS: 
CASEY  A.  WOOD,  CM.,  M  D. 
GEORGE  E,  ARMSTRONG,  CM.,  M.D. 

SUIISCKU'TIUN    TWO    IJOLLAIIS    I'ER    ANNUM. 

All  cnmmunic'ilinii ^  iind  Kjtcliiiviirs  mu.sl  he  atUressed  to 
iM  Editors, Oriiwer'iM,  Post   Office,  Montreal. 

MONTREAL,  MAY,  1887. 

We  publish  with  this  number  of  the  Rfxord  the 
Title  Page  and  Inde.x  for  Volume  XI 1 1.  This 
should  have  appeared  in  the  October,  1885,  num- 
ber, but  through  an  oversight  was  left  out.  We 
trust  our  Readers  will  pardon  the  delay  on  the 
principle  of  "  better  late  than  never."  The  Title 
Page  and  Index  for  Volume  XIV  will  be  published 
with  the  next  (June)  number  of  the  Record. 


COLLEGE    OF    PHYSICIANS    AND    SUR- 
GEONS, PROVINCE  OF  QUEBEC. 
Ojfirrrs/nr  188(^-89.— Wm.  H.  Kingston,  M.D,, 
President;  Dr.  J.  L.   Leprohon  and  the  Hon.  Dr. 
Ross,    Vice-Presidents ;    Dr.    Leonidas  La   Rue, 
E  (Quebec)  Registrar;  Dr.  E.  P.  Lachapelle,  Mon- 
treal, Treasurer;  Drs.  F.  W.  Campbell,  Montreal, 
and  A.  G.  Belleau,  Quebec,  Secretaries. 

GOVERNORS. 

Citij  iif  Monti-cid. — Dr.  J.  L.  Leprolion,  Dr.  T. 
A.  Rodgers,  Dr.  R.  Palmer  Howard  and  Dr. 
Robert  Craik  (McGill  College  representatives)  ; 
Dr.  William  H.  Kingston  and  Dr.  Durocher 
(Victoria  College  representatives)  ;  Dr.  Francis 
Wayland  Campbell,  and  Dr.  R.  A.  Kennedy 
(Bishop's  College  representatives)  ;  Dr.  E.  P. 
Lachaiielle,  and  Dr.  Dagenais  (Lav.il  branch 
representatives). 

District  nf  MnntriuJ. — Drs.  II.  A.  Mignault,  J. 
E.  Ducheneau,  J.  B.  Gibson,  Marcil,  Lafontaine, 
Ladouceur,  A.  Longpre,  J.  E.  Turcot,  Hon.  Dr. 
Church. 

City  of  Qiicliec. — Drs.  A.  G.  Belleau.  Leonidas 
La  Rue,'  R.  T.  Rinfret,  W.  Walters,  C  S.  Parke, 
E.  A.  de  St.  George,  C.  E.  Lemieux,  Wells. 

District  of  Quebec. — Drs.  M.  Guay,  J.  Fortier, 
V,.  Rousseau,  Grandbois,  L.  H.  Lebrecque,  Hon. 
Dr.  Robitaille,  Dr.  A.  A.  Laferriere. 

District  of  Tlircc  liiiers. — Drs.  Baddcaux,  Hon. 
Dr.  Ross,  Desaulnier. 

District  of  St.  Francis. — Drs.  Austin,  Pare, 
Thos.  LaRue. 


190 


THE   CANADA    MEDICAL   RECORD, 


OBITUARY. 
DR.  JOHN  FULTON,  TORONTO. 
On  Sunday,  May  15th,  Dr.  John  Fulton  of 
Toronto,  Editor  and  Proprietor  of  the  Canada 
Lancet,  after  a  somewhat  brief  iUness  of  Typhoid 
Pneumonia,  passed  to  his  eternal  rest.  Our  de- 
ceased friend  was  a  prominent  man  among  the 
Medical  Profession  of  Canada.  Possessed  of  ex- 
cellent abilities,  and  an  indomitable  energy,  he 
worked  and  toiled  till,  we  might  say,  almost  the 
hour  of  his  death.  It  is  as  a  journalist  that  Dr. 
Fulton  was  best  known,  though  in  Victoria  and 
Trinity  College  Medical  Schools  he  filled  most 
ably  several  chairs.  In  1870  he  started  the 
Canada  Lancet,  having  purchased  the  good  will 
of  the  Dominion  Medical  Journal.  From  that 
time  till  his  last  illness,  his  energy  and  his  abilities 
have  been  devoted  to  its  success.  The  position 
which  the  Lancet  occupies  to-day  is  a  tribute  to 
his  business  capacity  and  his  intellectual  worth. 
Dr.  Fulton  was  born  in  Western  Ontario  early  in 
1837,  ^"d  ^^s  brought  up  on  a  farm,  then  became 
a  school  teacher,  and  finally  entered  Medicine, 
graduating  at  Victoria  College,  or  as  it  was  best 
known  at  that  time,  "  Dr.  Rolph's  School.  "  He 
subsequently  passed  some  time  in  England  and 
elsewhere,  returning  to  Canada  with  the  L.R.C.P. 
Lond.,  and  the  M.R.C.S.  England.  His  death,  at  a 
comparatively  early  age,  is  a  great  public  loss.  To 
those  who  will  feel  his  loss  most  keenly,  his  orphan 
children,  we  bestow  our  deep  sympathy.  Let  their 
consolation  be  ;  "  No  man  could  have  more  com- 
pletely done  his  duty,  to  his  profession — to  his 
country — to  his  God." 


PERSONAL. 

Dr.  A.  L.  Smith,  Professor  of  Medical  Juris- 
prudence, University  of  Bishop's  College,  who  has 
for  the  past  two  months  been  furthering  his  Clini- 
cal knowledge  in  the  Hospitals  of  London,  Paris, 
and  Berlin,  purposes  returning  to  Montreal  by  the 
Beaver  Line  S.S.,  Lake  Ontario,  due  here  about 
June  2ist. 

Dr.  A.  P.  Scott  (Bishop's  1887)  has  left  for 
London,  Eng.,  where  he  purposes  residing  for  some 
time  to  walk  the  hos[)itals,  and  also  to  take  out 
some  of  the  British  qualifications. 

Dr.  W.  E.  Fairfield  (Bishop's  '8;.)  has  started 
practice  at  Wequiock,  Michigan,  U.S. 

Dr.  A.  E.  Phelan,  (Bishop's  '87)  has  put  out 
his  sign  at  Watersnieet,  Mich,,  U.S.A. 


REVIEW. 

On  Fevers:  Their  Histuri/,  Etiologi/,  Diuijnosis, 
Prognosis  and  Treatment.  By  Alex.ander  Col- 
lie, M.D.,  With  colored  plates.  Philadelphia,  P. 
Blakiston,  Son  &  Co.,  1012  Walnut  street,  1S87. 
Price  §2.50. 

In  the  preface,  the  fact  is  mentioned  by  the 
author,  that  the  observations  are  for  tlie  mo.st  part 
founded  upon  over  21,000  cases,  which  had  been 
personally  treated  by  him.  The  work  is  well 
written,  and  throughout  the  book  mumerous  quota- 
tions are  mentioned  from  known  writers,  for  the 
purpose  of  bearing  out  the  views  of  the  author.  It 
contains  plates,  four  in  number,  which  are  well 
exx-cuted,  a  dietary  scale,  and  also  formula;  from 
the  Pharmacopceia  of  the  London  Fever  Hospital. 
The  book  is  well  printed  in  large,  clear  type  and 
on  good  paper,  the  whole  being  bound  in  a  cloth 
cover,  with  neat  gold  lettering,  and  altogether 
makes  a  very  presentable  appearance. 

Ancemia  by  Frederick  P.  Henry,  Prof,  of  Clini- 
cal Medicine  in  the  Philadelphia  Polyclinic,  etc., 
etc.,  Philadelphia,  P.  Blakiston,  Son  &  Co.,  1012 
Walnut  street.  Price  75  cents. 
This  is  the  first  time  that  the  above  named  sub- 
ject has  been  systematically  treated  in  book  form, 
it  being  a  reprint  of  a  series  of  articles  published 
during  the  last  year  in  the  Polyclinic.     This  little 
work  is  the  result   of  several  years'  study  of  the 
blood,  and  the  disorders  consequent  upon  its  im- 
perfect elaboration.     The  facts  therein  stated    are 
mostly  based  on  the  personal  observations  of  the 
author.     This  book  will,  no  doubt,  supply  a  long 
felt  want  in  the  treatment  of  a  very  common  affec- 
tion. 


Dose  and  price  labels  of  edl  the  drugs  and  jyrepara- 
tions  of  the  United  States  Pharmiicojm'ia  of  1880. 
By  C.  L.  LocHMANjSecond  Edition, Philadelphia, 
Dunlop  &  Clarke,  Printers,  819  and  821  Filbert 
street,  1887.  Price  inflexible  muslin,  $1.50. 
This  is  the  second  edition  of  this   very  useful 
little  book.     It  has  been   entirely  rewritten,  cor- 
rected,improved  and  enlarged,  and  contains  double 
the  number  of  pages  of  the  former  edition.     Each 
label  contains  a  lot  of  useful  information,  e.g.,  solu- 
bility of   th.e  chemical  in  water,  alcohol,  etc.,    the 
doses   in  apothecaries'  weight  and  measure,    with 
their  equivalents  in  the  metric  system,  the  medi- 
cal properties   and  many  useful  hints,  in  this  way 
condensing  in  a  ready  form  an  amount  of  informa- 
tion, which  could   not   be    gained  in  the  ordinary 
way  without   a    vast    amount    of  research.     This 


THE   CANADA    MEDICAL    RECORD. 


I'll 


book  should  especially  recommend  itself  to  Drug- 
gists. There  is  also  at  the  end  of  the  work  a 
descripliiin  of  ni;uiy  new  remedies,  which  adds 
very  mui  li  to  ihc  wiltie  of  the  hook. 


A  Ri-fcrciicc  Hand-Book  of  Ihc  Affdical  Science  : 
lieing  a  com])lete  and  convenient  work  of  refer- 
ence for  information  upon  topics  belonging  to 
the  eiitire  range  of  scientific  and  practical  medi- 
cine, and  consisting  of  a  series  of  concise  essays 
and  brief  [jaragraphs  arranged  in  the  alphabeti- 
cal order  of  the  topics  of  which  they  treat,  [jre- 
pared  by  writers  wlio  are  ex])erts  in  their 
respective  department.  Illustrated  by  chromo- 
lithographs and  fine  wood  engravings.  Edited 
by  Ar.HF.RT  H.  Buck,  M.D.,  New  York  City. 
Vols.  II.  III.  and  IV.  \Vm.  Wood  &  Co.  New 
York,  1887. 

As  we  mentioned  in  our  review  of  volume  I.  of 
this  work,  it  is  gotten  up  in  the  style  of  an  Ency- 
clopedia. The  task  of  getting  up  such  a  work 
must  entail  an  immense  amount  of  time  and  labor  ; 
but  the  author  appears  to  be  competent  for  the 
task,  for  he  seems  to  have  succeeded  in  keeping 
up  the  superior  quality  and  style  of  the  work,  of 
which  we  take  volume  I.  as  the  example.  The 
various  articles  seem  to  be  carefully  prepared,  are 
very  concise,  the  most  salient  points  being  brought 
prominently  to  view,  and  the  most  important  sub- 
jects have  been  treated  very  minutely,  as  suiting 
the  style  and  character  of  the  work.  The  ciiromo- 
lithographs  are  very  handsome,  the  engravings 
clear  and  distinct,  and  the  type,  paper,  and  print- 
ing are  all  of  the  best  workmanship,  so  that  the 
volumes  will  make  a  very  handsome  addition  to 
the  physician's  library. 


T/ic  Physician's  Dose  and  Hyniploni  Book.  By 
Jos.  H.  WvTHE,  M.D.,  Professor  of  Histology 
and  Microscopy,  Cooper  Medical  College,  San 
Francisco. 

Seventeenth  edition,  completely  rewritten    and 
enlarged. 

Philadelphia:  P.  Blakiston,   Son  &  Co.,    1012 
Walnut  Street. 

This  little  work  being  now  in  its  seventeenth 
.edition  proves  that  it  must  be  invaluable,  being 
especially  adapted  to  the  wants  of  students  when 
grinding  for  examinations.  It  will  also  be  of  great 
service  to  the  busy  practitioner  as  a  means  of 
handy  reference  at  such  times  when  more  elaborate 
works  are  not  at  hand. 


A  CiiMpiinlnn  to  t]ie,  (J.  »S'.  J^hiiimnaijKvi'i,  Being 
a  Practical  Commentary  and  Key  to  the  latest 
edition  of  the  Pharmacopceia.  Second  edition, 
liy  Osc.\K  OLOiiiiRc;,  Pharm.  D.,  and  Otto  A. 
^V'ALL,  M.U.,  Ph.  G.  Octavo,  1226  pages,  650 
illustrations.  Muslin,  $5.00  ;  New  York  :  Wm. 
Wood  &  Company,  1887. 

As  this  is  the  second  edition  of  this  well  known 
work,  it  does  not  of  a  necessity  require  any  very 
elaborate  review,  especially  as  most  of  our  readers 
are  already  familiar  with  the  scope  and  purpose 
of  the  book.  One  fact  which  surprises  us  is  the 
absence  of  any  comment  on  some  of  tlic  latest 
remedies  in  general  use,  such  as  antijjyrin  and 
antifebrin,  especially  as  the  volume  does  not 
appear  to  be  limited  in  size,  and  as  other  medicines, 
by  no  means  in  such  general  use,  have  been  fully 
taken  note  of  by  the  authors.  However,  the  work 
will  prove  a  worthy  second  to  its  elder  brother, 
the  U.  S.  Pharmacopceia. 


Manwd    of   Operative    SiD'gen/.     By     Joseph   D. 
Bryant,  M.D.,  Professor  of  Anatomy  and  Clini- 
cal Surgery,  and  Associate  Professor  of  Ortho- 
l)edic  Surgery   in   Belle vue    Hospital   Medical 
College,  etc.,  500  pages  ;  800  illustrations.  New 
York,  I).  Applcton  &  Co.,  1887. 
On  turning  over  the  pages  of  this  work,  one  is  at 
once  struck  by  the  great  number  of  the  illustra- 
tions.    This   fact   alone    would    recommend   the 
book  to  students,  for  whom  in  truth  the  work  was 
especially  prepared.     Another,  and   very  impor- 
tant point,  is  the   large  size  of  the  type,  which 
renders  reading  for  any  length  of  time  a  compara- 
tively easy  matter.     The  wood-cuts  are  reprinted 
from  some  of  the  best  standard  works  on  Surgery, 
such  as  Ashhurst,   Agnew,  Gross,   Erichsen,  etc., 
and  the  references  are   clear  and   easily    found. 
Altogether  the  work  is  of  the  best,  and  we  predict 
for  it  a  large  sale. 


Practical  Human  Anatomy,  a  working  guide  for 
students  of  medicine,  and  a  ready  reference  for 
Surgeons  and  Physicians.  By  Faneuil  D. 
Weisse,  M.D.,  Professor  of  Practical  and  Surgi- 
cal Anatomy,  Medical  Department  of  the  Uni- 
versity of  the  city  of  New  York.  Illustrated  by 
222  lettered  plates,  containing  331  figures.  New 
York,  William  Wood  &  Co.,  56  and  58  Lafayette 
Place,  1886. 

This  work  is  the  very  beau-ideal  book  for  the 
student  of  Surgery  to  carry  with  him  into  the  cis- 
secting  room,  the  plates  being  large  and  the  Utter- 
ing very  distinct,  and,  in  fact,  the  cuts  are  so 
accurate  that  they  might  really  be  mist.ikei  for 
photographs.     The  author  says  that  the  wcrk  was 


100 


THE  CANADA  MEDICAL  RECOED. 


commenced  wilh  a  desire — after  an  experience  of 
nearly  twenty  years  in  study,  actual  dissections, 
and  the  teaching  of  anatomy — to  produce  a  prac- 
tical working-guide  for  the  student  at  the  cadaver, 
and  a  ready  reference  book,  which  would  take  the 
place  of  the  cadaver  for  practitioners  of  surgery 
and  medicine.  In  this  endeavor  the  author  has 
assuredly  succeeded,  and  to  the  student  and  busy 
practitioner  alike  we  heartily  recommend  the  book 
as  ranking  first  on  the  list  among  works  of  a  surgi- 
cal character. 


Drug  Eruptions.  A  Clinical  Study  of  the  Irri- 
tant Effects  of  Drugs  upon  the  skin.  By  Prince 
A.  Morrow,  A.M.,  M.D.,  Clinical  Professor  of 
Venereal  Diseases,  Bellevue  Hospital  Medical 
College,  New  York.  W.  Wood  &  Co.  1887. 
Price  §1.75. 

There  is  an  axiom  which  says  that  the  physician 
should  be  familiar  with  the  effects  of  every  drug 
which  he  may  employ  in  the  treatment  of  various 
diseases.  This  fact  may  be  true,  but  we  doubt  if 
many  physicians  have  given  particular  attention 
to  such  abnormal  manifestations  as  the  eruption 
produced  by  the  various  remedies  prescribed  in 
the  treatment  of  disease.  We  doubt  if  most  phy- 
sicians have  spare  moments  to  devote  to  the  culture 
of  such  a  theme.  This  subject  is  of  importance 
in  one  point,  viz.,  that  drug  eruptions  might  very 
closely  simulate  some  of  the  exanthematous  fevers 
and  also  certain  skin  diseases  ;  in  such  an  instance 
a  clear  knowledge  of  their  differences  would  be 
well  worth  bearing  in  mind.  This  work  is  the 
result  of  the  author's  personal  observations  and 
investigations,  and  will  doubtless  prove  of  con- 
siderable value  to  those  desirous  of  obtaining  the 
latest  information  on  this  subject. 


Tic  Vest  Pocket  Anatomist  (founded  upon  Gray). 
By  C.  Henri  Leonard,  A.M.,  M.D.,  Professor 
of  the  Medical  and  Surgical  Diseases  of  \Vomen 
in  the  Detroit  College  of  Medicine.  13th  Revised 
Edition,  Enlarged  by  Sections  on  Anatomical 
Triangles  and  Spaces,  Herniaj,  Gynaecological 
Anatomy  and  Dissection  hints.  Detroit  ;  The 
Illustrated  Medical  Journal  Co.,'iS87.  cloth,  86 
illustrations,  154  pages,  postpaid,  75  cents. 

This  little  volume  in  its  former  editions  is  so 
well  known,  that  it  is  only  necessary  to  confine  our 
notice  to  this,  the  thirteenth  edition,  which  con- 
tains very  clear  and  accurate  typographical  jilates 
of  the  Venous,  Arterial  and  Nervous  sj'stems, 
phc  t  j-e  igraved  from   the    English  cuts   in  Gray's 


Anatomy.  This  makes  the  work  especially  of 
value  to  accompany  the  surgical  case  of  any  prac- 
titioner that  is  doing  much  work  in  this  line,  who 
may  wish  at  his  hand  a  "  regional  reminder  "  of 
the  placement  of  arteries,  and  veins  that  he  may 
wish  to  avoid  in  making  his  incisions.  For  this 
special  purpose  this  little  book,  since  it  has  the 
addition  of  these  86  engravings,  is  of  a  good  deal 
of  value  to  the  country  practitioner,  who  sometimes 
does  not  have  the  time  to  return  to  his  office  to 
consult  his  more  pretentious  volumes.  The  "  Dis- 
section Hints  "  show  the  incisions  to  be  made  in 
post-mortems  to  advantage. 


r^f^-. 


The  above  cut  represents  an  Artificial  arm  with 
Ball  and  Socket  Wrist  Joint,  recently  invented  and 
manufactured  by  Geo.  R.  Fuller,  successor  to  the 
late  Dr.  Bly,  of  Rochester,  N.  Y. 

The  improvement  admits  of  placing  the  artifi- 
cial hand  in  any  position  that  can  be  attained  with 
the  natural  hand,  and  is  an  important  advance  in 
the  progress  of  prosthesis. 


SALOL. 

This  new  remedy  for  rheumatic  affections  is  a 
crystalline  powder,  having  a  marked  but  not 
unpleasant  odor  resembling  wintergreen.  It  was 
first  introduced  by  Prof.  Neucke,  of  Berne,  and 
has  been  used  extensively  on  the  continent.  Dr. 
Siefert,  of  Wurtzburg,  has  prescribed  it  frequently 
as  a  mouth-wash  with  happy  results  in  such  cases 
as  ulceration  of  the  tongue— wounded  during  an 
epileptic  seizure — or  ulceration  following  the  use 
of  the  cautery,  or  when  due  to  stomatitis,  and  also 
as  an  application  in  ozcena  and  tubercular  ulcera- 
tion of  the  larynx.  As  an  anti-rheumatic  remedy 
it  is  greatly  vaunted  by  Bielschowsky,  of  Breslau, 
and  Rosenberg,  of  Berlin.  In  the  majority  of 
cases  where  the  latter  used  this  drug  the  effect  was 
prompt  in  causing  a  lowering  of  temperature,  and 
greatly  lessening  the  pain  of  the  joints  in  from 
twenty-four  to  forty-eight  hours.  The  dose  admin- 
istered whilst  pain  and  fever  were  present  was  fif- 
teen grains  every  hour  or  two.  The  quantity  was 
reduced  as  the  symptoms  disappeared.  Rela])ses, 
however,  were  of  frequent  occurrence,  and  in  every 
case  he  detected  the  carbolic  odor  in  the  urine. 
Canadian  Practitioner. 


THE  CANADA  MEDICAL  RECORD. 


Vol.  XV. 


MONTREAL,    JUNE,    1887. 


No.  9. 


SOCIETY  PEOCEEDINGS. 

McJico-Chii-urgioal   Soci>;tv   of  Mont- 
real    193 

COREESPONB£HCE. 

I.etter  from  Birliu 191 


PROGRESS  OF  SCIENCE. 


198 
2ul 


S|.raiii^_i  .I.-ints 

1  hi-  Tr.;3tlllelit  of  Whitliin 

The  Treainitrut  of  Cbroiiic  Abscesses 
by  iiij.  i-tions  of  an  Ethereal  iiolu- 

tion  cf  I'^'^loform 2<t2 

The  L)o<u.r  as  Palient LirJ 

On  the  Local  Trealmeul  of  the  Bladiler.  201 J 


Notes  on  Some  Forgotten  or  >f  uoli  Xe- 
eleeted  Kemedies  and  'Xberapeutic 

Slea^urei" 204 

r>fln£?er  in  Santonin 2(*'7 

l*erfiniiery  as  a  St-datiTe 207 

Stroplianthiis  in  Heart-Disease 307 

I'annic  Acid  a^  a  Snrcfieal  Dn'&'ing 20£ 

The  Tr»-atment  of  Orchitis  and  Epidi- 
dymitis  208 

Calomel  in  the  treatment  of  Cardiac 

Dropsy 209 

Simple  Constipation  and  its  successful 

ManagnnK-nt 209 

Salicylate  of  IJthia  in  Acute  Articular 

Rheumali-m 211 

Treatment  of  Sciatica. 211 


How  to  Give  Castor  Oil 211 

Tlie  Treatment  of  ttye i!ll 

Antiseptic  Gauze 211 

Cheadle :  Constipation  in  Childhood 
and  its  Se*|uel-  Antony,  and  Dilata- 
tion of  the  Colon ' 211 

The  Antiseptic  Treatment  of  Summer 
Diarrh<£a 212 

EDITORIAL 

Canadian  Me(li<-al  As>ociation 214 

Sir  .lames  A.  Grant,  M.J) 214 

A  Magnificent  Donation 215 

Personal  215 

Review 215 

I 


Sociciij  sProccedi/iO'i, 

MEDICO-CHIRURGICAL  SOCIETV  OF 

MONTREAL. 

Stated  Meeting,  Alarch   wth,   18S7. 

Dr.  WiLKiN's,  1ST  Vice-President,  ix  the 
Chair. 

Dr.  Geo.  H.  Fox  of  New  York,  Dr.  Phelps  of 
Chateauguay.  and  Dr.  Jackson  of  Brockville  were 
present  at  the  meeting. 

Common  Errors  in  the  Treatment  of  Skin  Dis- 
eases.— Dr.  Fcx  read  a  paper  on  the  common  errors 
in  the  treatment  of  skin  diseases.  He  said  that  the 
great  error  made  by  practitioners  in  treating  skin 
diseases  was  failure  to  treat  the  patient ;  the  disease 
is  treated,  not  the  patient.  It  is  most  important 
that  the  patient  have  fresh  air,  wholesome  food — 
in  short,  everything  that  tends  to  improve  the  gen- 
eral health.  Special  treatment  of  the  disease  is  of 
no  avail  without  improving  the  condition  of  the 
patient.  He  regarded  attention  to  the  diet  as  most 
important,  and  said  there  should  be  a  radical 
change  both  in  the  quantity  and  quality  of  the 
food;  a  strict  course  of  diet  should  be  given  the 
patient ;  the  majority  of  patients  improve  on  star- 
vation diet.  He  advised  his  patients  to  increase 
the  quantity  of  fluids  taken  and  decrease  the  solids ; 
to  eat  less  and  exercise  more.  A  change  of  diet 
almost  invariably  proves  of  value,  the  more  radical 
the  better;  he  gets  the  best  therapeutical  effects 
from  a  vegetable  diet  in  the  treatment  of  inflam- 
matory skin  affections.  A  meat  diet  congests  the 
skin  ;  a  vegetable  diet  relieves  the  congestion. 
He  is  in  the  habit  of  restricting  the  meat  in  winter 


and  forbidding  it  in  summer.  In  giving  directions 
to  a  patient  it  is  better  to  tell  them  what  to  eat  than 
what  to  avoid.  Water  should  be  taken  sparingly 
at  meals,  but  in  quantit}^  between  meals.  In 
speaking  of  local  applications,  he  said  that  very 
few  are  needed.  If  the  disease  be  acute,  soothing 
applications  should  be  given  ;  if  chronic,  stimulat- 
ing ones.  Infantile  eczema  is,  as  a  rule,  too  much 
stimulated,  and  chronic  eczema  with  infiltration  too 
little  stimulated.  In  treating  psoriasis,  chrj'so- 
phanic  acid  is  the  best  remedy,  but  even  this 
remedy  should  not  be  used  in  every  case,  as  it 
does  positive  injur}'  where  there  are  congestion 
and  inflammation,  but  later,  when  the  eruption 
becomes  dry,  it  does  good.  In  acne  a  tonic  treat- 
ment is  best.  In  speaking  of  local  applications, 
the  reader  of  the  paper  stated  that  when  the  sub- 
stance is  needed  to  be  absorbed  by  the  skin,  then 
the  animal  fats  should  be  used ;  when  mere  pro- 
tection is  wanted,  then  vegetable  fats  do  very  well. 
Vaseline  has  but  little  power  of  penetrating  the 
skin.  He  then  went  on  to  speak  of  arsenic,  which, 
he  said,  is  used  too  much  by  the  general  practi- 
tioner in  the  treatment  of  skin  diseases,  and  which, 
as  regards  skin  diseases,  would  not  be  missed  if 
abolished  from  the  pharmacopceia  ;  he  now  rarely 
uses  it.  It  is  at  best  a  much  over-rated  remedy, 
and  its  indiscriminate  use  in  skin  diseases  is 
fraught  with  e\il. 

Discussion. — Dr.  Shepherd  said  he  was  not 
prepared  to  go  the  length  Dr.  Fox  did  in  attribut- 
ing such  a  vast  influence  to  diet  in  the  treatment 
of  skin  diseases.  Xo  doubt  it  is  often  of  impor- 
tance, but  he  thought  that  Dr.  Fox,  like  many 
others,    was   riding  his  special   hobby  too   hard. 


194 


THE   CANADA  MEDICAL   RECORD. 


Did  not  think  that  individuals  among  the  poorer 
classes  with  eczematous  diathesis  or  when  the  dis- 
ease was  due  to  their  occupation  could  be  cured 
by  dieting.  No  doubt  people  eat  too  much,  and 
this  is  especially  true  in  the  higher  ranks  of  society. 
In  such  patients  diet  is  of  the  utmost  importance. 
In  this  country,  people  eat  too  much  meat, and  he 
is  in  the  habit  of  limiting  it  to  one  meal  a  day. 
In  regard  to  local  applications,  he  was  thoroughly 
in  accord  with  Dr.  Fox.  Most  physicians  in  inflam- 
matory diseases  stimulate  too  much.  It  is  a  com 
mon  thing  for  physician.i  to  prescribe  zinc  oint- 
ment in  every  case,  and  give  no  directions  about 
the  use  of  soap  and  water.  He  found  many  skins 
in  the  acute  stage  of  eczema  unable  to  bear  oint- 
ments at  all,  and  to  be  much  relieved  by  mild  lead 
lotions.  He  also  agreed  partially  with  Dr.  Fox 
concerning  the  misuse  of  arsenic ;  it,  like  zinc 
ointment,  is  prescribed  in  routine  practice  by 
many  practitioners.  Thougli  of  little  value  in  ecz- 
ema, he  thougln  he  had  given  it  with  good  effect 
in  psoriasis  and  bullous  eruptions.  He  had  no 
hesitation,  however,  in  stating  that  it  was  a  valu- 
able tonic,  and  he  would  be  sorry  to  do  without  it. 

Dr.  How.ARD  said  that  the  jjaiier  presented  but 
few  novelties  in  the  present  state  of  the  science 
of  medicine.  Skin  diseases  are  but  local  manifes- 
tations of  a  general  condition,  and  it  is  but  natural 
that  the  most  successful  treatment  would  be  an 
alterative  one,  aimed  at  the  cause  of  the  unhealthy 
condition  of  the  skin.  He  was  not  prepared,  how- 
ever, to  hear  that  so  much  attention  is  given  to 
diet,  but  it  seems  only  rational.  Chronic  diseases 
generally  requir(i  dietetic  treatment,  so  one  should 
not  be  suprised  to  find  it  efficient  in  chronic  forms 
of  skin  diseases.  Formerly  arsenic  was  given  for 
all  forms  of  skin  disease.  He  agreed  with  the 
last  speaker  in  thinking  that  arsenic  was  valuable 
as  a  tonic,  and  he  had  obtained  good  results  from 
its  use  in  psoriasis  and  bullous  affections. 

Dr.  Kingston  said  that  for  the  last  ten  or  fif- 
teen years  he  had  practically  abandoned  local 
treatment  in  skin  affections  and  used  only  consti- 
tutional, and  had  always  regarded  a  carefully  regu- 
lated diet  of  the  first  importance.  He  could  not 
agree  with  Dr.  Fox  in  what  he  said  about  a  meat 
diet.  The  French  Canadians  are  great  meat  eaters, 
yet  they  were  remarkably  free  from  skin  affections. 
Some,  however,  visit  the  United  States,  work  in 
factories,  and  live  in  boarding-houses  where  the 
diet  is  largely  composed  of  hot  biscuits,  doughnuts, 
pies  and  pastry,  and   live  in  small  rooms;  then 


come  back  with  skin  diseases  which  cannot  be  due 
to  a  meat  diet.  The  speaker  attributed  most  of 
the  skin  affections  he  had  met  with  to  want  of  fresh 
air  and  use  of  highly-spjced  and  other  forms  of 
irritating  food,  while  not  a  few  cases  could  be  traced 
to  the  excessive  use  of  green  tea.  Bread  and  meat 
he  considered  a  good  diet  in  skin  diseases ;  he  also 
believed  in  taking  large  quantities  of  water  between 
meals. 

Dr.  Phelps  said  that  as  a  gener.al  practitioner 
in  the  country  he  could  endorse  every  word  Dr. 
Fox  had  said.  He  believed  most  thoroughly  in 
a  com|  lete  change  of  diet  in  skin  affections.  He 
had  even  found  a  change  from  a  good  diet  to  an 
apparently  bad  one  beneficial.  He  mentioned 
some  severe  cases  of  infantile  eczema  which  were 
completely  cured  by  changing  the  diet  from  fresh 
cow's  milk  to  condensed  milk.  Acne  in  female^ 
is  very  generally  caused  by  uterine  disease,  and 
until  this  is  cured  the  acne  cannot  be  relieved. 

Dr.  Lapthorn  Smith  said  he  had  long  held 
that  all  skin  diseases  not  parasitic  or  specific  were 
due  to  errors  in  diet.  He  had  little  faith  in  local 
treatment,  but  considered  that  it  is  most  import- 
ant to  attend  to  the  condition  of  the  stomach.  He 
thought  that  the  good  old  mixture  of  rhubarb  and 
soda  is  too  much  neglected  in  the  treatment  of 
skin  diseases. 

Dr.  Mills  believed  Dr.  Fox's  paper  to  be  of 
great  miportance  to  the  medical  public.  He 
regarded  Dr.  Fox  as  a  type  of  a  specialist,  who, 
though  a  specialist,  treats  his  patients  from  a  broad 
knowledge  of  general  medicine  and  dietetics.  To 
this  in  no  small  degree  he  believed  Dr.  Fox's  suc- 
cessful career  to  be  due. 

Dr.  WiLKiNS  asked  if  Dr.  Fox  believed  in  an 
exclusive  milk  diet  in  eczema ;  also  if  in  peniten- 
tiaries, where  the  diet  was  regulated,  was  there  less 
skin  disease.  He  also  asked  if  in  Germany,  where 
little  meat  is  eaten,  there  is  a  less  amount  of  skin 
disease. 

Dr.  Fox,  in  reply,  stated  that  he  did  not  so  much 
object  to  meat  as  an  article  of  diet  as  to  its  exces- 
sive use.  He  had  found  the  most  obstinate  cases 
of  eczema  yield  to  a  complete  change  of  diet  that 
was  only  temporary.  With  regard  to  milk  diet  in 
eczema,  he  formerly  believed  in  it,  but  found  many 
patients  could  not  take  it.  He  had  tried  it  on 
himself,  and  found  he  was  unable  to  stand  it  for 
more  than  a  few  days.  The  excessive  amount  of 
skin  disease  in  Germany  could  be  accounted  for 
by  the  habitual  use  of  cabbage  and  beer  as  articles 


THE   CANADA   MEDICAL   RECORD. 


195 


of  diet.  He  found  beer  very  injurious  in  inflam- 
matory skin  affections,  much  more  so,  indeed,  than 
whiskey.  Rliubarb  and  soda  he  regarded  of  great 
use,  but  are  jM'escribed  too  much  in  a  routine  man- 
ner in  dispensaries  and  hospitals.  One  must 
ahvays  treat  each  particular  case,  remembering  thai 
what  is  suitable  Ireatmvnt  in  one  case  m;iy  1>'' 
[lOsitively  injurious  in  aiiolhci  ]ialieiit  with  the 
same  disease. 

IJr.  Howard,  in  proposing  a  vote  ut  thanks  to 
Dr.  Fox,  referred  to  a  great  privilege  the  Society 
had  enjoyed  in  so  being  brought  in  contact  with  a 
man  of  such  extensive  experience.  In  Dr.  Fox's 
jiaper  there  was  nothing  new,  and  in  saying  this  he 
paid  him  the  highest  possible  compliment,  for  the 
whole  tendency  of  his  paper  was  to  illustrate  the 
great  scientific  truth  that  in  medicine  we  cannot 
treat  the  disease.  We  must  treat  the  individual, 
the  constitution.  He  was  struck  by  the  effect  of 
change  of  diet,  as  shown  by  the  numerous  examples 
quoted  by  the  previous  speakers,  in  breaking  up 
the  sequence  of  disease  ;  one  speaker  even  advising 
the  use  of  peaches  as  an  article  of  diet. 

Dr.  HiNGSTON  seconded  the  motion.  In  the 
course  of  a  few  happy  remarks  he  referred  to  the 
effect  that  the  present  fishery  dispute  might  have 
in  lessening  the  supply  of  a  wholesome  article  of 
food  in  the  American  maiket. 

It  was  then  moved  by  Dr.  Trenholme,  seconded 
by  Dr.  Lapthorn  Smith,  that  Dr.  Fox  be  made 
an  honorary  member  of  the  Society.  Tliis  was 
carried  unanimously. 

LETTER  FROM  BERLIN. 

(^From  cur  otin  Coi r^spoiiili'iit .) 
In  my  letter  from  Paris  I  had  so  much  to  say 
about  Apostoli  and  his  wonderful  clectricd  treai- 
ment  of  diseases  of  women,  that  I  had  no  space 
left  for  that  wonder  of  this  medical  age,  Professor 
Charcot.  Have  you  ever  seen  him  ?  Of  medium 
height  but  most  commanding  presence  ;  his  long 
hair  drawn  back  from  his  massive  forehead  and 
hanging  down  his  neck  ;  his  head  poised  high  and 
bringing  into  strong  prominence  his  aquiline  nose  ; 
his  eagle  eyes  which  pierce  through  yours  so  that 
he  seems  to  read  your  very  soul,  but  which  you 
cannot  look  beyond.  No  wonder  that  he  can  tame 
the  wild  maniacs  of  the  Salpetriere  vvith  one  magic 
glance.     He  calls  it  hypnotisme  this  power  that 


he  has,  and  he  and  many  others  say  that  many 
people  might  learn  to  acquire  it.  Btit  I  think  it  is 
mesmerism /«/- rf  siiiif/e;  that  incomprehensible 
[lower  which  a  great  mind  has  over  a  weaker  one. 
lly  it  he  is  alile  to  cure  many  diseases  of  defective 
innervation,  of  the  hysterical  class,  which  are  due 
to  weakness  or  absence  of  will  power,  and  which 
power  he  sup])lies  for  them  until  they  regain  their 
own.  It  is  a  wonderful  sight  to  see  him  like  the 
'  (heat  Physician  "  commanding  the  paralysed  to 
take  uji  their  bed  and  walk  ;  or  to  see  him  step  up  to 
another  tortured  with  ceaseless  movements,  which 
are  at  once  arrested  by  a  single  look.  What  a 
charming  Ici  tiirer  ;  he  does  not  call  them  lectures 
or  clinics,  but  conferences.  We  all  sit  around  him 
leaving  a  little  open  space  between  him  and  the 
patients  about  whom  he  is  speaking,  and  he  just 
talks  away  as  if  he  was  recounting  reminiscences 
of  the  past,  now  a  case,  now  an  anecdote,  now  a 
theory  and  now  a  fcct,  but  every  one  of  them 
directly  to  the  point.  As  you  listen  you  too  be- 
come infatuated  with  him  and  feel  that  you  must 
do  like  the  poor  maniacs  and  cast  yourself  in 
humble  submission  at  his  feet.  Two  years  ago  I 
prepared  a  paper  on  a  case  of  genuine  scleroder- 
ma under  my  care  at  the  Children's  hospital  in 
London.  Charcot  had  such  a  case  but  not  nearly 
so  marked.  But  how  he  described  it  I  All  that 
I  had  discovered  aliout  it  in  six  months  of  research 
he  gave  forth  in  polished  and  familiar  terms. 

Within  the  last  ten  years  Berlin  has  made  im- 
mense strides  forward  in  the  advance  of  medical 
education.  By  the  well  organized  German  sys- 
tem of  centrahzation  the  best  man  in  each  subject 
is  always  brought  to  the  capital,  but  before  reach- 
ing that  summit  of  his  ambition  he  may  have  been 
promoted  twenty-three  times,  as  there  are  that 
many  universities  in  the  empire,  and  they  are  all 
under  the  control  of  the  Government.  The  nura- 
lier  of  the  students  attending  them  varies  all  the 
way,  from  forty  at  Giessen  to  thirteen  hundred  at 
Berlin,  besides  at  the  latter  place  some  five  hun- 
dred foreign  doctors  constituting  the  medical  float- 
ing population.  Just  before  my  arrival  there 
Schrceder,  the  Professor  of  Gyntecology,  had  died, 
and  Olshausen  of  Halles  was  promoted  to  his 
place,  and  so  on  all  down  the  line  until  thty  catne 
to  Giessen  which  was  thus  left  without  any.  Then 
they  took  Hofmeier,  who  was  Schroeder's  first 
assistant,  at  Berlin  and  made  him  Professor  at 
Giessen  where  he  will  have  to  remain  until  there 
is  a  vacancy  in  one  of  the  twenty-two  other  univer- 


196 


*HE   CANADA   MEDICAL   RECOR!}. 


sities,  when  he  will  be  promoted  one  or  perhaps 
several  steps  at  a  time.  When  I  called  upon 
Hofmeier  a  day  or  two  after  his  appointment  he 
was  all  ready  with  his  effects  packed  prepared  to 
march  on  the  morrow.  In  the  same  way  Olshausen 
walked  into  the  Women's  hospital  a  few  daj's 
after  leaving  Halles  and  began  operating  as  if  he 
had  been  working  in  the  same  tlieatre  all  his  life. 
He  brought  his  own  first  assistant  with  him,  Dr. 
Thorn,  who  will  in  turn  be  promoted  to  Giessen 
when  Olshausen  dies,  but  the  other  five  assistants 
of  Schrceder  remain  as  before.  Even  the  private 
hospital  of  the  deceased  professor  is  generally  pur- 
chased by  his  successor. 

Olshausen  is  a  thin,  pale,  slightly  built  man  with 
black  hair  commencing  to  turn  gray,  and  he  wears 
on  his  face  that  intensely  earnest  and  anxious  ex- 
pression which  is  an  indication  of  the  price  he  has 
to  pay  for  being  great.  As  one  of  his  critics  told 
me  he  owed  his  position,  a  really  exalted  one,  not 
to  natural  talent,  but  to  indomitable  energy  and 
unceasing  toil. 

He  is  a  splendid  lecturer,  using  only  the  most 
classical  language,  but,  unfortunately  for  strangers, 
speaks  very  little  French  or  English.  Apropos  of 
this  difficulty  of  languages,  I  found  a  growing  feel- 
ing in  favor  of  having  one  universal  language  for  the 
whole  world,  and  as  English  is  already  spoken  by 
five  hundred  millions,  it  would  be  most  graceful 
and  on  the  whole  easiest  for  the  other  nations 
using  some  fifty  other  languages  to  gradually  adopt 
it.  It  could  be  done  in  a  few  generations,  if  Eng- 
lish were  taught  in  every  school  in  the  world  in 
addition  to  the  mother  tongue.  The  same  result 
is  being  reached,  but  much  more  slowly,  by  the 
present  method  of  introducing  English  words  into 
the  French  and  German  languages.  Even  in  that 
way  in  the  course  of  a  few  hundred  years  there 
will  probably  be  only  one  mongrel  language  for 
all  civilized  nations.  In  the  meantime  I  would 
strongly  recommend  all  medical  men  who  have 
sons  destined  for  the  medical  profession  to  have 
them  taught  to  speak  English,  French  and  German 
by  nurses  or  servants  from  those  countries,  before 
they  are  sent  to  school.  Pardon  my  digres- 
sion. I  was  speaking  of  the  splendid  organization 
of  medical  teaching  in  (Germany.  One  of  its  great- 
est advantages  is  the  economising  of  time  to  the 
medical  visitor.  Thus  I  went  there  for  Gynaeco- 
logy and  Midwifery,  and  this  is  how  I  spent  my 
day.  Rising  at  6  a.m.  and  after  a  bath  and  putting 
on  clean  underclothes, both  of  which  are  obligatory, 


and  a  light  breakfast,  which  is  at  you  own  discre- 
tion, I  arrived  at  the  Franenclinic  or  Woman's 
Hospital  at  7  sharp.  The  porter  requires  you 
to  sign  a  book  in  which  you  state  that  you  under- 
stand the  principle  of  antisepsis  and  that  you  have 
taken  a  bath,  put  on  clean  clothes,  not  been  to  any 
septic  case,  etc.  You  then  go  to  a  small  waiting 
room  where  you  remove  your  outer  clothing,  collar, 
necktie  and  braces,  and  where  you  are  furnished 
with  a  clean  white  coat.  The  air  of  this  room  is 
saturated  with  carbolic  spray  in  which  you  remain 
until  7.15,  at  which  time  you  are  invited  to  enter 
the  operating  theatre  where  you  find  the  patient 
narcotized,  the  assistants  in  their  places  and  the 
operator  just  about  to  make  his  incision.  Absolute 
silence  prevails ;  and  no  one  dares  to  touch  an 
instrument ;  if  he  did  it  would  be  discarded. 

Martin,  who  is  the  best  operator,  never  speaks 
during  an  operation  ;  Olshausen,  the  next  best, 
being  slower  and  more  labored,  speaks  occasion- 
ally, while  Gusserow,  who  is  much  inferior  to  either 
of  them  as  an  operator,  keeps  up  a  lively  conversa- 
tion all  the  time.  Olshausen  operates  from  7.15 
until  about  9.45,  in  which  time  he  generally  gets 
through  an  extirpation  of  the  uterus  or  a  laparo- 
tomy and  two  fistula  or  prolapsus  operations.  He 
then  comes  down  to  the  Midwifery  clinic  where  he 
remains  till  1 1  o'clock.  Here  he  generally  has  a 
case  of  labor  under  chloroform  or  serveral  cases 
in  different  stages,  or  perhaps  a  case  of  pregnancy 
at  the  eighth  month,  a  case  of  ovarian  cyst  and  a 
case  of  ascites,  in  order  to  practice  the  students  at 
diagnosing. 

The  stranger  who  is  so  fortunate  as  to  receive 
an  invitation  to  Martin's  private  hospital,  a  walk  of 
eight  minutes  distant,  at  once  proceeds  there,  where 
the  operations  last  from  10.15  to  1.15  O""  ^^^^'  ^^ 
Martin  is  a  much  quicker  operator,  often  doing  a 
laparotomy  in  i  r  minutes.  He  generally  has  one 
or  two  of  these  and  one  or  two  prolapsus  operations, 
of  which  I  shall  speak  later.  After  dinner  you  can 
go  to  Wyder's  private  course  on  operative  gynaeco- 
logy on  the  dead  subject,  which  lasts  from  2  to  4 
and  then  across  the  street  is  Gusserow's  clinic  at  the 
Charite.  In  the  evening  you  can  have  a  teacher 
of  German  to  come  to  your  house.  If  by  chance 
some  day  there  is  no  operation  at  one  of  these  three 
hospitals  the  student  is  seach  of  Gynaecology  can 
go  to  Veit's  clinic  in  the  Steinmetz  Straus,  where  he 
can  learn,  what  it  is  difiicult  to  do  at  the  others, 
die  routine  treatment  of  ordinary  diseases,  in  ad- 
dition to  a  fair  assortment  of  operations.     Veil  is 


THE    CANADA   MKDICAL    RECORD. 


197 


very  original,  a  bold  operator,  but  not  so  careful  as 
Martin.  He  is  very  affable  and  ready  to  explain 
every  thing  you  ask  of  him. 

Berlin  offers  equal  advantages  to  the  student  of 
general  surgery.     Hahn,  the  surgical  director  of 
the  Berlin  city  hosj)ilal,  situated  in   the  centre  of 
the  Fried iicl;shalm  park,  where  he  has  nearly  400 
beds  under  his  immediate  care,  begins  to  operate 
every  day,  Sundays  included,  at  10  a.m.,  and  gener- 
ally keeps  on  until  2  or  3  o'clock  p.m.     In  order 
to  save  time  two  patients  are  being  chloioformed 
outside  while  two  are  being  operated  on,  the  assis- 
tants tying  the  arteries  and  apjilying  the  dressings 
while  Hahn  goes  on  with  the  next  oi:)eration.  Thus, 
the  morning  that    I   casually  dropped    in    there, 
he  opened  the  stomach  on  account  of  stricture,  he 
performed  tracheotomy,  an  excision  of  the  shoulder 
and  another  of  the  knee  ;  amputated  an  arm,  and 
removed  a  dead  tibia,  besides  performing  a  number 
of  minor  though  difficult  operations.     Chloroform 
was  the  only  anassthetic  used,  and  the  usual  inhaler 
was  a  light  wire  frame  covered  with  flannel.  While 
I  was  inquiring  whether  they  ever  had  deaths  on  the 
table,  and  the  assistant  was  telling  me  that  he  had 
never  seen  a  death  but  several  narrow  escapes,  the 
patient  who  was  having  her  stomach  opened  sud- 
denly  ceased  to  breathe    and    nearly   a    minute 
elapsed  before  it  was  noticed  by  the  operator.  But 
in  less  time  than  it  takes  me  to  describe  it,  he  had 
the    electrical   faradic   machinery  going   and  the 
tongue  drawn  out.     For  two  or  three   minutes  the 
current  seemed    to  have  no    other   effect  than  to 
cause  diabolical   contortions  of    the  muscles  and 
features  of  the  apparently  lifeless  woman  ;  as  soon 
as  he  removed  the   poles  the  artificial  respiration 
ceased.     He  persevered,  however,  until  at  last  she 
drew  a   breath  of  her   own   accord,  when   Hahn 
threw  down  the  electrodes,  picked   up  his  needle- 
holder   and   went   on  with   the  delicate  work  of 
sewing  the  stomach  to  the  abdominal  parietes  as 
though  nothing  had  occurred.     The  stomach  was 
so  contracted  from  want  of  use  that  it  could  not  be 
drawn  down  below  the  ribs  or  cartilages  but  had  to 
be  brought  out  between  the  9th  and  loth  ribs.      I 
have  already  said  that  the  hospital  is  situated  in  a 
park,  but  I  omitted   to  mention  that  it  is  built  on 
the   pavillion   system,  there  being  about  si.xteen 
separate  buildings,  all  separate,  the  only  connection 
between  them  being  a  smooth  stone  tramway,  on 
which  the  rubber  wheeled  waggons  for  hauling  the 
beds  to  the  operating  building,  and  the  food  from 
the  kitchen  pavillion  to  the  wards.      What  strikes 


one  most  are  the  sjilcudid  arrangements  for  cleanli- 
ness ;  thus  the  floor  of  the  operating  room  is  tiled, 
with  a  slope  to  the  centre,  so  that  after  every 
bloody  operation  a  hose  is  turned  on  and  the 
floor  washed  clean  in  a  minute.  All  the  shelves 
are  made  of  [jlate  glass  and  iron  ;  and  rubber  tubes 
of  different  colors  bring  the  disinfecting  solutions 
fiom  barrels  on  the  wall  right  over  to  the  operating 
tables  in  the  centre  of  the  room. 

In  tlie  afternoon  you  can  go  to  Bergman's 
clinic  in  the  Ziegel  Strasse  where  they  "run" 
three  or  four,  and  I  have  been  told  as  many  as 
eight  tables,  simultaneously;  I  can  believe  it  as 
the  material  is  enormous. 

But  to  return  to  my  Gynajcology.  I  spoke  above 
of  the  prolapsus  operation  as  the  usual  treatment 
now  for  prolapsus.  Martin  does  not  waste  much 
time  on  these  cases.  As  the  os  is  generally  hyper- 
tro|)hied,  the  bladder  and  rectum  prolapsed,  and 
the  uterus  down,  he  treats  nearly  all  these  cases 
simply  by  an  operation  which  may  be  divided  into 
4  stages  :  ist,  amputation  of  the  cervix  uteri  ;  2nd, 
colporrhaphy  anterior  or  removing  a  piece  of  sur- 
plus mucous  membrane  from  the  vagina  covering 
the  bladder,  and  sewing  the  wound  together ;  3rd, 
posterior  colporrhaphy  making  the  posterior 
vaginal  wall  smaller  in  the  same  way,  and,  finally, 
4th,  sewing  up  the  torn  p>erineum.  By  this  means 
even  an  old  woman  with  a  vagina  big  enough  to 
l)ass  your  fist  into,  comes  off  the  table  with  one 
into  which  you  can  barely  introduce  your 
first  finger.  All  these  plastic  operations  are  per- 
formed under  continual  irrigation  which  com- 
pletely does  away  with  the  need  of  sponges,  the 
liquid  used  being  generally  one  in  five  thousand 
of  sublimate.  Instruments  are  kept  during  the 
operations  in  a  solution  of  carbolic  one  in  fifty. 
In  the  abdominal  cavity  filtered  water  which  has 
been  boiled  is  generally  employed.  I  did  not  once 
see  wire  of  any  kind  employed;  catgut  being  the 
favorite  ligature.  It  is  prepared  by  immersion  for 
five  days  in  01.  Juniperi  Baccharum  and  then 
preserved  in  absolute  alcohol.  Silk  ligatures  are 
usually  employed  for  tying  pedicles  and  vessels  ; 
they  are  sometimes  prepared  by  soaking  in  an 
etherial  tincture  of  iodoform  ;  or  else  in  a  subli- 
mate solution.  \Vhen  they  wish  to  make  the  cat- 
gut resist  absorption  longer  than  three  or  four  days, 
they  soak  it  in  a  solution  of  chromic  acid  which 
hardens  it.  Sjjonges  when  needed  at  all  are  re- 
placed by  rolls  of  absorbent  cotton  covered  with 
sublimate  gauze,  and   which  are    destroyed  after 


198 


THE  CANADA  MEDICAL   RECORD. 


being  used  once.  Strange  to  say  the  favorite 
remedy  in  subinvolution  is  the  fluid  extract  of  our 
own  Hydrastis  Canadensis,  of  which  they  speak 
in  the  highest  terms.  Want  of  time  pievents  me 
from  saying  more  at  present,  but  I  may  write  again 
about  two  wonderful  cases  of  recovery  after  lapa- 
rotomy for  extra  uterine  fcetation,  complicated 
with  shock  and  internal  hemorrliage. 
Till  then  adieu. 

Yours  trnly, 
A.  LAPTHORN  SMITH,  M.D. 

J^'m0erU  0/  Scienci'. 

SPRAINED  JOINTS. 

BY   EDMOND   OWEN   F.R.C.S. 

A  sprain  is  the  result  of  a  twist  or  wrench  which 
has  stretched  the  fibrous  capsule  of  an  articula- 
tion and  its  synovial  membrane,  but  which  has 
not  sufficed  to  cause  either  fracture  or  dislocation. 
The  injury  should  be  treated  upon  exactly  the 
same  surgical  principles  as  those  which  guide  us  in 
dealing  with  a  fracture  or  dislocation  of  a  joint ; 
yet  a  joint  which  is  only  "sprained  "  is  somewhat 
apt  to  obtain  but  scant  professional  attention. 
Though  the  common  saying  teaches  us  that  ''  A 
sprain  is  worse  than  a  break,"  the  unfortunate 
sul)ject  of  a  sprain  is  usually  contented  with  doing 
the  best  that  he  can  for  himself  with  arnica,  cold 
water,  or  oil,  as  chance,  exjierience,  or  advice 
may  suggest,  seeking  the  surgeon's  aid  only  for 
the  remote  and  often  intractable  complications. 
In  unhealthy  subjects,  and  especially  in  children, 
want  of  treatment  often  entails  articular  troubles 
which  run  a  lingering  course  and  may  end  disas- 
trously ;  and  even  with  the  strong  a  severe  sprain 
is  apt  to  involve  a  long  continued  enfc-eblemcnt  of 
the  part. 

Immediately  after  a  sprain  there  is  a  want  of 
pliability  in  the  joint,  due  in  part  to  the  pain  and 
tenderness  caused  by  the  violence,  in  part  to  the 
tension  of  the  sensory  nerve  filaments  from  the 
sudden  effiision,  and  in  part  also  to  the  mere  me- 
chanical effect  of  the  presence  of  blood  and  other 
fluids  in  and  around  the  joint.  In  certain  situa- 
tions a  serious  wrench  of  an  articulation  may  give 
no  visible  sign  upon  the  surface  of  the  body;  espe- 
cially is  this  the  case  with  the  hip,  the  shoulder 
and  the  spinal  articulations,  all  of  which  are  thickly 
covered  ;  stiffness  will  then  be  only  the  objective 
sign  indicative  of  the  lesion. 

If  a  joint  in  tlie  lower  extremity  be  seriously 
sprained,  temporary  but  absolute  rest  should  be 
secured  liy,  if  practicable,  putting  the  patient  at 
once  to  bed  ;  by  raising  the  limb  on  a  pillow  or  in 
a  swing  cradle,  until  the  heel  is  above  the  level  of 
the  chin,  so  as  to  hinder  capillary  and  venous 
conjestion,   and  by  applying  firm  and  even  com- 


pression. I  am  convinced  that  judiciously  applied 
compression  not  only  checks  eftusion,  but  also 
promotes  the  absorption  of  fluid  which  has  already 
been  poured  out,  and  as  a  rule  the  patient  expe- 
riences immediate  comfort  from  it.  At  times,  how- 
ever, it  is  possible  that  from  tenderness  of  the 
skin  or  from  mere  ap]jrehension,  the  patient  will 
not  submit  to  the  compression  immediately  after 
the  injury.  Then  one  must  be  content  to  apply 
either  the  ice  bag  or  an  evaporating  lotion.  Cold 
plays  a  doable  part:  by  stimulating  the  vaso-motor 
nerves  it  causes  a  contraction  of  the  small  arteries, 
with  the  effect  of  checking  further  hemorrhage  and 
inflammation  and  limiting  the  effusion,  and  by 
numbing  the  sensory  nerves  it  diminishes  pain. 
The  lotion  should  not  be  used,  however,  as  is  often 
dune,  as  a  water  dressing  under  oil  silk.  It  must 
be  applied  on  a  single  fold  of  lint,  with  the  fluffy 
side  outwards,  so  that  evaporation  may  proceed 
with  energy.  The  lint  should  never  be  allowed  to 
get  dry,  nor  should  the  limb  be  covered  with  the 
bed  clothes. 

If  a  man  sprains  his  ankle  while  out  in  the  fields, 
it  should  as  quickly  as  possible  be  put  into  running 
water,  and  then  be  firmly  bandaged  with  strips  of 
wetted  handkerchiefs  ;  the  boot  should  be  worn,  if 
he  can  get  it  on  again,  for  the  sake  of  the  compres- 
sion it  affords,  but  it  is  better  not  to  remove  the 
boot  at  all  until  the  joint  can  be  bandaged. 

Nothing  short  of  absolute  rest  in  bed  suffices 
when  a  child  sprains  a  joint  in  the  lower  extrem- 
ity ;  he  must  not  be  trusted  to  lie  on  a  sofa,  for  he 
would  soon  be  off  it.  Where  the  hip-joint  is 
sprained,  the  limb  should  be  raised  and  rest  in- 
sured in  the  extended  position  by  the  application 
of  the  weight  and  pulley,  so  that  if  matters  do  not 
clear  up  there  will  be  no  need  for  further  change 
of  ])osition.  A  sprain  is  often  the  beginning  of  an 
attack  of  hip-joint  disease. 

In  the  case  of  the  knee  being  sprained,  the  leg 
would  be  extended  ;  in  case  of  the  ankle  being 
sprained,  the  foot  would  be  put  up  at  a  right 
angle.  But  in  each  instance  the  limb  should  be 
carefully  bandaged  u])wards  before  the  compres- 
sion is  applied,  or  cedema  may  follow ;  complete 
rest  would  be  still  further  insured  by  adjusting  a 
splint  to  the  back  or  side  of  the  limb.  Compres- 
sion may  be  applied  by  means  of  a  roller  of 
domette,  or  by  the  additional  aid  of  plastic  splint- 
ing moulded  on.  With  children  a  well  padded, 
flexible  metal  splint  is  of  great  service,  but  a  ca- 
sing of  plaster-of-Paris  and  house  flannel  answers 
even  better. 

I  have  at  present  two  men  under  my  care,  each 
with  a  severely  sprained  ankle,  the  part  being 
swollen  and  discolored  and  the  foot  stiff  and  use- 
less. The  foot  and  leg  have  been  immoblized  in 
well-lined  plaster-of-Paris  casings,  and  thus  the  pa- 
tients are  quickly  enabled  to  get  out  of  bed  and  go 
about  with  crutches,  without  risk  or  discomfort. 
In  neither  of  these  men  was  a  fracture  to  be  de- 
.  tected. 
I      When  an  ankle  is  greatly  swollen  from  a  recent 


THE   CANADA    MEDICAL   RECORD. 


199 


I 


injury,  and  signs  of  fiacture  are  not  evident,  it  is 
not  advisable  to  conduct  the  examination  for  ob- 
taining a  knowledge  of  the  exact  nature  of  the 
injury  in  too  inquisitive  a  manner.  If  the  limb  be 
treated  on  the  principles  enunciated  above,  it  will 
be  well  either  for  a  severe  sprain  or  a  fracture 
without  disjjlacement.  Possibly  the  [jaticnt  might 
be  unsettled  at  not  being  definitely  informed  whe- 
ther there  be  fracture  or  not,  for  the  oft  repealed 
question  of  the  patient  or  parent  as  the  surgeon 
examines  the  part  is,  "is  the  bone  broken?  "  But 
I  am  speaking  merely  of  the  principle  involved  in 
the  surgery. 

Absolute  rest  is  demanded  as  long  as  heat  of 
the  surface  and  intra-articular  pains  persist.  As 
ihe  pains  subside  recourse  must  be  had  to  frictions 
and  rubbings,  and,  he  use  of  stimulating  linamenls 
and  cold  douches.  The  rubbings  should  be  exe- 
cuted always  in  the  direction  of  the  venous  and 
lymphatic  return,  and  may  be  combined  with  firm 
fingering  about  the  part  and  the  rubbing  in  of 
olive  oil.  When  effusion  persists  over  the  painless 
joint,  one  may  apply  over  the  jotnt  the  even  com- 
pression of  a  Martin's  elastic  roller  for  a  certain 
length  of  time  each  day,  the  *ikin  being  duly  pro- 
tected by  a  soft  covering.  This  is  a  highly  satis- 
factory method  of  treatment  in  cases  of  chronic 
thickening  and  effusion.  Leslie's  soap  strapping, 
too,  when  evenly  and  liberally  ap]jlied  over  a 
sprained  joint,  is  an  excellent  therapeutic  measure 
in  the  days  following  close  upon  the  injury. 

At  other  times  nothing  seems  to  render  such 
efficient  aid  as  a  wetted  calico  bandage.  Com- 
pression in  some  form  is  needed. 

On  physiological  grounds  the  early  treatment  of 
a  sprained  joint  by  poultices  or  fomentation  is 
inexpedient.  The  application  of  warmth  produces 
a  vascular  fullness  of  the  part,  and  a  relaxed  con- 
dition of  the  tissues  which  are  in  need  of  being 
toned  up  and  strengthened ;  though  if  synovial 
inflammation  of  an  acute  kind  follow  the  sprain, 
leeches  and  fomentations  may  not  improperly  be 
indicated  later  on.  For  the  promotion  of  the  ab- 
sorption of  the  lingering  products  of  effusion,  an 
alternation  of  douchings  under  streams  of  hot  and 
cold  water  gives  valuable  aid.  In  no  stage  of  the 
pathological  process  associated  with  a  sprain  should 
arnica  solution  be  applied.  One  has  met  with 
instances  in  which  painful  and  serious  cellulitis 
has  followed  its  use,  even  where  there  has  been  no 
previous  lesion  of  skin.  How  is  it  that  arnica  has 
earned  its  reputation  in  the  treatment  of  sprains, 
and  how  has  that  reputation  managed  to  survive 
so  long  ? 

A  surgeon  was  driving  his  wife  in  the  countiy 
when  the  pony  fell  and  the  occupants  of  the  car- 
riage were  thrown  out  into  the  road.  When  I  saw 
him  a  few  hours  after  the  accident,  he  was  wearing 
his  right  arm  in  a  sling,  the  elbow  being  at  an 
obtuse  angle.  He  said  that  in  the  fall  the  right 
hand  (in  which  he  was  holding  the  reins)  and  the 
arm  were  doubled  and  twisted  underneath  him, 
and  that  thousih  he  was  sure  no  bone  had  been 


broken,  he  could  neither  bend  nor  straighten  the 
elbow  on  account  of  the  severe  sprain  it  had 
received.  He  said  that  on  his  way  home,  and 
certainly  well  within  an  hour  of  the  fall,  on  plac- 
ing his  left  hand  under  the  damaged  elbow,  he 
found  a  soft  swelling  which  seemed  pretty  nearly 
as  large  as  an  egg  ;  his  wife  could  also  feel  it 
through  his  coat  sleeve.  Having  taken  the  limb 
out  of  the  sling  and  removed  some  water  dressings, 
universal  and  extensive  effusion  in  the  articulation 
was  evident  ;  the  distended  synovial  membrane 
was  especially  bulging  about  the  head  of  tlie  radius. 
The  intra-ariicular  pain  was  intense.  There  was 
no  contusion  of  the  skin  nor  any  definite  ecchy- 
mosis  ;  movement  caused  great  distress. 

Beginning  at  the  fingers,  we  firmly  bandaged 
the  extremity  with  a  roller  of  domette  (wliich  Irom 
its  softness  and  elasticity  adapts  itself  with  delight- 
ful evenness  and  comfort),  drawing  the  turns 
which  surrounded  the  swollen  joint  itself  more 
closely  and  firmly  for  the  sake  of  compression. 
Then,  having  bent  to  the  proper  form  of  the  arm 
a  padded,  flexible  iron  splint,  and  carefully  ad- 
justed it,  the  elbow  was  packed  round  with  cotton 
wool,  and  having  enclosed  all  in  a  second  and 
wider  domette  roller,  and  having  got  the  patient 
to  bed,  we  arranged  the  arm  upon  a  pillow.  The 
compression  and  the  security  afforded  by  the  roller 
and  the  splint  gave  great  satisfaction.  On  the 
second  day  we  readjusted  the  splint  and  the  band- 
ages which  had  now  become  slack.  Most  of  the 
tenderness  and  swelling  had  departed.  Two  days 
later  and  at  other  intervals  we  tightened  the 
bandage,  finding  always  steady  improvement.  In 
ten  days  the  splint  was  removed  and  cautious  use 
of  the  arm  was  allowed,  but  for  the  entire  removal 
of  the  stiffness  a  course  of  shampooing  from  a  pro- 
fessional rubber  was  resorted  to.  The  effusion 
which  had  come  on  so  quickly,  within  an  hour  of 
the  injury,  was  evidently  not  inflammatory  in  its 
nature  ;  probably  it  consisted  of  synova,  blood  and 
serum. 

The  other  occupant  of  the  carriage  had  severely 
sprained  her  left  ankle,  which  was  painful,  stiff, 
and  full  of  sero  synovial  effusion.  There  was  no 
fracture.  The  swelling  was  confined  within  the 
limits  of  the  synovial  membrane  ;  it  did  not  extend 
up  above  the  external  malleolus  in  the  manner  so 
characteristic  of  Pott's  fiacture.  The  treatment 
adopted  consisted  in  surrounding  the  ankle  with 
an  even  layer  of  cotton  wool  and  in  bandaging 
from  the  metatarsus  upward  with  a  soft  roller,  the 
turns  of  which  were  continued  well  up  the  calt  of 
the  leg.  The  foot  thus  firmly  encased  was  raised 
upon  a  pillow.  In  a  few  days  all  the  excess  cf 
synovial  fluid  had  disappeared,  but  the  firmly  ap- 
plied bandage  was  still  worn.  In  a  week  she  be- 
gan to  use  her  foot,  and  was  finding  comfort  in 
having  it  and  the  ankle  rubbed  with  oil  several 
times  during  the  day.  On  the  occasion  of  my  first 
interview  the  patient  volunteered  the  important 
clinical  statement  that  after  the  accident  her  foot 
and  ankle  were  fairly  comfortable  until  her  boot 


200 


THE   CANADA    MEDICAL   RECORD, 


was  removed.  Probably  if  a  bandage  of  plaster  of- 
Paris  casing  could  have  been  applied  immediately 
after  the  accident,  but  little  effusion  or  cedema 
would  have  occurred.  Certainly  compression  of  a 
recently  sprained  joint  gives  results,  both  as  re- 
gards expedition  and  thoroughness,  with  which 
those  obtainable  by  the  system  of  evaporating  lo- 
tions cannot  be  compared. 

If  the  sprained  joint  be  in  the  thumb  or  finger 
much  pain  and  want  of  pliancy  may  result.  A  small 
splint  should  be  moulded  on  ;  firm  compression 
with  a  pad  of  cotton  wool  and  a  soft  bandage  ex- 
ercised;  and  the  hand  worn  in  a  sling — it  should 
not  be  left  free  except  for  the  cold  douchings.  A 
few  days'  absolute  rest  is  expedient. 

Even  long  years  after  all  the  local  signs  of  a 
sprain  have  passed  away,  a  jerked  or  sudden  move- 
ment of  the  joint,  or  a  change  in  the  weather, 
reminds  the  subject  that  the  part  is  not  absohitely 
sound.  Nearly  twenty  years  ago,  I  severely 
sprained  my  left  wrist  at  football,  and  to  this  day  it 
has  not  absolutely  recovered.  I  cannot  flexor  ex- 
tend it  as  I  can  its  fellow.  A  sudden  movement 
of  it  is  ofteil  accompanied  with  audible  crackling 
and  discomfort.  From  a  close  and  interested  ob- 
servation of  this  joint  I  feel  convinced  that  in  the 
crevices  between  the  articular  surfaces  of  the  bones, 
and  against  the  attached  parts  of  the  capsule  out 
of  the  way  of  pressure,  there  are  growing  delicate 
and  injected  fringes  of  the  synovial  membrane. 
The  synovial  fluid  is  thin  in  quality  and  in  excess 
of  the  normal  amount  ;  there  are  no  adhesions  in- 
side the  articulation,  but  tliere  is  probably  some 
shortening  of  the  extra-articular  fibrous  tissues 
which  were  implicated  in  the  inflammation — a 
shortening  secondary  to  inflammatory  thickening. 
Probably  this  shortening  of  the  fibrous  tissues  plays 
the  important  role  of  a  perpetual  splint  shielding 
the  enfeebled  synovial  membrane  from  further 
shock  and  distress.  On  no  account,  therefore,  will' 
these  adhesions  be  broken  down  or  stretched  by 
manipulation  ;  such  a  treatment  is  contra-indicated 
by  the  pain  which  closely  attends  any  attempt  at 
more  than  the  accustomed  movements  of  the  joint. 
The  very  audible  crackling,  which  even  a  by- 
stander may  sometimes  hear  on  working  the  joint, 
is  the  result  of  the  altered  synovial  fluid  being 
quickly  driven  by  the  movements  of  the  joint  be- 
tween the  vascular  fringes. 

Occasionally  when  a  joint  has  been  wrenched 
by  a  recent  accident,  and  is  in  consequence  pain- 
ful and  useless,  the  manipulative  examination  which 
it  receives  from  the  surgeon  is  the  means  of  re- 
moving much  of  the  pain,  as  well  as  of  restoring 
a  good  deal  of  the  lost  function.  I  am  satisfied 
that  such  impro\ement  is  real,  and  not  merely 
subjective.  Vet  because  in  the  weakly  and  ailing 
such  a  therapeutic  measure  might  ])robably  be  at- 
tended either  immediately  or  remotely  by  disas- 
trous results,  and  because  of  its  utterly  speculative 
nature,  it  is  not  to  be  reconnnended  as  routine 
practice,  though  it  may  well  be  kept  in  reserve  for 
rare  and  special  occasions.     It  certainly  has  a  close 


and  important  bearing  upon  the  question  of  bone- 
setting.  A  man  sprains  his  ankle  ;  the  surgeon 
examines  and  reports  accordingly  ;  but,  because 
no  bone  is  broken,  he  perhaps  speaks  of  the  lesion 
in  a  careless  or  offhand  manner,  and  does  not  in- 
sist on  the  necessity  of  rest  and  of  other  appropri- 
ate treatment.  So  the  ankle  does  not  get  sound, 
and  the  faithless  patient  resorts  to  a  quack,  who 
at  once  finds  "a  small  bone  out  of  place."  Then 
come  a  sudden  twist  and  a  crack,  and  lo  !  "the 
bone  is  in  again."  'J1ie  patient  believes  that  a  bone 
has  there  and  then  lieen  restored  to  its  place 
because  he  is  at  once  absolutely  more  comfortable, 
and  can  not  only  move  the  joint  freely,  but  can 
even  accejit  the  advice  to  throw  away  his  crutch  or 
his  stick,  and  walk  on  his  damaged  foot  without 
further  help.  Perhajis  he  is  told  to  go  home  and 
apply  ice  ;  and  at  any  rate  from  that  time  he  con- 
siders himself  to  be  and  indeed  is — cured.  Forcible 
manipulation  is,  of  course,  the  bone-setter's  pana- 
cea. I  have  known  him  employ  it  in  the  case  of 
fracture  of  the  surgical  neck  of  the  humerus,  and 
as  may  be  expected,  with  very  serious  results.  In 
the  case  of  recent  sprain,  however,  the  patient 
cannot  but  believe  that  the  bone-setter's  statement 
is  true,  because,  beyond  a  doubt,  his  manipulation 
has  proved  effectual. 

Tlie  following  report  illustrates  the  point  :  A 
gentleman  of  highly  nervous  temperament  came  to 
me  with  considerable  bruising  of  the  deltoid,  the 
day  after  receiving  a  fall  which  might  have  been 
attended  with  much  more  serious  consequences. 
The  arm  was  so  stiff  at  the  shoulder-joint  that  he 
could  not  raise  it  to  dress  himself,  nor  could  he 
touch  the  ear  of  the  opposite  side  whilst  his  elbow 
was  brought  towards  the  front  of  the  chest — it  re- 
mained permanently  though  slightly  abducted.  Any 
movement  of  the  arm  was  attended  with  pain  and 
distress.  There  was  no  definite  hollow  beneath 
the  acromion  process,  nor  any  other  unequivocal 
sign  of  discoloration.  There  was  a  great  element 
of  obscurity  in  the  case ;  the  patient  was  in  pain 
and  ajiprehension,  and  expressed  his  fear  that  the 
shoulder-bone  was  "  out." 

A  consultation  on  the  case  was  not  obtainable, 
and  the  course  of  action  had  to  be  decided.  So, 
to  err  upon  the  safe  side — if  error  there  might  be 
— and  in  order  to  make  a  thorough  and  practical 
examination  of  the  joint,  I  agreed  with  him  that 
there  was  "  displacement  of  the  shoulder  bone," 
and  laying  him  upon  the  floor,  with  my  heel  in  the 
axilla,  I  flexed  the  fore-arm  to  slacken  the  biceps, 
rotated  and  pulled  down  the  arm. and  then  adducted 
it  vi  ct  arte  and  in  a  most  determined  manner. 
There  was  no  click,  or  the  sign  of  a  readjustment 
having  taken  place,  I)ut  immediately  on  the  patient 
rising  from  the  ground  he  said  that  he  was  much 
more  comfortable  ;  he  had  lost  most  of  the  pain  ; 
he  could  move  his  arm  with  comparative  freedom  ; 
and  to  his  deliglit,  and  my  satisfaction,  he  dressed 
himself  without  assistance.  He  was  convinced 
that  I  had  reduced  a  dislocation.  In  my  own  mind 
I  was  sure  that  I  had  not,  but  for  obvious  reasons 


THE   CANADA    MEDICAL   RECORD. 


201 


I  did  not  tell  him  that  the  success  attending  my 
tivatment  was  worthy  of  a  more  exact  diagnosis. 
It  is  witli  no  sense  ofjiridc  that  I  record  the  case; 
nevertheless,  it  might  be  expedient  to  ado[)t  tiiis 
treatment  on  another  similar  occasion.  With  a 
hypcr-sensitive  and  nervous  patient,  and  a  fat  or 
swollen  shoulder,  it  is  occasionally  impossible  to 
affirm,  without  the  aid  of  an  an;csthetic,  that  there 
is  no  displacement.  Traction  on  the  bent  elbow, 
with  the  heel  in  the  axilla,  enables  the  surgeon  to 
make  the  necessary  examination.  Certain  am  I 
of  this, — that  my  nervous  patient  would  not  have 
allowed  me  thoroughly  to  examine  him  if  I  had 
first  said  that  I  thought  there  was  no  displace- 
ment. * 

I  have  observed  the  same  course  of  events  in 
other  cases.  For  instance,  a  man  has  just 
damaged  his  ankle,  which  is  now  painful,  swelled 
and  stiff;  a  thorough  manipulative  examination  re- 
veals no  definite  lesion.  But  immediately  after 
the  handling  the  patient  finds  the  foot  so  much 
better  in  every  respect  that  he  talks  too  lightly  of 
his  injury  and  wishes  at  once  to  walk  about.  Or 
an  elbow,  knee,  or  wrist  is  stiffened  by  a  wrench. 
On  being  thoroughly  overhauled,  nothing  is  found 
absolutely  wrong  with  it ;  but  the  jiatient,  though 
a  sufferer  during  the  examination,  finds  the  joint 
greatly  improved  by  it.  The  surgeon  will  rightly 
refuse  to  include  such  a  speculative  thera]icutic 
measure  in  his  routine  practice  ;  but  its  blind  em- 
ployment by  the  charlatan  is  the  means  of  secur- 
ing many  a  triumphant  success. 

Where  a  limb  is  stiff  from  chronic  muscular 
rheumatism,  much  good  may  often  be  done  by 
massage,  and  by  sudden  movements  imparted  to 
it,  the  stiffness  disappearing  by  magic,  whilst  no 
harm  can  follow  the  treatment. 

Stiffness  may  follow  on  a  sprain  from  effusion 
taking  place,  not  into  the  synovial  membrane  of 
the  articulation,  but  into  a  sheath  in  connection 
with  a  neighboring  tendon.  One  has  often  to  treat 
such  effusion  in  the  sheaths  of  the  extensors  of  the 
thumb  and  wrist,  and  also  in  those  of  the  tendons 
of  the  tibial  muscles  and  extensors  of  the  toes.  It 
is,  of  course,  easy  to  differentiate  between  an  arti- 
cular and  a  thenar  effusion  ;  the  same  principles 
direct  the  treatment  in  each  case.  I  have,  at  die 
present  time,  under  my  care,  a  wrist  which  is 
stiffened  from  slight  effusion  into  the  sheath  of  the 
radial  extensors;  great  relief  is  being  afforded  by 
the  firm  compression  and  support  of  a  domette 
roller  which  is  kept  constantly  wet— 7/;t-  Practi- 
tioner. 


THE  TREATMENT  OF  WHITLOW. 

From  time  immemorial  the  treatment  of  whitlow 
has  consisted  in  the  early  performance  of  deep 
incisions  carried  down  to  the  bone  and  prolonged 
poulticing.  This  routine  treatment  is  in  the  main 
accepted  by  most  surgeons,  yet  great  varieties  of 
opinion  are  held  as  to  the  time  when  incision  should 
be  performed,    the  locality,  and  the  duration  of 


poulticing,  it  being  held  by  many  that  the  necrosis 

that  so  often  follows  this  affection  is  due  to  the 
l)rolongcd  heat  from  the  poultice  as  much  as  to  the 
disease    itself.     The    subject    recently    has    been 
attracting  considerable  attention,  and  Mr.  Ailing- 
ham   {Afedical  Press,  %Q.Y\.Q.m\t(iv  2<^,  1886)  shows 
that  there  are  several  varieties  of  whitlow,  and  each 
of  these  requires  a  special  mode  of  treatment.    Mr. 
Allingham  described  five  varieties  of  whitlow.  The 
first,  which  he  terms  phlyzacious  pustule,  is  noth- 
ing more  than  an  accumulation  of  fluid  between 
the  epidermis  and  true  skin.     Of  course,  all  that  is 
required  is  to  puncture  the  blister  and  let  out  the 
fluid.     In  another  form,  a  collection  of  pus  may 
form  under  the  nail,  as  a  result  of  a  puncture  or  a 
breaking  down  of  blood,  following  a  pinch,  and 
so  give  rise  to  considerable  [win  of  a  throbbing 
character.     In  the  treatment  of  this  class  of  the 
disease,  Mr.  Allingham  recommends  the  insertion 
of  a  hare-lip  pin,    or   some   such    narrow-bladed 
instrument,  beneath  the  nail,  keeping  it  quite  close, 
so  as  not  to  wound,  if  possible,  the  tissue  beneath, 
passing  it  down  to  the  collection  of  pus,  and  then 
depressing  the  needle,  and  then  allowing  the  pus  to 
flow  out.     This  gives  instant  relief,  and  prevents 
the  matter  from  burrowing  beneath  the  nail,  and  so 
separating  it  from  its  bed.     Poulticing  and  waiting 
for  the  pus  to  work  itself  to  the  surface  will  entail 
a  needless  amount  of  unnecessary  suffering  upon 
the    patient.     Another  form  of  treatment,    which 
may  be  employed  when  the  collection  of  pus  is  sit- 
uated at  the  root  of  the  nail,  is  to  cut  away  tlie  nail 
from  the  seat  of  the  inflammation. 

Under  the  term  cellular  wliitlow,  Mr.  Allingham 
describes  the  inflammation  of  the  cellular  tissue 
covering  the  terminal  phalanx,  where  the  bone  is 
free  from  periosteum.  Inflammation  of  this  local- 
ity, by  producing  strangulation  of  the  vessels,  cuts 
off  the  supply  of  blood  to  the  part,  and  as  a  result 
causes  necrosis  of  the  phalanx.  Almost  as  soon  as 
the  first  symptoms  of  this  affection  develop,  as  may 
be  recognized  by  acute  pain  in  the  part,  with  the  tip 
of  the  finger  swollen,  tender,  tense,  and  sometimes 
red,  a  free  incision  should  be  carried  directly  down 
to  the  bone,  and  necrosis  of  the  terminal  phalanx 
will  thus  often  be  prevented.  When  cases  come 
under  observation  in  which  necrosis  of  the  phalanx 
has  already  taken  place,  deformity  may  be  prevent- 
ted,  according  to  Mr.  Allingham,  by  making  an 
incision  along  the  palmar  surface  of  the  finger,  re- 
moving the  necrosed  bone,  and  placing  a  narrow 
splint  on  the  back  of  the  finger,  allowing  it  to  pro- 
ject half  an  inch  beyond  the  nail.  The  nail  should 
then  be  fastened  to  the  splint  by  adhesive  plaster, 
so  as  to  prevent  it  curling  up,  and  it  thus  may  act 
as  a  background  on  which  new  bone  may  develop. 
The  fourth  form  of  whitlow  described  is  an  inflam- 
mation in  the  sheath  of  the  tendons  over  the  first 
or  second  phalanx.  It  may  arise  from  inflamma- 
tion spreading  from  without,  or  by  a  ])uru'lent 
inflammation  of  the  synovial  shealh  of  the  flexor 
tendon.  The  great  dangers  arising  from  this  foim 
of  whitlow  are  that  the  tendons  m;iy  be  destroyed, 


202 


THE   CANADA   MEDICAL   RECORD. 


the  inflammation  extend  into  the  joints,  or  the  pus 
find  its  way  into  the  pah->i  of  tlie  hand.  The  finger 
in  this  affection  soon  becomes  swollen  and  flexed, 
and  is  the  seat  of  severe  throbbing  pain,  the  part 
is  hot,  and  in  the  latter  stages  deep-seated  fiuctua- 
tion  may  be  recognized.  If  this  is  allowed  to 
progress,  the  whole  finger  may  become  involved, 
so  as  to  present  two  swellings  separated  by  a 
constriction  corresponding  to  the  joint. 

The  treatment  of  this  affection  is  identical 
according  to  Mr.  Allingham,  with  that  of  perios- 
teal whitlow,  from  which,  in  fact,  the  tendinous 
inflammation  can  only  be  recognized  with  very 
great  difiiculty.  Mr.  Allingham  is  strongly  in 
favor  of  treating  these  affections  by  lateral  incisions, 
for  on  account  of  the  difficulty  of  recognition  of 
the  locality  of  inflammation  should  the  inflamma- 
tion be  confined  to  the  periosteum,  the  central  inci- 
tion  must  be  carried  through  the  tendons  to  reach 
she  bone,  of  course  unnecessarily  damaging  the  ten- 
don. Mr.  Allingham,  therefore,  recommends  later- 
al incision,  claiming  for  it  the  following  advantages  : 

First. — As  it  is  difficult  to  tell  whether  the 
whitlow  is  periosteal  or  tendinous,  by  the  lateral 
incision,  if  it  should  be  periosteal,  no  damage  is 
done  to  the  tendons  by  cutting  through  them. 

Second. — By  lateral  incision  the  tendons  cannot 
prolapse  from  their  sheaths,  and  therefore  the  lia- 
bility to  gangrene  is  diminished. 

Third. — After  this  method  of  treatment  the 
finger  can  be  flexed,  and  so  relax  all  the  structures 
and  relieve  pain,  whereas  by  the  central  mcision 
the  finger  should  be  kept  straight,  to  prevent  the 
tendons  slipping  out  of  their  sheaths,  at  the  same 
time  straightening  such  inflamed  part  greatly 
increases  the  pain. 

Fourth. —  If  the  incisions  are  on  the  side  they 
they  are  less  likely  to  be  ])ressed  uiion,  for  the 
cicatrix  may  become  tender,  which,  if  in  the 
centre  of  the  hand,  is  exposed  to  pressure  every 
time  the  hand  is  closed.  Again,  a  cicatrix  in  the 
middle  line  may  contract,  and  cause  the  finger  to 
become  permanently  flexed,  whereas,  if  the  inci- 
sions are  at  the  side,  such  a  result  could  not  take 
place. 

So  much  for  the  most  recent  opinions  as  to  the 
surgical  treatment  of  whitlow,  a  mode  of  proce- 
dure which  is  unavoidable  wlicn  pus  has  collect- 
ed. 

The  less  severe  forms  of  furuncular  inflammation 
may  be  aborted  in  many  cases,  according  to  Dr. 
Weiss  {Mcdicul  Record,  November  27,  1S86),  by 
the  inoculation  of  resorcin,  a  plan  wliich  he  has 
employed,  as  foUov/s  : 

A  number  of  shallow  parallel  incisions  about 
one-quarter  of  an  inch  long  are  made  in  and 
around  the  lesion  and  through  the  integument, 
pain  being  prevented  by  the  use  of  a  twenty 
per  cent,  solution  of  cocaine  and  ten  per  cent, 
resorcin.  Lanolin  salve  is  then  applied  in  a  very 
thick  layer  to  the  scarifications.  The  entire  part 
is  enveloped  in  a  strip  of  lint,  which,  in  turn,  is  to 
be  thoroughly  saturated  with  the  salve,  and  over 


this  a  layer  of  guttapercha  tis-sue,  absorbent  cotton, 
and  moist  gauze  bandage  may  be  applied  in  the 
order  mentioned. 

Dr.  Weiss  reports  a  number  of  cases  in  which 
the  employment  of  this  nfode  of  treatment  in 
twenty-four  hours  produced  complete  cessation  of 
pain  and  arrest  of  inflammation. 

Of  course  it  can  hardly  be  expected  that  this 
mode  of  treatment  would  operate  in  the  more 
serious  cases  of  periosteal  or  tendinous  inflamma- 
tion, but  it  seems  well  worthy  of  trial  in  the  less 
grave  forms  of  phlegmonous  inflammation. — 
T^icrapeutic  Gazette. 


THE  TREATMENT  OF  CHRONIC  AB- 
.SCESSES  BY  INJECTIONS  OF  AN  ETHE- 
REAL SOLUTION  OF  IODOFORM. 

Verchere  {Rev.  de  Chir.,  June,  1886)  reports 
twenty-three  cases  which  were  treated  in  this  man- 
ner, and  gives  the  following  directions  in  regard 
to  the  operation  :  The  solutions  of  iodoform  should 
be  of  varying  strength,  one  of  five  per  cent,  being 
used  for  large  abscesses,  and  one  of  ten  per  cent, 
for  small  ones,  while  small,  superficial  abscesses 
may  be  filled  with  a  saturated  solution.  If  the 
skin  over  the  abscess  is  not  affected,  the  needle  of 
hyijodermatic  syringe  is  introduced  in  an  oblique 
direction,  so  as  to  form  a  valvular  fold ;  the  pus  is 
then  drawn  off,  and  the  iodoform  solution  is  inject- 
ed. If,  however,  the  skin  over  the  abscess  is  quite 
thin,  the  pus  is  removed  wiih  an  aspirator,  and  the 
opening  made  by  the  needle  is  sealed  with  collo- 
dion, after  which  a  hypodermatic-syringe  needle  is 
inserted  into  the  abscess  cavity,  and  the  injection  is 
made  as  before.  The  object  of  these  manceuvres 
is  to  prevent  the  ether  from  escaping  through  the 
puncture,  as  it  at  once  tends  to  do  on  becoming 
volatilized.  As  the  solution  volatilizes,  the  iodo- 
form deposited  over  the  entire  inner  surface  of  the 
abscess,  and  is  slowly  absorbed — so  slowly  in  fact 
that  the  danger  of  poisoning  by  the  drug  is  said  to 
be  very  slight.  The  phenomena  observed  after  an 
injection  are,  briefly,  as  follows :  Rapid  and  some- 
times excessive  swelling  results  from  the  volatiliza- 
tion of  the  ether,  but  this  soon  subsides.  If  the 
skin  over  the  abscess  is  healthy,  the  abscess  cavity 
will  speedily  be  replaced  by  indurated  tissue,  with- 
out the  occurrence  of  any  external  change.  If  the 
.skin  is  already  inflamed,  it  will  separate  in  a  few 
days  in  the  form  of  a  yellowish  slough,  after  which 
healing  will  occur  by  granulation,  the  resulting 
cicatrix  being  slight.  The  advantages  alleged  for 
tins  method  of  treatment  are  the  perfect  safety  of 
the  operation,  the  rapidity  of  the  cure,  the  fact 
that  the  patient  is  not  confined  to  his  bed  during 
the  treatment,  and  the  non  recurrence  of  the  abs- 
cess. 


THE  DOCTOR  AS  PATIENT. 

"The  study  of  medicine  and  personal  devotion 
to  the  alleviation  of  suffering  do  not  insure  the 


The  CANADA  Medical  RECoftt). 


20.^ 


doctor  against  the  ills  common  to  all  mankind  ; 
nor  docs  an  intimate  acriuaintance  with  the  vaga- 
ries of  the  sick  enable  a  j^liysician  to  pass  through 
his  own  trials  witli  equanimity.  In  fact,  die  doc- 
tor is  far  from  apijearing  at  his  best  in  the  role  of 
patient ;  he  feels  as  much  out  of  place  on  a  sick 
bed  as  would  a  general  oflicer  if  he  were  reduced 
to  the  ranks.  He  has  been  so  long  arcustonied 
to  eommand  that  he  finds  it  very  hard  lo  oliey,  at 
least  without  some  sort  of  a  protest. 

"  During  his  student  days  he  was  led  astray  by 
his  imagination,  which  made  him  suffer  from  the 
ills  of  which  he  studied.  He  i)robal)ly,  at  that 
tiaie,  convinced  himself  of  the  ea^,e  with  which  one 
e.\aggerates  his  own  sensations,  and  learned  to 
disregard  his  own  feelings  for  the  most  part.  Only 
in  such  a  way  as  this  can  we  account  for  the  neg- 
lect in  himself  of  those  beginnings  of  disease  which 
a  layman  would  suppose  would  infallibly  airest 
a  doctor's  attention,  as  they  certainly  would  in  a 
second  person  ;  as  it  is,  he  usually  disregards  his 
early  symptoms  and  goes  about  with  a  temperature 
higher  than  that  of  the  patient  whom  he  sends 
inexorably  to  bed.  He  hopes  for  the  best  in  his 
own  case,  as  in  others,  but  he  fails  to  prepare  for 
the  worst,  as  he  advises  his  patients  to  do,  for  he 
uses  up  by  continuing  his  work,  the  strength  he 
ought  to  reserve  to  carry  him  through  the  sickness 
it  needs  no  angel  sent  from  heaven  to  foretell. 
Once  fairly  prostrate,  it  is  usually  the  alarmed 
relatives  who  summon  the  doctor,  rather  than  the 
patient  himself. 

"And  it  is  no  light  task  for  the  brother  physi- 
cian who  presides  over  his  sick  bed  to  care  for  the 
prostrate  individual,  who  insists  on  discussing  the 
method  of  treatment,  and,  with  a  disordered 
imagination  and  weakened  intellect,  desires  to 
sit  in  judgment  on  the  conduct  of  his  own  case. 
The  patient  is  apt  to  be  skeptical  as  to  the  powers 
of  the  drug  on  which  his  friend  and  adviser  relies. 
He  suspects  his  friend  of  a  want  of  candor  in  his 
bedside  talk.  The  little  talk  outside  his  door,  the 
ruses  of  his  wife  to  gain  a  little  private  conversation 
with  the  doctor,  excite  his  anger.  He  listens  for 
the  noise  of  the  wheels  after  his  friend  has  left  the 
room,  and,  if  the  sound  of  his  chariot  is  too  longed 
delayed,  he  feels  sure  that  the  long  suffering  man 
is  delaying  at  the  door  to  tell  what  he  'really 
thinks,'  and  he  takes  pains  to  interrupt  the  conver- 
sation by  some  abrupt  message ;  ])erhaps,  if  it 
happens  to  be  evening,  by  saying  that  it  is  time  to 
close  the  house  for  the  night. 

"But  if  he  is  critical  and  somewhat  skejjtical, 
he  learns  to  know  his  physicians  by  their  steps, 
and  even  the  roll  of  their  carriages  on  the  street; 
and  no  patient  gives  them  a  more  cordial  welcome, 
or  parts  with  them  more  reluctantly.  He  feels 
sure  that  his  memory  of  their  kind  attentions 
certainly  must  be  longer  than  that  of  certain 
patients,  who,  according  to  the  tamiliar  lines,  whose 
truth  is  too  often  con'firmed  by  experience,  forget 
even  the  doctor's  face  when  they  have  recov- 
ered. 


"He  seldom  escapes  making  himself  disagree- 
able to  his  nurses.  It  is  hard  to  convince  him 
that  it  is  his  own  fault  that  his  food  does  not  taste 
as  it  ought.  He  is  indignant  that  his  own  kitchen 
can  not  jiroduce  broth  as  good  as  that  of  his 
neighbor:  but  the  tales  of  his  own  peevishness, 
when  he  hears  them  after  recovery,  he  can  but 
believe  are  grossly  exaggerated. 

'•N(jthing  is  more  siuiirising  to  the  doctor,  when 
rt-duced  to  the  |K)siti(jn  of  p.:tient,  then  to  find 
that  he  himself  is  subject  to  like  weaknesses  as  other 
mcmliers  of  the  himian  family.  The  nervousness, 
for  which,  in  others,  he  has  had  too  little  sympa- 
thy shows  itself  in  a  thousand  ways.  The  little 
noises  impossible  to  avoid  distuib  him,  and  the 
children  of  his  household  seem  most  unruly. 
IMost  strange  of  all,  and  most  humiliating  in  his 
remembrance  afterward,  he  even  calls  his  doctor 
for  nothing.  He  wakes  from  sleep,  sure  he  is 
going  to  have  a  chill,  or  some  eqii.ally  unpleasant 
manifestation,  and  when,  with  grave  face  and 
careful  attention,  his  hastily  summoned  physician 
has  felt  the  pulse,  taken  his  temperature,  and 
sought  for  the  signs  of  any  possible  complicaticn. 
to  inform  him  at  the  end  that  there  is  nothing  to 
justify  his  fears,  he  admires  and  is  grateful  for  the 
patience  that  has  borne  with  his  apprehensions, 
but  he  feels  great  curiosity  to  know  what  his  doc- 
tor says  to  himself  as  he  goes  home  to  renew  his 
broken  sleep;  and  most  of  all,  he  wonders  at  him- 
self and  mutters,  'Is  thy  servant  a  dog  that  he 
should  have  needlessly  disturbed  a  doctor's  sleep  ?' 

"But  especially  trying  to  an  invalid  doctor  is  a 
tedious  convalescence.  His  knowledge  of  the 
jjossible  complications  and  sequels  gives  a  wide 
field  of  possibilities,  over  which  his  imagination 
wanders  uncontrolled,  and  he  is  fortunate  if  he 
does  not  become  a  hypochondriac.  He  is  pretty 
apt  to  partake  of  the  lay  fondness  for  talking 
about  the  unusual  features  his  case  has  shown. 
If  he  thinks  about  the  matter  at  all,  he  finds  how 
difficult  it  is  to  know  at  what  length  to  detail  his 
symptoms  to  inquiring  friends.  Unless  he  keeps 
his  tongue  in  due  subjection,  he  is  apt  to  realize 
that  few  men  are  really  good  listeners,  and  his 
kind  friends,  when  they  are  released  from  his  story, 
may  be  excused  if  they  say,  'Poor  fellow,  he  needs 
bracing  up.'  But  realy  there  is  some  excuse  for 
him  if  he  is  a  little  garrulous ;  i)ersonal  experience 
of  pain  is  different  from  looking  on,  but,  interested 
as  he  is  in  his  own  closer  acquaintance  with  dis- 
ease, his  account  of  it  differs  little, in  the  ears  of 
his  medical  brethren,  from  the  story  they  have 
often  heard  before. 

"  But  a  little  personal  experience  of  the  sick-bed 
teaches  the  doctor  many  things.  He  certainly 
learns  that  a  sick  man  does  not  look  upon  things 
as  a  well  man  does,  and  his  charity  towards  an 
invalid's  whims  is  greatly  increased.  He  cannot 
fail,  too,  to  be  touched  and  softened  by  the  many 
kind  inquiries  and  pleasant  messages  that  come 
to  him.  Busy  men  come  and  sit  down  beside  him 
as  though  the  dearest  object  of  their  hearts  was 


204 


!'nE   CANADA   MEDICAL  RECoRfi. 


to  see  him  recover;  men  who  justly  plead  bodily 
infirmity  as  an  excuse  against  the  slightest  exer- 
tion climb  his  stairs  to  express  their  sympathy, 
and  patients  who  have  seemed  thankless  and  for- 
getful show  that  they  needed  only  die  opportunity 
to  show  their  gratitude.  And,  when  the  sick  man 
resumes  his  place  in  life,  he  is  pretty  sure  to  have 
not  merely  an  increased  enjoyment  in  living,  and 
a  better  idea  of  his  fellow-men,  but  also  a  higher 
estimate  of  the  value  of  his  own  profession." — 
Boston  Mod.  fl  Surg.  Jour. 


ON  THE  LOCAL  TREATMENT  OF  THE 
BLADDER. 

BV  PROF.  ULTZMANN. 

The  local  treatment  of  the  bladder  should  only 
be  undertaken  in  the  chronic  forms  of  disease, 
since  in  the  acute  process  appropriate  dietetic  and 
therapeutic  measures  bring  about  a  cure  in  a  short 
time.  In  the  majority  of  cases  we  have  to  do  with 
chronic  catarrh  of  the  bladder,  in  which  we  must 
manage  the  treatment  according  as  the  disease 
affects  young  or  old  persons  and  according  to 
its  etiological  origin.  If  it  is  a  case  of  a  young 
individual  where  the  catarrh  is  only  an  extension 
of  a  gonorrhoeal  process  in  the  posterior  urethra, 
then  the  treatment  of  the  neck  of  the  bladder  must 
also  be  pursued  in  connection.  This  is  best  accom- 
plished by  placing  the  patient  in  the  horizontal 
position,  with  the  pelvis  raised,  and  then  introduc- 
ing a  thin  catheter  (No.  7  English),  with  a  short 
piece  of  rubber  tubing  attached  to  it,  with  which 
the  bladder  is  emptied.  The  catheter  is  then  with- 
drawn about  three  centimetres  into  the  neck  of  the 
bladder,  and,  with  a  syringe,  about  200-300  gram- 
mes of  tepid  medicated  fluid  gradually  injected. 
If  no  fluid  flows  back,  it  is  the  best  proof  that  the 
eye  of  the  catheter  is  in  the  right  place.  After  the 
injection  the  patient  should  stand  up  and  empty  the 
bladder  himself,  so  that  the  whole  medicated  fluid 
passes  over  the  diseased  neck  a  second  time.  Soft 
catheters  are  not  good  for  this  kind  of  injection 
because  the  pressure  of  the  fluid  easily  forces  them 
out.  If  the  bladder  of  itself,  is  insufficient  to  expel 
the  fluid,  then  it  must  be  removed  again  by  the 
catheter,  and  this  is  best  done  in  the  upright  posi- 
tion. 

When  the  disease  affects  the  fundus  of  the  bladder 
only,  then  the  treatment  is  directed  to  that  part 
alone.  It  must  be  carefully  washed  out  with  a  soft 
elastic  catheter  till  the  fluid  flows  back  quite  clear. 
This  can  best  be  done  in  the  upright  or  sitting 
positions,  since  then  the  bladder  will  be  most  com- 
pletely emptied.  If  performed  in  the  recumbent 
position  the  pelvis  must  be  raised.  A  syringe  is 
more  suitable  than  the  irrigator,  because  by  the 
former  one  can  better  measure  the  pressure  used. 
Prof.  Ultzmann  also  does  not  recommend  the 
double  catheter,  because,  he  says,  the  fluid  can 
easily  flow  back  through  the  efferent  canal  without 
the  bladder  being  properly  washed. 


The  treatment  by  means  of  the  irrigators  is  to  be 
recommended  in  cases  of  contracted  bladder, 
caused  by  parenchymatous  gonorrhoeal  cystitis, 
when,  through  the  consta'nt  pressure  of  the  fluid 
on  the  bladder,  an  increase  in  its  capacity  may  be 
expected.  For  the  removal  of  sediment  the  irriga- 
tor is  not  well  adapted. 

■J'epid  injections  are  to  be  used,  except  in  paresis 
and  insensitive  bladders,  and  in  cases  of  hemorr- 
hage, when  cold  injections  are  of  advantage.  In 
sensitive  bladders  warm  water  injections  are  to  be 
employed,  or  the  same  witli  tinct.  opii  (10  drops 
to  100  c.  cm.),  or  a  quarter  per  cent,  solution  of 
cocaine,  a  half  to  one  per  cent,  solution  of  resorcin, 
or  one-sixth  to  one-fourth  per  cent,  carbolic  solu- 
tion, a  three  per  cent,  boracic  acid,  a  five  per  cent, 
sulphate  or  chloride  of  soda  solutions. 

An  astringent  solution  may  be  used — a  one-half 
per  cent,  alum  solution;  one-quarter  to  one-half 
per  ceut.  zinc  sulphate ;  or  one-fifteenth  to  one- 
tenth  per  cent,  nitrate  of  silver. 

In  cases  of ammoniacal urine,  one-tenth  percent, 
permanganate  of  potash ;  tepid  water,  with  a  few 
drops  of  aniyl.  nitrite;  three  to  five  drops  amyl 
nitrite  to  half  a  litre  of  water. 

In  phosphaturia,  one-tenth  per  cent,  chlorine 
water  and  cabolic  acid,  equal  parts  ;  one-fifth  per 
cent,  salicylic  acid  solution  ;  two  per  cent,  salicylate 
of  soda. 

When  Bacteria  are  present,  a  one  to  ten  thousand 
sublimate  solution,  or  a  strong  solution  of  potass, 
permang.  may  be  used. 

For  hemorrhage  :  cold  water ;  one-tenth  to  one- 
half  nitrate  of  silver  solution;  ferruin  sesquichlora- 
tuni,  fifty  to  sixty  drops  to  litre  of  cold  water. — Cen- 
tralblatt  f.  Therapie. 


NOTES  ON  SOME  FORGOTTEN  OR  MUCH 
NEGLECTED  REMEDIES  AND  THERA- 
PEUTIC MEASURES. 

By  Caleb  Green,  M.D.,  Homer,  New  Voik. 
Those  who  have  lived  through  many  years  o^ 
the  history  of  medicine,  and  have  observed  the  pro- 
gress and  oscillations  of  therapeutic  ideas  and  prac- 
tices, have  become  familiar  with  the  tendency  of 
medical  men  to  run  to  extremes  in  pursuing  some 
new  measure  or  in  making  a  hobby  of  some  new 
remedy,  until,  finding  that  the  remedy  or  measure 
would  not  do  all  that  unreasoning  enthusiasm  had 
promised,  they  have  come  to  neglect  or  set  it  aside 
for  something  new, — something  having  similar 
therapeutic  results,  but  promising  to  act  more  in 
accordance  with  the  old  saw,  "  Tuto,  cito  et 
Juoundc." 

Those  who  have  been  observant  for  the  last 
thirty  or  forty  years  of  the  changes  alluded  to  have 
seen  many  remedies,  therapeutical  ideas,  and  patho- 
logical theories  rise  higher  than  they  ever  ought 
to  have  risen,  and,  on  the  other  hand,  have  seen 
them  fall  lower  than  they  deserved  to  fall.  The 
tendency  has  been,  and  still  is,  to  an  extreme  sweep 
of  the  pendulum. 


THE  CAKADA  MEDICAL  RECORD. 


205 


Those  who  practised  our  art  forty  or  forty-five 
years  ago  will  remember  the  beginning  of  the  decline 
of  the  great  and  oversiiadowing  therapeutic  agent, 
li/ooif/eltiiig.  Previous  to  that  period  no  aciUe 
inHamniation  or  congestion  escaped  the  lancet,  or 
scarificator,  or  leech.  If  ayoung  practitioner  was 
so  unfortunate  as  to  lose  a  case  of  pneumonia  or 
peritonitis,  in  which  he  had  not  bled  his  patient 
profusely  and  repeatedly,  he  was  in  danger  of  Ijeing 
accused  liy  his  medical  fathers  and  nin'sing  mothers 
ot  allowing  his  patient  to  die.  The  young  doctor 
was  set  down  as  timid  and  inefficient  ;  he  was  not 
to  be  trusted.  The  wise  and  designing  .Sangrados 
could  "  sit  down  on  him"  in  cool  assurance  tliat 
they  would  be  sustained  by  the  laity  ;  for,  notwith- 
standing the  rising  prejudice  against  the  excessive 
use  of  the  lancet  and  other  powerful  agents,  the 
rank  and  file  of  people  still  blindly  worshipped  the 
"  bold  practitioner,''  while  the  cautious  young 
physician  was  often  looked  upon  as  a  skulker. 

As  time  wore  on,  however,  a  better  system  of 
clinical  study  began  to  prevail ;  empiricism  gave 
place  to  a  more  tlioughtful  method  of  observation, 
which  resulted  first  in  the  diminution  of  the  amount 
of  blood  lost  by  the  patients,  and  finally  in  the 
number  of  cases  in  which  it  was  thought  that 
bloodletting  was  required  in  any  measure.  The 
laity  also  began  to  have  opinions.  Slowly  the  fashion 
began  to  gain  ground  of  rejecting  the  lancet  except 
in  extreme  cases,  until  at  last  venesection,  instead 
of  being  the  rule,  became  between  1850  and 
i860  the  rare  exception.  This  change,  however, 
did  not  in  that  period  become  alike  complete  in 
all  localities. 

lit  the  period  between  1840  and  1850  two  forms 
of  empiricism  which  had  existed  for  several 
years  began  to  rear  their  heads,  and  even  to  assert 
themselves.  I  refer  to  the  Botanic  or  Thomsonian 
"  system,"  so  called,  but  which  now  has  acquired 
or  assumed  the  sounding  name  of  "  Eclectic,"  in 
which  all  sorts  of  bad  things  are  accepted, — and 
all  sorts  of  bad  things  rejected, — in  which  fierce 
lobelia,  emetics,  and  huge  draughts  of  bitter 
or  aromatic  infusions  and  decoctions  figured  as  the 
health-giving  agents.  The  other  extreme  and  more 
attractive  form  of  charlatanism  was  distinguished 
by  its  therapeutic  dictum  of  similia  similibus,  etc., 
and  its  infinitesimal  dosage.  These  agencies,  with 
the  waning  faith  of  both  doctors  and  people  in 
the  former  rough  plans  of  medication,  made 
unfashionable  the  former  leading  remedies  and 
therapeutic  measures, — bloodletting,  mercurials, 
antimony,  and  counter-irritants.  Cathartics  never 
lost  their  hold  on  the  people, — as  witness  the 
triumphs  of  Brandreth  and  Ayer. 

The  unpojjularity  of  the  lancet  in  pneumonia 
— croupous  pneumonia — arose  from  its  outrageous 
abuse  in  former  times.  Its  use  and  usefulness  as 
an  adjuvant  of  other  antiphlogistic  means  in  early 
stages  of  this  disease  have  been  forgotten  or  over- 
looked by  those  who  were  in  practice  thirty-five 
years  ago.  If  they  will  recall  the  prompt  relief  which 
they  witnessed  from  an  effective  but  judicious  blood- 


letting, supplemented  by  the  ])roper  administra- 
tion of  antimony,  they  will  wonder  how  they  ever 
came  to  wholly  abandon  the  treatment.  'I'he  sub- 
stitution of  veratrum  viride  for  antimony,  much  as 
it  is  decried  on  theoretical  grounds  (after  the  over- 
bindened  heart  has  been  relieved  by  the  abstraction 
of  a  portion  of  the  circulating  fluid),  is  a  decided 
advance  in  the  therapeusis  of  ])neumonia.  But, 
like  the  lancet  and  tartaiized  antimony,  it  is  a 
[lowerful  remedy,  and  is  to  be  used  with  judgment, 
and  when  so  used  will  help  to  limit  the  inflamed 
area  as  well  as  its  duration,  notwithstanding  the 
fact  that  pneumonia  in  a  certain  but  very  limited 
proportion  of  cases  suddenly  subsides  by  crisis 
on  the  seventh  or  eighth  day.  That  we  do  cut 
short — or,  as  the  French  f,^y  jugulate — pneurro.iia 
in  a  fair  proportion  of  cases  under  the  plan  above 
indicated  is  a  clinical  fact  too  well  known  to  be 
doubted,  especially  by  those  whose  reaction  from 
the  extreme  practice  of  other  days  was  only 
moderate. 

In  a  discussion  which  arose  in  the  American 
Medical  Association  a  few  years  ago,  on  venesec- 
tion in  pneumonia,  a  wide  range  of  views  was  held. 
A  Cincinnati  professor  indulged  in  inconse- 
quential talk  ;  '■  What  advantage  is  there,"  said 
he,  "  in  checking  the  force  and  frequency  of  the 
heart,  when  this  increase  in  force  and  frequency  is 
only  compensatory,  and  is  to  be  favored  rather 
than  checked  ?  Pneumonia  is  due  to  a  poison 
entering  the  blood  and  affecting  the  whole  body, 
and  no  amount  of  bloodletting  could  let  it  out 
any  more  than  we  can  drain  out  the  impurities  of 
a  stream  with  a  bucket."  I  say  that  this  is  incon- 
clusive talk,  and  is  not  worthy  of  an  attempt  at 
refutation.  In  the  same  discussion  such  men 
as  Dr.  N.  S.  Davis,  Dr.  William  Brodie,  Dr.  A.  C. 
Post,  and  Dr.  .S.  D.  Gross  of  Philadelphia,  spoke 
in  favor  of  bloodletting  and  regarded  it  as  an  adju- 
vant or  auxiliary  of  great  value.  Dr.  Post,  in 
allusion  to  the  lower  percentage  of  deaths  from 
pneumonia  treated  by  the  modern  methods,  very 
justly  remarked  that  no  reliance  could  be  placed 
on  statistics,  as  they  were  chiefly  drawn  from  a 
class  of  patients  found  in  hosjjitals,  who  had  been 
badly  clothed,  badly  housed,  and  badly 
fed  all  their  lives,  and  such  statistics  were 
not  reliable  guides.  And  a  little  reflection  will 
show  any  one  that  in  such  a  class  of  patients 
the  modern  expectant  plan  of  management  of 
pneumonia  would  show  a  better  percentage  of 
recoveries  than  the  spoliative  treatment  of  former 
times.  But  with  the  judicious  use  of  the  lancet 
among  the  healthy  denizens  of  country  villages 
and  farming  populations,  I  venture  the  opinion  that 
the  favorable  percentage  of  recoveries  would  be 
recorded  on  the  other  side.  If  a  name  is  treated 
instead  of  a  condition,  we  must  expect  disappoint- 
ment in  the  results. 

Among  modern  writers.  Dr.  Henry  Hartshorne, 
of  Philadelphia,  took  a  most  sensible  view  of  this 
whole  question.  He  gave  as  reasons  for  the 
fact  that  bloodletting    has  more   opponents  than 


m 


faE  CANADA  MEDICAL   RECOfeB. 


defenders  now,  than  at  any  earlier  period  in 
medical  history:  ist,  the  reaction  from  the  pre- 
viously existing  abuse  of  the  remedy  ;  2nd,  a  change 
in  the  average  human  coHstitution  (in  large  cities 
especially)  occurring  under  the  artificial  habits  of 
civilized  life  ;  3rd,  false  construction  misapplica- 
tion of  recent  science  (as  in  the  case  of  the 
Cinciimati  professor)  ;  4,  leadership  and  fashio:]. 
And  he  might  have  added  a  fear  on  the  part  of 
the  practitioner  of  the  jirejudices  of  tlie  conmiu- 
nity,  and  of  becoming  unpopular  if  he  should  bleed 
and  blister,  iiotv/ithstanding  the  soundness  of  his 
convictions  as  to  the  value  or  necessity  of  these 
measures. 

By  the  timely  and  suitable  letting  oi  ijlood  we 
lessen,  for  a  time  at  least,  the  fullness  of  the  blood- 
vessels, the  number  of  the  red  corpuscles,  the 
force  of  the  heart's  impulse  and  of  the  arterial 
impulse,  and  the  excitement  of  nerve  centres. 
"  By  all  these  influences,''  Dr.  Hartshorne  remarks, 
"  we  diminish  the  vascular  e.xcitement  connected 
with  an  inflammation,  and  thus  lessen  the  amount 
of  the  resultant  exudation,  and  render  its  history 
more  normal  and  its  charge  less  degenerative  and 
destructive." 

I  need  only  refer  again  to  the  comparative 
percentage  of  deaths  under  the  old  plan  of  indis- 
criminate bleeding  in  the  treatment  of  inflamma- 
tions, especially  of  pneumonia,  as  compared  even 
with  the  expectant  plan,  to  show  you  that,  if  we 
study  the  figures  alone. and  not  the  facts  which 
generate  or  make  the  figures,  we  may  still  harbor 
the  delusion  that  "  figures  don't  lie ;"  but,  if 
we  honestly  compare  facts  and  figures,  we  shall 
see  how  unreliable  are  some  statistical  tables,  and 
how  wofuUy  figures  do  sometimes  //>. 

I  have  alluded  to  tartarized  antimony  as  one  of 
the  agents  resorted  to  in  the  treatment  of 
inflammations,  and  especially  pneumonia  Betore 
the  introduction  of  veratrum  viride,  which  began  to 
be  more  especially  noticed  by  Dr.  Norwood,  of 
South  Carolina,  about  thirty-five  years  ago, 
although  mentioned  by  Bigelow,  Tully,  and  others 
twenty  years  earlier,  antmiony  was  the  sedative 
generally  relied  on ;  but  after  a  timid  probation  of 
a  few  years,  veratrum  viride  acquired  very  gener- 
ally the  confidence  of  the  profession,  and  tartarized 
antimony  was  forgotten.  That  antimony  was 
nearly  as  olien  abused  as  the  lancet  is  a  fact 
recognized  by  those  familiar  with  its  literature,  or 
who  thirty  or  forty  years  ago  were  obliged  to  rely 
on  it  as  a  sedative, — the  synergist  or  adjuvant  of 
bloodletting.  But  the  abuse  of  such  a  potent  and 
reliable  antijjhlogistic  was  not  a  sound  reason  for 
iis  neglect  or  rejection.  It  is  true  that  it  is  still 
used  in  combination  and  as  an  emetic  in  croup ; 
but  its  valuable  properties  in  the  various  forms  of 
pulmonary  iufiammation  are  not  often  recognized, 
or  are  forgotten.  In  some  conditions  it  cannot 
take  the  place  of  veratrum,  and  yet  it  is  spoken  of 
by  some  recent  writers  as  "  the  most  powerful 
antiphlogistic  (arterial  sedative)  medicine."  This 
is  high  praise,  but  a  little  excessive ;  for,  by  all 


odds,  it  is  greatly  excelled  by  veratrum  viride  as 
a  cardiac  sedative. 

It  seems  not  to  be  very  generally  known  that 
tartar  emetic  is  one  of  our  most  efficient  agents  in 
promoting  parturition.  AVhen  the  pulse  is  tense, 
the  OS  rigid,  the  skin  dry  and  hot,  the  advance  of 
the  head  slow,  I  have  seen,  by  the  use  of  small 
doses  of  antiui'iny,  the  most  prompt  and  happy 
change  for  the  better,  'ihe  jmlse  softens,  the 
skin  becomes  moist,  the  rigid  os  relaxes,  the 
vagina  becomes  bathed  in  a  jjlentiful  supply  of 
mucus,  and  the  uterine  contractions  hasten  on  to 
a  speedy  termination  of  the  labor. 

It  is  not  a  substitute  for  ergot,  but  it  has  proper- 
ties which  make  it  much  ofiener  available  as  a 
means  of  hastening  labor  to  a  happy  termination. 
If  the  dose  can  be  so  graduated  as  to  produce  its 
effect  as  a  parturient,  just  short  of  nausea,  and 
especially  short  of  vomiting,  the  effect  seems  to 
be  better  than  where  vomiting  occurs. 

In  this  connection  I  may  allude  to  the  very 
general  neglect  or  abandonment  of  emetics, 
except  as  simple  evacuants  of  the  stomach  and 
air-passages.  Thirty  or  forty  years  ago,  one  class 
of  irregular  practitioners  were  notorious  for  their 
frequent  and  empirical  use  of  lobelia  emetics, 
which  they  generally  administered  in  person,  in 
order,  perhaps,  to  be  in  readiness  to  counteract 
the  drastic  violence  of  this  agent  should  mischief 
threaten  or  occur,  as  it  frequently  did.  This 
abuse  of  emetics,  as  well  as  the  increasing  preju- 
dice against  strikingly  potent  measures  of  all  sorts, 
probably  had  its  influence  in  inducing  physicians 
to  restrict  emetics  to  their  use  as  evacuanrs  simply. 
But  emetics  for  the  purpose  of  evacuating  the  bile- 
ducts  and  stimulating  a  torpid  liver  to  a  mor^healthy 
perforniance  of  its  functions,  and  at  the  same  time 
exerting  an  '•'  alterative  "  effect  on  the  glands  of  the 
stomach  and  intestines,  are  not  as  often  resorted 
to  as  formerly.  They  often  relieve  in  a  most 
evident  manner  that  condition  which,  for  want  of 
a  better  name  (and  we  scarcely  need  a  better 
one),  we  call  biliousness.  But  the  phx'sician  who 
will,  even  "  semi-occasionally,"  resort  to  emetics 
with  all  proper  precautions  is  in  danger  of  being 
branded  a  "  fogy."  Yet,  with  the  proper  restric- 
tions and  precautions,  we  know  that  they  are  power- 
ful for  good.  Shall  we  be  brave  enough  to  use 
them  ? 

Fashion  in  medicine  is  shown  in  a  marked  degree 
in  the  change  of  professional  opinion,  or  rather  of 
practice,  in  the  use  of  blisters  in  chest-affections. 
Rubefacients  and  poultices  are  relied  on  when 
active  vesication  should  be  resorted  to,  especially 
if  there  is  pleuritic  pain  indicating  a  simple  pleu- 
risy or  one  complicating  pneumonia.  Of  course, 
the  other  depleting  and  sedative  measures  should 
accompany  or  precede  the  blister.  It  is  a  power- 
ful adjuvant  to  other  antiijhlogistic  measures,  even 
when  resorted  to  early  in  many  cases  of  pneumonic 
inflammation,  and,  as  1  intimated  before,  where 
pleuritis  is  an  early  and  marked  complication.  I 
am    fully    aware    that   this    is  not    the    doctrine 


THE   CANADA   MEDICAL   RECORD. 


207 


or  the  practice  of  the   profession  at  the    present 

time,  and  tlial  I  shall  l)c  crilicisfd  for  luilding 
this  view.  Jf  rubefacients  will  contribute  to 
the  reduction  of  pain,  vesicants  will  more  surely 
reduce  the  ])leuritic  inflammation,  and  thus  help 
to  arrest  and  limit  the  amount  of  pulmonic 
engorgement,  and  not  add  to  it,  as  we  arc  taught 
to  believe.  One  distinguished  writer  on  the 
])ractice  of  medicine  objects  to  the  early  use  of 
blisters  in  pneumonia,  in  ]iart  because  it  interferes 
with  the  physical  exploration  of  the  chest,  render- 
iiig  it  dilticult  to  follow  the  ]ir(>gress  of  the  exuda- 
tion,— as  though  the  object  of  the  blister  was  not, 
with  the  other  remedial  measures,  to  helj)  to  arrest 
ami  limit  that  exudation. 

In  pleuritis  1  am  positive  that  we  withhold  one 
of  the  most  potent  measures  for  its  arrest  and 
reduction  if  we  do  not  at  once  resort  to  liberal 
vesication. 

Even  in  the  progress  of  tubercular  phthisis  I 
believe  that  we  may  protract  the  lives  of  some 
patients,  and  add  to  their  comfort  bv  attacking  the 
local  pleurisies  that  occur  from  time  to  time  in  the 
progress  of  the  case  by  small  blisters,  thus  arrest- 
ing the  inflammatory  condition  beneath,  and  pre- 
venting the  early  softening  and  breaking  down  of 
tubercular  deposits  at  the  seat  of  pain.  I  am 
sure  that  in  several  instances  I  have  thus  post- 
poned the  inevitable,  and  that  without  debilitating 
the  patient. 

I  hope  that  in  all  that  I  have  said  (and  much 
more  in  the  same  line  might  with  profit  be  said) 
no  one  will  infer  that  I  do  not  appreciate  the 
many  valuable  recent  additions  to  our  materia 
medica  and  to  our  therapeutic  measures.  My 
object  has  been  rather  to  call  atteniion  to  the 
partly-forgotten  remedies  and  measures  which  are 
still  worthy  of  our  notice  and  regard,  and  also  to 
call  attention  to  the  tendency  to  push  new  reme- 
dies to  extremes,  and  then,  if  tiiey  fail  to  accom- 
plish all  that  they  at  first  promised,  to  abandon 
them,  so  to  speak,  as  fossils  of  a  former  art  buried 
deeply  under  the  succeeding  accumulations,  which 
must  also  wait  their  turn  for  historic  extinction 
unless  a  better  medical  philosophy  shall  assert 
itself.     Hold  fast  that  which  is  good. 

I  am  aware  that  the  tendency  of  advanced  life 
is  to  conservatis  ;  but  then  there  need  be  no  bigotry 
if  the  individual  has  continued  to  cultivate  his 
art  and  its  literature  during  his  accumulation  of 
years.  He  will,  however,  be  better  able  to  point 
out  thatwhich  is  of  permanent  value  in  former 
views  and  practices,  but  which  in  the  rush  of  new 
discoveries  and  inventions  is  liable  to  be  forgotten 
or  neglected. — Phil.  Medical  Times. 


DANGER  IN  SANTONIN. 

Danger  in  santonin,  even  when  given  in  moder- 
ate doses,  was  reported  some  weeks  since  in  the 
Lyon  Medical  to  have  been  observed  so  frequently 
that  the  matter  has  been  inquired  into  by  the 
Rip.  de  Pharm.,  with  the  following  results :     The 


white  santonin  was  found  more  toxic  than  that 
which  had  become  yellow  through  exposure  to 
sunlight,  though  the  latter  did  not  show  any  dim- 
inution in  its  thera])eutic  properties.  Lawre  thinks 
that  the  dose  for  a  child  of  less  than  two  years 
should  not  exceed  three-fourths  of  a  grain.  In  all 
cases  it  should  be  associated  with  a  purgative  — 
calomel,  for  example — to  lacilitate  iis  elimination. 
"  Santonin  is  innocuous  or  toxic,"  he  says,  "  in 
proportion  to  the  rapidity  with  which  it  may  be 
eliminated,  and  this  varies  in  individuals."  Lcwin 
and  (^aspari  recommend  that  it  be  administerel 
in  oily  solution.  In  this  form  it  is  absorbed  by 
the  intestines  slowly  enough  to  permit  a  direct  and 
prolonged  contact  with  the  worms. —/t;///-//,?/  of 
I'/iarfiiary,  June,  1887. 

PERFUMERY  AS  A  SEUAIIVE. 

Dr.  AVatson  Smith,  Londo:i,  reports  the  case  of 
his  own  boy,  critically  sick  with  dysentery,  and  the 
stomach  so  sensitive  that  vomiting  was  excited 
immediately  any  attempt  was  made  to  administer 
anything.  The  doctor  then  thought  of  the  seda- 
tive effect  of  perfumery,  and  argued  that  if  he 
could  so  deceive  the  patient  as  to  cause  the 
imagination  to  attribute  to  the  article  administered 
the  delicate  flavor  of  the  perfumery,  the  effect 
upon  the  olfactory  nerves  would  be  soothing  upon 
the  nerves  of  the  palate  and  stomach. 

Some  simple  diet  was  given  in  a  spoon  held 
with  a  handkerchief,  upon  which  a  delicate  perfume 
was  sprinkled.  The  effect  was  excellent,  and  after 
a  short  time  medicines  cculd  be  given  in  the  same 
way,  and  were  retained  without  further  disturbance 
of  the  stomach  and  the  patient  rapidly  recovered. 

This  plan  of  masking  the  sense  of  taste  through 
the  influence  of  perfumery  upon  the  olfactory 
nerves  may  be  equally  pleasant  to  adults. 


STR0PHANTHU5  IN  HEART-DISEASE. 

Dr.  J.  Hutchinson,  of  Glasgow,  writes  as  follows 
to  the  British  Medical  Jounial: 

''As  the  influence  and  value  of  strophanthus  in 
heart-disease  is  at  present  attracting  a  good 
deal  of  attention,  my  experience  may  be  of  inter- 
est. I  have  administered  the  drug  in  twelve  cases 
of  heart-disease :  nine  were  functional  and  three 
organic,  and  I  have  much  reason  to  be  jileased 
with  the  success  of  the  treatment,  and  with  the 
amount  of  relief  I  gave  my  patients. 

"  On  looking  over  my  notes  I  find  two  cases  of  ■ 
mitral  disease,  in  one  of  which  there  was  a  loud 
murmur,  both  obstructive  and  regurgitant.  The 
patient  was  a  woman,  aged  45,  in  whom  the 
prominent  symptoms  were  harsh,  hacking  cough, 
occurring  in  |)aroxysms,  dyspnoea,  and  at  times 
orthopnoea  ;  palpitation  and  tedema  of  feet  and 
legs.  The  pulse  w-as  intermittent,  with  a  regular 
irregularity,  and  beating  go  to  the  minute.  Strop- 
]>hanthus  was  gi\en  in  half-drop  doses  at  first,  and 
was  gradually  incieased  imtil  she  was  takmg  2 
minims  three  times  a  day.     Almost  from  the  first 


208 


THE  CANADA   MEDICAL   RECORD. 


dose  taken,  an  alteration  in  the  sufferings  of  the 
patient  was  observed.  The  heart-sounds  were 
firmer  and  steadier;  pulse-beats,  though  still  irreg- 
ular, were  not  so  fast ;  cough  was  much  less  trouble- 
some, and  the  palpitation  was  neither  so  frequent 
nor  so  violent.  Along  with  this  there  was  a  copi- 
ous increase  in  the  renal  secretion,  which  soon 
relieved  both  the  visceral  engorgement  and  cedema 
in  the  feet  and  legs.  In  fourteen  days  she  felt  so 
well  as  to  be  able  to  return  to  her  household  duties. 
In  the  other  case  of  mitral  disease  the  symi>tom3 
were  much  the  same,  but  not  nearly  so  severe. 
The  same  dose  was  given,  and  the  effect  was  as 
satisfactory  and  rapid. 

"Another  case  of  aortic  stenosis  in  an  old  lady 
aged  60,  who  had  for  years  been  a  martyr  to  chronic 
cough,  palpitation,  and  the  other  symptoms  atten- 
dant upon  stenosis  of  the  aortic  orifice,  received 
great  relief  from  a  one-minim  dose  of  the  drug. 
In  this  case  palpitation  was  very  violent,  the  pulse 
was  rapid,  and  there  was  extensive  passive  con- 
gestion of  both  lungs.  CEdema  of  the  feet  and 
legs  was  also  present  in  a  marked  degree.  Under 
the  influence  of  strophanthus  the  pulse  became 
slower  and  firmer,  the  congestion  in  the  lungs  les- 
sened day  by  day  and  copious  diuresis  soon  made 
an  alteration  in  the  cedema.  The  palpitation  was 
trifling  compared  to  what  she  previously  suffered, 
and  her  cough  was  much  relieved. 

"  In  the  other  nine  cases  in  which  I  adminis- 
tered the  drug  I  could  find  no  trace  of  a  murmur, 
and  the  purpose  for  which  the  medicine  was 
administered  was  to  allay  in  some  measure  the 
turbulent  palpitation  of  which  these  people  com- 
plained. In  seven  of  these  cases  the  palpitation 
seemed  to  be  dependent  upon  dyspepsia  ;  remedies 
were  given  for  that  condition.  Strophanthus  was 
also  used  in  the  hope  of  its  exerting  a  calming  and 
steadying  influence  upon  the  heart,  which  in  all  of 
them  it  succeeded  in  doing. 

"The   remaining  two  were  cases  of  disordered 
innervation.     The  pulse  was  very  rapid  and  irreg- 
ular, the  heart's  action  turbulent— so  much  so  that 
at  times  the  sounds  could  not  be  differentiated, 
but  seemed    all   merged    in    a   confused   rumble. 
Both  of  these  patients  were  much  benefited,  and 
though  the  symptoms  of  which  they  complained 
the  loudest— namely,  palpitation— is  not  banished, 
they  find  that  it  can  be  kept  within  reasonable 
bounds  by  a   timely    dose  of  strophanthus.     All 
the  patients  expressed   the  opinion  that  the  drug 
had    a    stimulating  effect,  which,    however,    soon 
wore  off.     Some  of  them  jirofessed  to  feel  bene- 
ficial effects  ten  minutes  after  taking  their  a])pointed 
dose.     The  effect  of  the  medicine  was  rapid,  but 
did  not  remain  long,  and  at  the  end  of  three  or 
four  hours  required  to  be  renewed.     The  system 
quickly  became  used  to  the  drug,  and  to  get  the 
amount  of  benefit  the  dose  required  to  be  gradu- 
ally increased. 

"  In  prescribing  it  I  combined  it  with  some 
bitter  infusion,  and  never  failed  to  get  physiologi- 
cal action.     I  have  never  seen  sickness  or  gastric 


irritation  produced,  such  as  we  meet  with   some- 
times after  digitalis. 

"The  preparation  I  used  was  tincture  of   the 
strength  of  i  in  8." 


TANNIC  ACID  AS  A  SURGICAL  DRESS- 
ING. 
Dr.  T.  J.  Hatton  writes  to  \.\\c  Journal  oj  the 
American  Medical  Association,  that  after  sixteen 
years  use  of  tannic  acid  as  a  surgical  dressing,  he 
is  thoroughly  satisfied  as  to  its  efficiency : 

"  It  forms  an  excellent  dressing  in  three  classes 
of  wounds,  viz. : 

"  I.  Incised  wounds— applied  after  the  sutures 
are  inserted,  or  adhesive  plaster  is  on— if  the 
wound  does  not  require  stitching. 

"  2.  Small  wounds  of  irregular  form  and  recent 
occurrence. 

"3.    Wounds  of  moderate    size    m  compound 
fractures.     Whenever  applicable  it  excels  all  other 
dressings  in  the  tbllowing  respects. 
"  I.  Convenience. 
"  2.  Cheapness. 
"  3.  Cleanliness. 
"  4.  Efficiency. 

"  It  is  always  ready.  It  costs  but  a  trifle.  It 
requires  no  greasy  mixing,  measuring,  or  muddling, 
and  has  neither  smut  nor  smell. 

"  The  method  of  application  is  simply  to  keep 
the  wound  covered  with  the  powder.  Wounds 
thus  treated  heal  on  the  average  in  about  one-third 
of  the  time  required  for  similar  ones  treated  by 
liquid,  oily,  or  salve  dressings.  In  converting 
compound  fractures  into  simple  fractures  by  this 
method,  the  flesh-wound  is  often  healed  in  one- 
twelfth  of  the  time  required  to  heal  it  by  wet  dress- 
ings of  salves  that  arc  frequently  removed  and 
re-applied." 

THE    TREATMENT   OF    ORCHITIS    AND 
EPIDIDYMITIS. 

There  is  such  a  diversity  of  opinion  as  to  the 
best  treatment  of  orchitis  and  ejtididymitis  the 
result  of  acute  gonorrbcea,  that  the  results  obtain- 
ed by  Mr.  Frederick  W.  Lowndes  {Lancet,  ]\\\y  24 
1886)  for  the  last  eleven  years  in  the  Liverpool 
Lock  Hospital  are  of  considerable  importance. 
The  plan  practised  in  this  hospital  is  almost  invar- 
iably that  introduced  by  Mr.  Furneaux  Jordan  in 
1869,  namely,  by  painting  the  affected  testicle  with 
a  strong  solution  of  nitrate  of  silver  (two  drachms 
to  the  ounce),  at  the  same  time  enforcing  strict  rest 
in  bed,  and  supporting  the  inflamed  organ  upon 
a  small  pillow  so  as  to  prevent  it  hanging  down. 
Mr.  Lowndes  has  invariably  employed  the  same 
treatment,  and  in  eleven  years  has  treated  two 
hundred  and  sixty-nine  cases.  He  has  always 
found  his  plan  highly  successful.  The  acute  pani 
often  amounting  to  agony  is  soon  subdued,  and  in 
the  majority  of  cases  the  organ  returns  to  its  nor- 
mal size  in  the  course  of  a  few  days.     Sometimes  a 


THE   CANADA   MEDICAL   RECORD. 


209 


second  painting  is  necessary,  but  this  then  siiflnxs. 
I'lic  same  plan  of  treatment  has  also  been  used  by 
him  successfully  in  private  practice.  When  the 
patient  cannot  be  in(hiced  to  take  absolute  rest  in 
bed.  and  when  the  patients  are  compelled  to  follow 
their  usual  occupations,  the  reco\ery  must  obvious- 
ly be  slower,  as  it  is  not  jiossible  l)y  sus]iensory 
bandages  or  by  means  of  handkerchiefs,  however 
skilfully  applied,  to  insure  such  ])crfcct  rest  as  when 
the  ])atient  is  lying  in  bed.  While  the  rest  is  an 
im|)ortant  item  in  the  treatment,  it  is  not  by  itself 
sunicienl  to  effect  a  cure.  The  immediate  effects 
of  the  nitrate  of  silver  in  allaying  tlie  ])ain  are  most 
marked,  though  for  obvious  reasons  the  nitrate  must 
act  more  ])0\veil"ully  while  the  organ  is  in  a  state 
of  quiescence  than  when  constantly  active. — 
Therapeutic  Gazette. 


CALO.MEI,     IN    THE      TREATMENT     OF 
CARDIAC    DROPSY. 

The  striking  results  of  Jendrassik  as  to  the 
diuretic  action  of  calomel  in  the  treatmenlof  diO|  sy, 
especially  of  cardiac  origin,  have  already  received 
confirmation.  In  the  Wienier  Med.  Wochcn. 
(July  TO,  iS86)  Prof.  Stiller,  of  Buda-Pest,  pub- 
lishes the  details  of  eighteen  cases  of  dropsy  of  car- 
diac origin  which  he  has  treated  both  in  hospital 
and  in  private  practice  by  the  administration  of  cal- 
omel after  the  directions  given  by  Jendrassik.  His 
results,  although  he  but  seldom  obtained  the 
immense  increase  of  urinary  secretion  reported  by 
Jendrassik,  were  in  their  general  results  quite 
equally  favorable  to  his.  Two  cases  he  gives  in 
full  detail,  and  either  alone  would  be  sufficient  to 
prove  the  truth  of  the  statement  that  in  calomel  a 
drug  has  been  found  whose  value  seems  in  such 
cases  almost  inestimable.  Cases  with  intense 
oedema  of  the  extremities,  peritoneal  imd  pleural 
effusions,  enlarged  and  congested  liver  with  mark- 
ed dyspncea,  he  has  succeeded  in  restoring  almost 
to  health,  ceitiinly  to  comfort,  by  the  administra- 
tion of  calomel.  He  has  seen  cedema  entirely  dis- 
appear, abdominal  and  pleural  effusions  and  album- 
inuria removed,  an  enlarged  liver  return  to 
its  normal  size  with  complete  relief  of  respiratory 
distress.  Such  results  have  followed  the  adminis- 
tration of  calomel  alone  after  digitalis  had  failed  to 
produce  relief,  and  also  in  cases  where  the  use  of 
digitalis,  on  account  of  the  unfavorable  symptoms 
which  so  frequently  interfere  with  its  action  had 
compelled  its  susj'ension.  Dr.  Stiller  thinks  that 
he  is  perfectly  warranted  in  confirmiucr  in  all 
respects  the  statements  of  Jendrassik.  He  believes 
that  in  dropsy  of  cardiac  origin  small  doses  of  cal- 
omel constitute  the  most  efficient  and  rapid  means 
of  relief,  even  in  cases  where  digitalis  fails,  while 
no  other  drug  can  in  any  degree  sufficiently 
approach  it  to  be  worthy  of  being  brought  into  the 
same  category.  Its  action  is  not  only  exerted  on 
the  removal  of  the  cedema,  but  also  on  the  effusion 
of  serous  cavities. 

The  diuresis,  agreeing  again  with  Jendrassik,  he 


found  to  suddenly  occur  on  the  third  or  fourth  day 
after  the  commencement  of  the  administration  of 
the  drug,  and  it  is  advisable  to  suspend  its  use.  to 
be  renewed  again  in  considerably  decreased  doses, 
when  the  diuretic  action  ajjpears  to  be  disappear- 
ing. 'I'his  action  in  the  removal  of  effused  li<piid 
is  only  to  be  explained  by  some  particular  facili- 
tation of  absorjition  by  the  blood,  since  Stiller  as 
well  as  Jendrassik  found  that  calomel  so  adminis- 
tered was  entirely  without  influence  on  the  heart 
or  kidneys.  In  his  first  {k.'n  cases  Dr.  Stiller  foimd 
that  diarrhfea,  and  in  one  case  stomatitis,  compli- 
cated his  results,  but  in  his  later  experience  he 
found  that  the  administration  of  opium  with  the  cal- 
omel entirely  prevented  the  ajipearance  of  diar- 
rhoea, while  it  did  not  interfere  with  its  diuretic 
action.  According  to  his  experience,  the  most 
marked  diuretic  effects  have  been  produted  from 
calomel  without  the  least  sign  of  mercuriali/.ation. 
In  spite  of  these  favorable  reports,  calomel  can- 
not, however,  be  regarded  as  a  substitute  for  digi- 
talis, since  it  is  in  no  respect  a  heart  remedy.  In  the 
numerous  cases  where  digitalis  fails  or  is  contra-in- 
dicated, and  where  numerous  substitutes  for  digi- 
talis are  either  not  ap|j|icable  or  have  proved  them- 
selves unreliable,  according  to  the  above  authors 
the  value  of  calomel  cannot  be  overestimated. 
Enough  has  already  been  determined  by  those  two 
authors  to  prove  that  calomel  in  such  diseases 
must  in  future  occupy  a  very  important  place.  As 
to  the  more  exact  indications  as  to  its  use,  cases 
in  which  it  is  most  favorable  and  as  to  whether  its 
employment  exerts  any  influence  on  the  further 
progress  of  the  cardiac  disease,  these  facts  must, 
of  course,  be  left  to  future  investigations.  It  is 
to  be  ho]5ed  that  in  the  treatment  of  heart-disease 
calomel  will  receive  the  investigation  which  it  with- 
out doubt  seems  to  deserve. — -Therapeutic  Gazette. 


SIJMPLE    C0N.STIPATION    AND   ITS   SUC- 
CESSFUL MAN.AGEMENT. 

Among  the  morbid  states  of  the  system  for 
which  suffering  humanity  seeks  relief,  often  with 
but  oftener  without  medical  advice,  none  is  ]iro- 
bably  of  more  frequent  occurrence  than  constipa- 
tion. From  time  immemorial  to  the  present  day 
countless  expedients,  including  the  use  of  innume- 
rable drugs,  have  been  resorted  to  in  the  endeavor 
to  spur  to  renewed  activity  the  flagging  function 
of  defecation.  Sir  Andrew  Clarke  has  recently 
published  some  suggestive  remarks  concerning 
this  subject,  which,  though  not  very  original, 
nevertheless  carry  with  them  the  weight  of  large 
experience  and  eminent  practicality. 

Sir  Andrew  invciglis  ])articularly  against  the 
ignorant  and  unskilful  domestic  management  oi' 
constipation,  with  its  many  unlowaid  conseipien- 
ces,  some  of  which  may  indeed  become  quite  seri- 
ous, lie  might  w-ith  equal  jjropriety  have  denoun- 
ced the  unskilful,  because  routine,  practice  of 
dealing  with  this  disorder  still  practised  by  many 
medical  men.     The  real  mischief  often  begins  by 


210 


THE   CANADA   MEDICAL   RECORD. 


the  self-conscious  patient  seeing  imaginary  evils 
impending  from  the  accidental  failure  of  his  bowels 
to  act  on  some  occasion  when  he  has  decided 
that  they  ought  to  have  done  so.  The  malaJi: 
imaginaire  forthwith  concludes  that  the  only  way 
to  relieve  his  "  attack  of  constipation  "  is  to  take 
"  a  dose. "  And,  he  argues,  the  stronger  the 
dose,  the  more  effectual  the  cure.  The  medicine 
having  operated,  the  bowels  are  probably  found 
more  inactive  than  before,  which  leads  to  renewed 
"  doses. "  Soon  the  bowels  fail  to  respond  to 
natural  stimuli,  and  periodical  discharges  are 
excited  only  by  repealed  doses  of  stronger  and 
stronger  aperients.  In  the  words  of  Sir  Andrew, 
"  With  few  exceptions,  no  person  has  passed 
through  this  experience  and  fallen  under  the  ty- 
ranny of  aperients  without  finding  his  life  invaded 
by  a  pack  of  petty  nuisances  which  lower 
his  health,  vex  his  temper,  and  cripple  his 
work. " 

Now,  it  is  quite  true  that  "  for  the  most  part  all 
these  troublesome  consequences  of  constipation 
may  be  avoided  by  attending  to  the  conditions  of 
healthy  defecation.  "  Chief  among  these  condi- 
tions are  a  sufficient  quantity  of  digestible  food — 
including  plenty  of  liquid — the  presence  of  enough 
refuse  matters  in  the  colon,  a  decent  regard  to 
nature's  promptings,  regular  solicitation  once 
every  twenty-four  hours,  the  co-operation  of  the 
will,  and  contentment  with  a  moderate  evacua- 
tion. Of  course,  this  simjjle  and  natural  regimen 
presupposes  a  healthy  nervo-nniscular  ajsparatus, 
without  which  the  function  in  i|uestion  cannot  be 
properly  performed.  Sir  Andrew  briefly  discus- 
ses each  of  the  above  conditions  ;  but  they  are  so 
well  known  to  the  profession  that  it  is  unnecessary 
to  dwell  on  any  of  them,  except,  perhaps,  the  last- 
named —  i.e.,  contentment  with  a  moderate  dis- 
charge. On  that  score  there  is  probably  more 
ignorance  than  on  any  other  point  connected  with 
the  subject.  According  to  Clarke,  "  for  a  man  of 
average  weight,  consuming  an  average  amount  of 
food,  the  average  amount  of  freces  ready  for  dis- 
charge in  twenty-four  hours  is  about  five  ounces. 
This  should  be  formed,  sufficiently  aerated  to 
float,  and  coherent.  "  There  is  not  the  slightest 
doubt  that  "  many  people  expect  to  have  a  much 
more  abundant  discharge,  and  are  dissatisfied  or 
anxious  if  they  do  not  get  it.  "  Such  persons 
commonly  resort  to  aperients  in  order  to  obtain 
"relief"  from  their  imaginary  constipation,  and 
thus  invite  the  very  condition  from  which  they  are 
making  misguided  efforts  to  escape. 

To  effect  a  cure  in  such  cases  it  is  necessary, 
first  of  all,  to  stop  aperients,  and  then  to  renew 
obedience  lo  physiological  laws.  Sir  Andrew's 
instructions  to  this  large  class  of  patients  are  so 
simple,  direct,  and  practical  that  we  cannot  do  bet- 
ter than  here  transcribe  them  : 

"  I.  On  first  waking  in  the  morning,  and  also  on 
going  to  bed  at  night,  sip  slowly  from  a  quar- 
ter to  half  a  pint  of  water,  cold  or  hot.  2.  On 
rising,  take  a  cold  or  tepid  sponge-bath,    followed 


by  a  brisk  general  towelling.  3.  Clothe  warmly 
and  loosely  ;  see  that  there  is  no  constriction  about 
the  waist.  4.  Take  three  simple  but  liberal  meals 
daily ;  and,  if  desired,  and  it  do  not  disagree, 
take  also  a  slice  of  bread*and-butter  and  a  cup  of 
tea  in  the  afternoon.  When  tea  is  used  it  should 
not  be  hot  or  strong,  or  infused  over  five  minutes. 
.A.void  pickles,  spices,  curries,  salted  or  otherwise 
preserved  provisions,  pies,  pastry,  cheese,  jams, 
dried  fruits,  nuts,  all  coarse,  hard,  and  indigestible 
foods  taken  with  a  view  of  moving  the  bowels, 
strong  tea,  and  much  hot  liquid  of  any  kind,  with 
meals.  5.  W'alk  at  least  half  an  hour  twice  daily. 
6.  Avoid  sitting  and  working  long  in  such  a  position 
as  will  compress  or  constrict  the  bowels.  7.  Solicit 
the  action  of  the  bowels  every  day  after  breakfast, 
and  be  patient  in  soliciting,  Ifyou  fail  in  procuring 
relief  one  day,  wait  until  t'.ie  following  day,  when 
you  will  renew  the  solicitation  at  the  ap|)ointed 
time.  And  if  you  fail  the  second  day,  you  may, 
continuing  the  daily  solicitation,  wait  until  the 
fourth  day,  when  assistance  should  be  taken.  The 
simplest  and  best  will  be  a  small  enema  of  equal 
parts  of  olive-oil  and  water.  The  action  of  this 
injection  v/ill  be  greatly  helped  by  taking  it  with 
the  hips  raised,  and  by  previously  anointing  the 
anus  and  the  lower  part  of  the  rectum  with  vase- 
line or  with  oil.  8.  If  by  the  use  of  all  these  means 
you  fail  in  establishing  the  habit  of  daily  or  of 
alternate  daily  action  of  the  bowels,  it  may  be 
necessary  to  take  artificial  help.  And  your  object 
in  doing  this  is  not  to  produce  a  very  copious 
dejection,  or  to  provoke  several  smaller  actions : 
your  object  is  to  coax  or  persuade  the  bowels  to 
act  after  the  manner  of  nature,  by  the  production 
of  a  moderate  more  or  less  solid-formed  discharge. 
Before  having  recourse  to  drugs,  you  may  try,  on 
waking  in  the  morning,  massage  of  the  abdomen, 
practised  from  right  to  left  along  the  course  of  the 
colon  ;  and  you  may  take  at  the  two  greater  meals 
of  the  day  a  dessert-spoonful  or  more  of  the  beet 
Lucca  oil." 

The  author  maintains  that  if  this  programme  be 
faithfully  adhered  to,  aperients  will  rarely  be  found 
necessary.  Of  course,  Clarke  admits  that  the  use 
of  drugs  is  not  altogether  avoidable.  His  own 
preference  is  for  the  compound  aloin  pill  (aloin; 
gr.  Yz  ;  ext.  nucis  vom.,  gr.  3^  ;  ferri  sulph.,  gr.  y^  ; 
myrrh  and  soap  enough  to  make  one  pill),  taken 
half  an  hour  before  the  last  meal  of  the  day.  We 
fully  agree  with  Dr.  Clarke  in  believing  that  "  the 
particular  agent  employed  for  the  relief  of  consti- 
pation is  of  much  less  importance  than  its  mode  of 
operation."  Whatever  the  remedy,  it  should  act 
after  the  manner  of  nature  in  securing  a  daily 
formed  stool.  If  in  place  of  yielding  to  the  impor- 
tunities of  jiatients  demanding  new  and  stronger 
aperients  physicians  would  ah\  ays  take  the  pains 
to  insist  upon  some  such  plan  as  outlined  above, 
we  have  no  doubt  that  there  would  be  less  trouble 
for  and  from  constipated  persons. — N.  Y.  Medical 
Record. 


THE    CANADA    MEDICAL   KECORD. 


211 


SAI.ICYLATE  OF   LITHIA  IN  ACUTE 

ARTICULAR  RHEUMATISM. 

I  )r.  V'ulpian  states  tliat  salicylate  of  lithia  is 
iiiuic  cliicacious  than  salicylate  of  socki  in  cases  of 
acute  and  jirogressive  subacute  articuhr  rheuma- 
tism. It  also  has  some  effect  in  chronic  cases 
«1ku  a  ceiiaiii  number  of  the  joints  are  still 
tlelbrnKtl,  swollen,  and  painful.  Four  to  four 
and  a  half  grams,  and  even  five  grams,  may  be 
given  in  the  day.  If  the  improvement  is  not  last- 
ing, fifty  cenligiams  may  be  added  to  the  daily 
dose.  .Sometimes,  wlien  the  dose  is  increased  to 
five  or  five  and  a  half  grams,  symjitoms  of  intol- 
erance liegiii  to  be  shown.  .Salicylate  of  lithia  may 
be  given  dissolved  in  water,  in  powder,  or  in 
unleavened  bread,  during  or  after  meals,  in  doses 
ol  fifty  centigrams.  The  physiological  effects  of 
the  drug  are  headache,  giddiness,  and  deafness. — 
Brtiish  Mfdiciil Journal. 


TREATMENT  OF  .SCIATICA. 

Dr.  Metcalf,  of  New  York,  says  that  no  pres- 
crijition  for  sciatica  lias  ever  equalled  in  efficacy 
the  following:  Tinct.  aconit  rad.,  tinct.  colchic. 
sem.,  tinct.  belladonna,  aa  3  j.  M.  Sig  :  Dose, 
six  drops  every  six  hours.  He  also  uses  triturate 
tablets,- each  containing  three  drops  of  the  follow- 
ing : — Tincture  of  aconite  root,  tincture  of  actea 
racemosa — equal  parts  by  volume.  Dose,  one" 
every  four  or  eight  hours.  —  .lonnml  Aiiuricin 
M(  (liad  AsxoiJntion. 


HOW  TO  GIVE  CASTOR  OIL. 

Dr.  Field,  in  a  recent  book,  "  Evacuant  Medi- 
cation," gives  the  following  formula  :is  useful  in 
administering  castor  oil,  especially  in  dysentery 
and  enteritis,  when  purgation  and  a  healing  and 
tonic  influence  is  required  : 

Ok  terebinth gtt.lxxK, 

01.  cinnamon. Mv  ; 

Ol.  ricini 3v; 

Mucil .  acac q.s. ; 

Syr.  sinipl q.s  ; 

Aq.  purK,  q.  s  .ad 3  ij. 

M.  Sig:  Shake  thoroughly.  One  teaspoonful, 
repeated  /.  r.  n. 


THE  TREATMENT  OF  STYE. 

Styes  are  such  troublesome  little  ailments  that 
the  following  remedy  for  their  cure,  recommended 
by  M.  Abadii,  may  be  welcome  : — 

IJ     Acidi  boracic,  lo  grammes 

AquK  dest.,  300  giamnies 

Dissolve. 

With  a  wetted  piece  of  wadding,  drop  some  of 
this  solution  on  the  stye  several  times  a  day. 
It  is  said  not  only  to  effect  a  cure,  but  to  prevent 
a  return  of  the  annoyance. 


ANTISEPTIC  GAUZE. 

Dr.  \.  fi.  Gerster,  in  the  New  York  Medical 
Journal,  describes  a  way  to  make  antiseptic  gauze 
easily  and  cheajily.  Twenty-five  yards  of  cheese 
cloth,  which  can  be  procured  at  any  dry-goods 
store  for  a  tritlmg  sum  of  money,  are  divided  into 
four  equal  parts.  F^ach  of  these  is  folded  eight 
tip.-.es,  rolled  up  loosely,  and  tied  with  a  string. 
To  make  the  gauze  absorbent  it  is  put  into  a 
common  wash-boiler,  covered  with  w^ater,  to  which 
a  pound  of  washing  soda  or  saleratus  has  been  add- 
ed, and  boiled  for  an  hour.  After  this  it  is  rinsed  in 
colfl  water  for  ten  minutes  lo  free  it  from  tl  e 
soda,  jiassed  through  a  clothes-wringer,  and  pkiced 
in  a  stone  or  glass  jar  or  an  enamelled  kettle,  fill- 
ed with  a  corrosive  sublimate  lotion  of  1  to  loco 
strength, to  remain  therein  for  twenty-four  hours. 
It  is  then  passed  through  the  wringer  again,  ai  d 
hung  uj)  to  dry  over  night  when  the  air  is  free  from 
dust.  The  string  put  about  each  |)iece  should  not 
be  removed  until  the  time  of  drying,  as  it  will  keep 
the  folds  from  getting  disarranged.  The  dried 
pieces  are  ready  for  use,  and  will  keej)  clean  if 
wrapped  in  a  towel  or  put  away  in  a  jar. 

\Vhen  the  gauze  is  used,  suitable  sized  pieces, 
each  eight  folds  thick,  can  be  cut  out  with  a  pair  uf 
stout  scissors. 

Iodoform  gauze  is  made  by  sprinkling  iodoform 
jjowder  from  a  pepper-shaker  uniformly  over  the 
moist  comjiress,  and  rubbing  it  thoroughly  into  the 
meshes  between  the  fingers. 

An  excellent  substitute  for  gauze  in  an  emer- 
gency is  common  cotton  batting  well  soaked  in 
solution  of  corrosive  sublimate  (i  to  1000).  The 
package  of  batting  is  unrolled  in  an  ordinary  man- 
ner, and  cut  into  stjuare  pieces  of  desired  size. 
Each  of  these  is  refolded  into  a  small  scpiare, 
and  thoroughly  kneaded  in  a  wash-basin  filled  with 
the  mercuric  solution  till  completely  satuiated. 
When  wrung  out,  and  unfolded  to  its  original 
shape,  it  is  ready  for  use.  Any  clean  fabric  of 
cotton  or  linen,  soaked  in  mercuric  solution, makes 
a  good  antiseptic  dressing. 


CHEADLE:  CONSTIPATION     IN    CHILD- 
HOOD AND  ITS  SEQUEL,    ATONY,  AND 
DILATATION  OF  THE  COLON. 

{Lancet,  December  4  and  11,  18.86.) 

In  these  two  lectures  the  author  discusses  this 
important  subject  in  an  interesting  and  profitable 
manner. 

Among  the  causes  existing  in  adults  for  consti- 
pation, he  mentions  dread  of  stool  from  the  p:uii 
which  accompanies  the  act  as  being  an  im])ortant 
factor  in  many  cases  among  children.  The  con- 
tinued and  habitual  use  of  coarse  foods,  such  as 
oatmeal,  etc.,  he  thinks  not  advisable,  as  these, 
like  too  many  purgatives,  tend  to  produce  atony 
of  the  muscular  coat  from  continued  over-stimu- 
lation. 

The  habitual  use  of  enemata  is  productive  only 
of  haim.     Cases  are  cited  where  this  practice  had 


212 


THE   CANADA   MEDICAL   RECORD. 


been  continued  formontlis,  sometimes  two  or  three 
enemata  being  retained  in  tine  bowels  for  some 
time  before  expulsion  took  ]5lace,  with  the  result 
of  causing  such  dilatation  of  the  colon  as  to  crowd 
up  the  heart  and  lungs,  jiroducing  dyspncea  and 
impeded  circulation,  and  great  abdominal  disten- 
tion. 

Puncture  of  the  bowels  with  a  small  trocar  was 
used  in  one  case  with  success;  this  being  followed 
by  the  use  of  abdominal  bandages. 

The  method  of  treatment  he  has  found  most  sat- 
isfactory is  tlie  continuous  use  of  non-stimulating 
purgatives,  esjiecially  the  salines,  together  with 
the  administration  of  strychnia  and  belladonna  in 
all  cases  of  long  standing,  where  atony  is  probably 
a  feature. 

For  young  infants  he  employs  the  carbonate  of 
magnesia,  given  in  doses  of  gr.  x  to  gr.  xxx,  once 
or  twice  a  day  in  milk. 

For  older  infants  and  young  children  a  mixture 
of  the  sulphates  of  magnesia  and  soda  in  a  little 
larger  doses  than  the  above,  together  with  strych- 
nia, belladonna,  and  iron,  if  the  case  is  a  chronic 
one. 

Tn  older  children  a  nightly  pill  of  aloin  with  the 
last-mentioned  drugs  is  advised. 

Attention  to  diet,  exercise,  bathing,  and  habits 
generally,  is  not  overlooked  by  the  writer.  Great 
benefit  sometimes  results  from  systematic  massage 
of  the  abdomen  with  castor  or  cod-liver  oil. 
Archives  of  Pediatrics. 


THE  ANTISEPTIC  TREATMENT  OF 
SUMMER  DIARRHCEA. 

At  the  annual  meeting  of  the  New  York  Aca- 
demy of  Medicine,  held  January  6,  1887,  Dr.  L. 
Emmrt  Holt  read  a  paper  on  the  "  Antiseptic 
Treatment  of  Summer  Diarrhoea"  {MtJical  Record, 
January  15,  1S87).  The  sjteaker  stated  that  he 
did  not  undervalue  other  methods  of  treatment 
than  the  use  of  drugs,  such  as  careful  feeding, 
change  of  air,  etc.,  but  the  object  of  the  paper  was 
to  discuss  what  additional  measures  were  useful. 

All  the  causes  of  summer  diarrhcea — excessive 
lieat,  improper  or  artificial  feeding,  and  bad  hy- 
gienic surrounding.* — united  to  produce  a  dyspep- 
tic condition,  which  was  really  at  the  bottom  of 
nearly  all  of  these  cases.  The  age  showed  it  could 
not  bo  heat  alone,  for  the  disease  was  not  frequent 
a  t  the  most  tender  age, — under  six  months.  Of  43 1 
cases,  only  twelve  per  cent,  were  under  six  months, 
while  fifty-nine  per  cent,  were  between  six  months 
and  two  years.  The  explanation  was  that  under 
six  months  most  of  the  children  were  fed  at  the 
breast.  Improper  and  artificial  feeding  was  quite 
as  important  as  heat,  as  Hope  had  found  in  591 
fatal  cases  that  only  28  had  no  food  but  the  breast. 

Heat  depressed  vital  energy,  increased  decom- 
position in  the  streets  and  sewers,  and  thus  vitiated 
the  atmosi)here  ;  but,  most  of  all,  it  produced  in 
the  food  given  to  young  children  putrefactive 
changes  before  it  was  taken  into  the  stomach. 


This  was  especially  likely  to  occur  with  milk. 
One  instance  was  cited  of  every  one  of  twenty- 
three  healthy  children  being  taken  in  one  day  with 
diarrhcea  from  bad  milk.. 

Closely  related  to  this  subject  were  the  iioisons 
produced  from  food,  or  ptomaines.  Brunton  had 
stated  that  most  of  the  alkaloids  produced  from 
the  decomposition  of  albumen  caused  diarrhoea. 
It  was  believed  that  many  of  the  nervous  symp- 
toms in  summer  diarrhcea  had  their  explanation 
in  the  effects  of  these  alkaloids.  This  was  true 
especially  where  the  discharges  were  abrujitly 
arrested,  either  spontaneously  or  by  opium.  They 
were  to  be  looked  upon  as  a  form  of  toxremia. 

The  inflammatory  changes  found  in  the  intes- 
tine were  to  be  looked  upon  as  a  consequence  cf 
the  diarrhcea  rather  than  the  cause  of  it.  Tiie 
most  marked  lesions  were  always  found  in  tlie 
caecum  and  sigmoid  flexure,  just  where  the  irrita- 
ting substances  were  longest  detained  in  their 
passage. 

Immense  numbers  of  bacteria  were  found  in  the 
discharges,  but  no  sufficient  evidence  had  yet  been 
adduced  to  establish  the  existence  of  a  special 
microbe  as  a  causative  agent. 

The  indications  for  treatment  were  four  :  t .  To 
clear  out  the  bowels.     2.  To  stop  decomposition. 

3.  To  restore  healthy  action  in  the  alimentary  tract. 

4.  To  treat  the  consequential  lesions. 

It  was  proper  to  begin  with  a  cathartic  in  all 
cases  unless  the  stomach  was  very  irritable.  Cas- 
tor oil  was  by  far  the  best.  If  much  vomiting  were 
present,  a  copious  injection  of  water,  enough  to 
wash  out  the  colon,  should  be  given. 

Many  mild  cases  could  be  cured  by  the  oil  alone, 
provided  suitable  dietetic  regulations  afterwards 
could  be  carried  out.  In  severe  ones  it  gave  only 
temporary  benefit. 

For  the  second  and  third  indications  an  anti- 
septic should  be  given  and  the  diet  carefully  regu- 
lated. The  best  antiseptics  were  sodium  salicylate 
and  naphthalin.  The  former  should  be  given  in 
doses  of  I  to  3  grains,  according  to  the  age  of  the 
child,  every  two  hours,  and  the  latter  in  about 
double  the  dose. 

If  vomiting  were  present,  all  food  should  be 
stopped  for  from  twelve  to  twenty-four  hours,  and 
thirst  quenched  by  thin  barley-gruel  or  mineral- 
waters, — cold,  and  in  small  quantities. 

Unless  the  child  were  upon  the  breast,  in  which 
case  it  should,  of  course,  be  kept  there,  it  was 
better  to  wit/wld  milk  entirely.  Wine-whey, 
animal  broths,  expressed  beef-juice,  or  even  raw 
beef,  could  be  used,  and  were  usually  sufficient. 

To  meet  the  fourth  indication — i.e.,  to  treat  the 
lesions — astringents  by  the  mouth  were  useless, 
with  the  possible  exception  of  bismuth.  The  diet 
should  be  as  carefully  looked  to  in  chronic  cases 
as  in  acute.  The  antiseptic  should  be  continued, 
to  check  fermentation  and  decomposition  in  the 
intestine,  and  the  large  intestine  should  be  washed 
out  once  a  day  with  pure  water  or  a  we.ak  antisep- 
tic or  astringent  solution. 


•rlllB   CANADA    StEDICAL   RECORD. 


213 


Attention  was  called  to  the  foct  that,  except 
opium,  nearly  all  the  drugs  which  had  held  their 
place  in  the  treatment  v(  this  disease  were  antisep- 
tics of  more  or  less  power.  Jjismuth,  calomel,  llie 
mineral  acids,  iron  and  silver  salts  were  cited. 
Pure  antiseptics  had  been  used  in  the  treatment  of 
diarrhceal  diseases  since  1846.  Creasote  was  em- 
ployed, and  with  great  success  both  in  England 
and  in  this  country.  'J'en  or  fitteen  years  ago 
salicin  was  largely  used,  especially  in  the  South, 
with  uniformly  good  results,  particularly  in  chronic 
cases.  'I'he  use  of  salicylic  acid  and  its  salts,  the 
bichloride  of  mercury,  and  naphthalin  was  also 
referred  to.  Tlie  last  was  of  latest  introduction, 
and  seemed  likely  to  prove  of  very  great  value, 
perhaps  the  most  valuable  of  all. 

Notwithstanding  the  successful  results  obtained 
by  antiseptics,  the  great  majority  of  the  text-books 
still  advocated  the  old  plan  of  the  use  of  opium 
and  astringents  as  fifty  years  ago.  An  inquiry  into 
the  public  practice  of  this  city  showed  that  in  four- 
teen institutions  and  dispensaries,  where  it  was 
estimated  that  twenty-five  thousand  children  were 
treated  yearly  for  diarrhceal  diseases,  the  main  re- 
liance was  still  upon  opium,  bismuth,  chalk  mixture, 
and  castor  oil. 

U'he  speaker  had  tabulated  300  cases  of  his  own 
treated  by  such  remedies.  Of  these,  50  per  cent, 
were  cured  ;  27  ])er  cent,  improved;  18  per  cent, 
unimproved  ;  and  7  per  cent  died.  Dining  the 
past  year  he  had  treated  81  similar  cases  by  an 
mitial  dose  of  castor  oil,  followed  by  salicylate  of 
sodium,  these  being  the  only  drugs  used.  Of 
these,  84  per  cent,  were  cured ;  7  per  cent,  improv- 
ed ;  7  per  cent,  unimproved;  1.2  per  cent.  died. 
Forty-four  cases  were  treated  by  naphthalin, 
usually  preceded  by  the  oil.  Of  these,  67  per 
cent,  were  cured  :  15  per  cent,  improved  ;  13  per 
cent,  unimproved;  and  2  per  cent.  died.  Resor- 
cin  was  used  in  a  similar  manner  in  27  cases.  Of 
these,  55  percent,  were  cured;  22  per  cent,  im- 
proved ;  22  percent,  unimproved;  and  none  died. 

The  duration  of  the  disease  in  these  cases  be- 
fore treatment  was  about  the  same  in  each  class. 
The  duration  of  treatment  in  the  cured  cases  was 
much  shorter  by  sodium  salicylate  than  by  the  use 
of  opium,  astringents,  etc.  In  cases  of  long  stand- 
ing the  very  great  superiority  of  the  salicylate  and 
naphthalin  was  clearly  shown.  Resorcin  was 
much  inferior  to  the  drugs  just  mentioned. 

The  following  conclusions  were  drawn  from  the 
paper : 

/''irsf. — Sunnner  diarrhoea  is  not  to  be  regarded 
as  a  disease  depending  upon  a  single  morbific  agent. 

Seco/iii. — The  remote  causes  are  many, — heat, 
improper  and  artificial  feeding,  bad  hygiene,  etc. 

Third. — The  immediate  cause  is  the  putrefactive 
changes  which  take  place  in  the  stomach  and 
bowels  in  food  not  digested,  which  changes  often 
are  begun  outside  the  body. 

FoHith. — These  products  may  act  as  systemic 
poisons,  or  the  particles  may  cause  local  irritation 
and  inflammation  of  the  intestine. 


Fifth. — The  routine  use  of  opium  and  astrin- 
gents is  not  only  useless,  but,  especially  at  the  out- 
set, may  do  positive  harm  ;  since,  by  checking 
peristalsis,  opium  stops  elimination  and  increa.ses 
decomposition. 

Sixth. — Evacuants  are  to  be  considered  an 
essential  part  of  the  antiseptic  treatment. 

Seventh. — The  salts  of  salicylic  acid  and  naph- 
thalin are  the  antiseptics  which,  thus  far,  seem  to 
be  best  adapted  to  the  treatment  of  diarrhceal  dis- 
eases. 

Dr.  R.  W.  Wilcox  spoke  especially  with  refer- 
ence to  the  use  of  naphthalin  in  diarrhoea  in  adults. 
Since  reading  Rossbach's  paper  in  the  BerHner 
Kiinische  IVochensehrift,  in  November,  1884,  he 
had  used  naphthalin  in  thirty-two  cases,  nearly  all 
being  in  adults.  He  had  come  to  feel  as  much 
confidence  in  the  use  of  this  drug,  under  certain 
circumstances,  as  in  the  use  of  mercury  or  the  io- 
dides in  syphilis  or  of  quinine  in  intermittent  fever. 
As  mercury  and  quinine  may  fail  to  accomplish 
their  work  if  used  without  observance  of  a  few 
well-known  precautions,  so  naphthalin  may  fail  if 
improperly  employed.  The  most  frequent  cause 
of  failure  has  been  the  use  of  too  small  quantities, 
less  than  60  grains  daily  being  a  needless  waste  of 
a  very  good  medicine.  He  had  given  up  to  120 
grains  during  the  twenty-four  hours  in  divided 
doses,  usually  in  starch  capsules  with  a  small  quan- 
tity of  oil  of  bergamot  to  conceal  the  somewhat 
unpleasant  odor.  If  the  impurities  of  the  drug 
are  removed  by  washing  with  alcohol,  no  such  un- 
toward effects  as  have  been  occasionally  reported 
in  the  journals  will  occur.  Frequently  during  its 
administration  the  urine  will  assume  a  smoky  color, 
resembling  that  of  acute  nephritis,  but  a  careful 
examination  will  fail  to  detect  either  albumen  or 
casts. 

In  chronic  diarrhoeas  he  had  used  naphthalin 
as  the  only  drug  in  twenty-one  cases.  Nearly  all 
degrees  and  varieties  had  been  represented  ;  some 
could  be  traced  back  to  an  acute  process,  others 
were  the  result  of  improper  food  or  tollowed  debili- 
tating diseases. 

He  related  one  case  :  James  D.,  messenger,  i8 
years  of  age,  came  to  him,  complaining  of  a  diar- 
rhoea of  over  two  years'  duration.  Its  commence- 
ment was  in  the  second  summer  previous  to  his 
first  visit.  The  assigned  cause  was  overindul- 
gence in  unripe  or  spoiled  fruit.  The  trouble  had 
continued  through  the  following  winter,  with  inter- 
vals ot  cessation,  and  had  been  aggravated  the  fol- 
lowing summer.  Since  summer  his  loss  of  flesh, 
previously  considerable,  had  increased,  his  tongue 
was  heavily  coated,  the  appetite  poor;  his  dis- 
charges were  five  to  six  daily,  unformed,  varying 
much  in  amount,  sometimes  watery,  very  foul- 
smelling,  much  gas,  no  tenesmus,  no  blood  ;  pain 
at  times,  but  no  fever.  Although  he  was  in  a 
deplorable  condition,  and  so  long  as  his  work  re- 
mained severe  and  his  food  unsuitable  recovery 
seemed  impossible,  by  the  use  of  60  grains  of 
naphthalin  daily  the  number  of  movements  were 


^14 


*rHE   CANADA   MEDICAL   RECOHD. 


reduced,  within  a  week,  to  two  daily,  and,  for  the 
first  time,  became  formed  and  devoid  of  odor. 
About  six  months  afterwards  he  reported  that 
after  three  weeks  he  had  discontinued  his  medicine, 
having  had  no  further  necessity  for  using  it. 

In  chronic  dysentery  he  had  used  naphthalin  in 
seven  cases,  with  excellent  results.  The  most  in 
teresting  case  was  that  of  James  C,  66  )  ears  of 
age,  who  contracted  dysentery  while  serving  in 
the  Federal  army  in  1862  64.  He  had  never  been 
free  from  the  disease  exceijt  for  a  few  weeks  at  in- 
tervals. He  could  remember  no  day  during  which 
he  had  not  had  more  than  one  passage.  He  was 
emaciated,  with  sallow,  dirty  skin,  marked  tenes- 
mus, abdomen  painful  on  pressure,  red  tongue, 
pulse  very  feeble,  no  aijpetite.  His  stools  aver- 
aged seven  movements  daily, — slimy, bloodstained, 
of  extremely  foul  odor.  This  man  had  90  grains 
of  naphllialin  daily,  and  at  the  end  of  the  month 
he  would  have  hardly  been  recognized  as  the  same 
man.  Four  months  after  he  reported  himself  so 
much  improved  that  he  considered  himself  a  well 
man. 

His  experience  in  the  diarrhoea  of  typhoid  fever 
had  been  limited  to  two  cases  :  Charles  B.,  25 
years  of  age,  and  John  F.,  16  years  of  age,  both  of 
whom  he  saw  for  the  first  time  in  the  third  week, 
the  diagnosis  being  thoroughly  established.  In 
both  there  was  commencing  tympanites  ;  diarrhoea, 
to  the  extent  of  six  to  ten  passages  in  the  twenty- 
four  hours.  Naphthalin  was  administered  up  to 
60  and  90  grains  in  the  day,  with  the  result  of 
"  stiffening  up"  the  motions  and  reducing  them  to 
two  daily.  The  odor  of  the  stools,  in  both  cases, 
was  lost.  In  fact,  he  felt  so  confident  that  the  in- 
testinal canal  and,  consequently,  the  faeces  were 
disinfected  that  he  did  not  take  any  other  precau- 
tions. He  also  directed  attention  to  the  antipyretic 
effect  of  this  drug.  In  general,  the  use  of  antipy- 
retics in  typhoid  fever  he  considers  unsafe  ;  but  if 
the  practitioner  was  thoroughly  imbued  with  the 
idea  that  he  must  use  an  antipyretic,  let  him  use 
naphthalin,  which  reduces  temperature,  indirectly, 
by  disinfection  of  the  intestine.  In  point  of  salL^ty 
it  compared  favorably  with  such  drugs  as  antife- 
brin,  thallin,  antipyrin,  etc.  Whetlier  typhoid  fever 
had  ever  been  aborted  by  this  or  any  other  drug 
he  did  not  pretend  to  say;  but  if  it  could  beaccom- 
])lished,  in  his  opinion,  naphtlialin,  by  its  vigorous 
action  upon  the  contents  of  the  alimentary  canal, 
should  tend  to  that  result. 

Of  the  use  of  naphthalin  in  acute  intestinal  ca- 
tarrhs, and  in  the  diarrhoeas  of  children,  he  had 
had  no  experience.  In  the  diarrhcoa  of  chronic 
tuberculosis  he  h.ad  had  no  opportunities-  for 
experiment.  In  all  his  cases  of  diarrhcea  evidences 
of  tuberculosis  in  other  organs  were  sought  for, 
but  were  not  found.  He  would  enijihasize  the 
claims  of  naphthalin  as  the  drug  to  use  in  all  cases 
in  which  it  was  necessary  to  disinfect  the  alimen- 
tary canal,  as  in  typhoid  fever,  intestinal  catarrhs, 
and  dysentery,  because  it  seems  to  be,  of  all  the 
drugs  at  our  disposal,  the  most  certain,  and  at  the 


same  time  the  one  most  free  from  danger. —  T/ier- 

itpeiitic  Gazette. 


ANTI-DIARRHCEIC  PILLS. 

Trousseau  recommends  the  following  formula  in 
rebellious  cases  of  diarrhoea  which  have  resisted 
treatment  by  salines  : 

y  . — Powdered  ijjccac gr.  viij. 

Extract  of  oiiium. 

Calomel       .       .       .      ■      aa  gr.  iss. 
To  make  twenty  pills. 
The  dose,  one  to  three  pills  daily,  i.s  continued 
for  a  week  or  longer. — L  Union  Aledicale. 

The  Canada  Medical  Record. 

A  Monthly  Journal  of  Medicine  and  Surgery- 

EDITORS  : 

FRANCIS  W.  CAMPBELL.   MA.,  M.D.,  L.K.CP.  LOND 

Editor  :lli.l  I'].i|iri,.t"l-. 
R.  A.  KENNEDY,  M.A.,  M.D.,  Managing  ICUtor. 

ASSISTANT   EDITORS: 
CASEY  A.  WOOD,  CM.,  M  D. 
GEOKGE  E,  ARMSTRONG,  CM.,  M.D. 

SU]!30nU'TlllN    TWO   DOLI.AUS    PEIl    ANN'DM. 

All  communication!:  and  Kichavqrn  nivst  be  addresicu  to 
tile  Bdilors,Draiver35(>,  Post   Ol/ice,  Mniitrcal. 

MONTlfEAL,  JUNE,  1SS7. 

CANADIAN  MEDICAL  ASSOCIATION. 

We  would  remind  our  readers  that  this  Associa- 
tion holds  its  twentieth  annual  meeting  at  Hamil- 
ton, Ont.,  under  the  Presidency  of  Dr.  Holmes,  on 
the  31st  of  August  and  ist  of  September. 


SIR  JAMES  A.  GRANT,  M.D. 

Dr.  J.  A.  Grant  of  Ottawa,  who  ever  since  that 
city  became  the  capital  of  Canada  has  profession- 
ally attended  the  various  governor  generals  and 
their  families,  has  just  been  created  a  Knight  Com- 
mander of  the  most  distinguished  order  of  St. 
Michael  and  St.  George.  Dr.  Grant  has  the 
proud  distinction  of  being  the  first  Canadian 
medical  man  who  has  received  the  honor  of 
knighthood.  He  received  his  medical  education 
at  McGill  College,  where  he  gr.aduated  in  1854, 
since  which  time  he  has  become  an  L.R.C.P.  Lon- 
don, and  an  F.R.C.S.  at  Edinburgh.  Dr.  Grant 
has  been  President  of  the  Canadian  Medical  As- 
sociation and  of  the  College  of  Physicians  and 
Surgeons  of  Ontario ;  he  has  also  contributed  many 
valuable  articles  to  medical  science.  We  congra- 
tulate him  on  his  promotion  and  wish  him  long  life 
to  enjoy  it. 


THE   CANADA   MEDICAL   RECOnD. 


215 


A  MAGNIFICKNT  DONATION. 

Sir  Donald  Siuiili  aiul  Sir  George  Steplicn  li.i\c 
notified  ilic  Mayor  of  Montreal  of  their  intention 
to  contribute  the  sum  of  one  million  dollars  to 
build,  ei|ui|),  anil  eutlnw  a  General  Hospital  in 
this  eily,  to  be  known,  in  commemoration  of  Her 
Majesty's  jubilee,  as  "  I'he  Royal  \'icloria  Hosjii- 
tal."  'I'liis  magnificent  donation  is  accompanied 
by  a  request  that  the  city  should  contribute  the 
land  on  which  to  erect  the  building,  and  the 
donors  asked  for  a  site  on  the  side  of  the  ALoun- 
tain.  next  to  the  residence  of  Sir  Hugh  Allan. 
This  has  been  granted  and  perpetually  leased  to 
the  hospital  at  one  dollar  a  year  rental.  The 
charter  has  since  been  obtained  from  the  Domi- 
nion Legislature  and  the  money  has  been  deposit- 
ed in  the  Bank  of  Montreal.  Such  a  noble  dona- 
tion made  in  the  life  time  of  the  benefactors,  can- 
not be  too  highly  appreciated,  and  we  trust  that 
these  two  noble  hearted  .Scotchmen  will  live  many 
years  to  reali.se  the  benefit  which  their  liberality 
is  bestowing  on  suffering  humanity.  We  have 
not  yet  seen  the  charter,  but  trust  its  terms  jilace 
its  management  upon  a  broad  and  liberal  basis. 


PERSONAL, 

The  many  friends  of  Dr.  Robert  Howard,  of  St. 
Johns,  Q.,  will  be  glad  to  hear  that  he  is  now  able 
to  get  about  slowly,  with  the  aid  of  crutches.  His 
eye  sight,  however,  continues  poor.  His  progress 
so  far  has  been  a  surprise  to  many  of  his  medical 
friends,  when  the  serious  character  of  his  disease 
is  remembered.  They  are  now  hojjcful  of  a  still 
further  improvement — though  it  may  be  slow. 

Dr.  Kerr  of  Winnipeg  has  gone  to  England  on 
a  brief  triji. 

Dr.  Guerin  of  Montreal  has  returned  from 
Paris. 

Dr.  Grasett  has  been  appointed  to  the  chair  of 
•iurgery  in  Trinity  iMedical  College,  Toronto,  ren- 
dered vacant  by  the  death  of  Dr.  Fulton.  Dr. 
Covernton,  sr.,  takes  medical  jurisprudence,  and 
Dr.  Covernton,  jr.,  sanitary  science. 

Dr.  F.  W.  Campbell,  has  been  apjwinted  Medi- 
cal Referee  for  the  Dominion  of  Canada  for  the 
New  York  Life  Insurance  Company.  In  this 
capacity  he  has  entire  charge  of  all  Medical 
matters  pertaining  to  the  Company.  This  ap- 
pointment is  entirely  distinct  from  the  position  of 
Medical  Examiner  for  the  Company  in  Mont- 
real, which  he  has  held  for  the  last  nineteen  years. 


Dr.  Rirkett   (M.D.  McGill  College,   i886")  has 

been  nominated  Assistant  Surgeon  of  the  Victoria 
Rides  of  Canada,  (Montreal). 

Dr.  Corson  (M.D.  McGill  1885)  'las  been 
appointed  Surgeon,  and  [)r.  Rollo  Campbell, 
(.M.D.  Jiishops',  1887 j  Assistant  Surgeon  of  the 
Roy.il  Scots  of  Montreal. 

Dr.  Weir  Mitchell  of  Philadelohia  is  on  the 
Restigouche  River,  salmon  fishing,  as  is  also  Dr. 
Frank  Thompson  of  Philadelphia.  Dr.  F.  W. 
Campbell  of  Montreal  is  also  engaged  at  the  same 
sjiort  on  the  same  river. 

Dr.  Pare  of  Lachine  has  been  appointed  an 
Assistant  Surgeon  in  the  North  West  Mounted 
Police.     The  appointment  is  a  good  one. 

Dr.  R.  Palmer  Howard  of  Montreal  is  fishing 
on  the  Little  Cascapedia. 

Dr.  A.  L.  Smith,  Professor  of  Medical  Juris- 
prudence, University  of  l!isho])'s  College,  returned 
from  Europe  by  the  SS.  Lake  Ontario  which 
arrived  here  on  June  22nd. 

Dr.  James  Stewart  has  been  appointed  assistant 
])hysician  to  the  Montreal  General  Hospital,  vice 
Dr.  J.  C.  Cameron,  appointed  consulting  physician. 

Dr.  Wolficd  Nelson  (M.D.,  Bishops'  College 
and  McGill  College,  1872),  Foreign  Medical  In- 
spector for  the  New  York  Life  Insurance  Com- 
pany, sailed  a  few  days  ago  for  Europe  on  Company 
business.  He  will  be  absent  several  months,  and 
his  time  will  be  passed  entirely  on  the  continent. 

Dr.  T.  J.  Alloway  has  been  appointed  assistant 
surgeon  of  the  Montreal  General  Hospital  vice 
Dr.  Girdwood,  appointed  consulting  surgeon. 

Dr.  R.  A.  Kennedy,  Registrar  of  the  Univer- 
sity of  Bishop's  College  and  one  of  the  Editors  of 
this  journal,  has  returned  from  Colorado  where 
he  had  been  spending  a  few  weeks  for  the  benefit 
of  his  health,  which  we  are  glad  to  say  is  greatly 
inii)roved. 


REVIEWS. 
"  Which  i  or  Between  Two  lFo//ie/i,"  in  press 
for  immediate  publication  by  T.  B.  Peterson  & 
Brothers,  Philadelphia,  is  the  latest  and  most 
powerful  novel  from  the  pen  of  the  celebrated 
French  novehst,  Ernest  Daudet.  It  is  fully  worthy 
of  its  famous  author's  great  reputation,  and  is  one 
of  the  strongest  and  best  love  romances  ever  issued 
from  the  press.  The  action  is  brisk  and  spirited, 
while  the  interest  is  of  the  most  absorbing  kind. 


216 


fSE  Canada  medical  record. 


The  scene  is  laid  in  Paris  and  the  country,  and  the 
events  are  described  with  rare  vigor  and  complete- 
ness of  detail.  Many  of  the  incidents  are  of  the 
most  thrilling  and  dramatic  description,  while  the 
characters  are  all  well  drawn,  and  speak  and  act 
like  living  people.  It  will  be  issued  in  ^  large 
duodecimo  volume,  price  75  cents. 


Athothh,  A  Satire  on  Modern  Medicine  by 
Thomas  C.  Minor,  Cincinnati,  Robert  Clarke 
&  Co.,  1887. 

This  is  a  cleverly  written  Egyptological  fable,  in 
which  the  author  gives  some,  perhaps,  well  de- 
served hits  on  the  customs  of  fashionable  medical 
practice  in  this  the  nineteenth  century.  Even  the 
germ  theory  is  not  forgotten  and  comes  in  for  a 
goodly  share  of  criticism.  The  various  types  of 
successful  medical  practitioners  are  very  vividly 
caricatured,  and  the  general  style  and  contour  of 
the  book  will  amply  repay  the  physician's  perusal 
while enjo}ing  a  (t\y  days'  vacation. 


A  Treatise  on  Diphtheria  Historically  and  Prac- 
tically Considered ;  Including  Cioup,  Tracheo- 
tomy and  Intubation.  By  A.  Sanne.  Trans- 
lated, annotated  and  the  surgical  anatomy 
added ;  illustrated  with  a  full-page  colored 
lithograph  and  many  wood  engravings.  By 
Henry  Z.  Gill.  St.  Louis:  J.  H.  Chambers 
&  Co. ,1887.  665  pages.  Price:  Cloth,  $5  ; 
Sheep,  $6. 

We  highly  recommend  this  exhaustive  volume 
on  a  subject  of  such  very  vital  importance  to  the 
medical  profession  in  general.  The  work  deals 
with  diphtheria  in  all  its  various  forms,  with  its 
history,  prophylaxis  and  treatment  in  such  an  able 
manner  that  it  cannot  fail  to  be  appreciated  by  our 
readers.  The  pa])er  and  variety  of  type  are  of 
the  best  quality,  as  is  also  the  binding.  The 
translator  who  lias  so  ably  performed  his  duty  as 
well  as  the  publishers  are  deserving  of  all  possible 
success,  for  not  having  spared  any  effort  to  bring 
this  valuable  work  creditably  before  the  American 
public. 


What  to  do  in  cases  of  Poisoning.  By  William 
MuRRELL,  xM.D.,  F.  R.  C.  P.,  Lecturer  on 
Pharmacology  and  Therapeutics  in  the  West- 
minster Hospital,  etc.,  etc.  First  American 
from  the  Fifth  English  Edition,  Edited  by  Frank 
Woodbury,  M.D.,  Fellow  of  College  of  Physici- 
ans of  Philadelphia,  Professor  of  Materia  Medica, 
Therapeutics  and  of  Clinical  Medicine  in  the 
Medico-Chirurgical    College    of    Philadelphia. 


Published  by  the  Medical  Register  Co.,  Phila- 
delphia, 1887. 

This  little  work  having  gone  through  five  edi- 
tions in  England  pro^-es  beyond  doubt  that  it 
must  have  supplied  along  felt  want  in  the  medical 
literature  of  a  toxicological  character.  The  author 
says  he  disclaims  any  responsibility  in  the  matter 
of  the  large  circulation  of  this  work.  That  this 
book  has  saved  some  lives  is  doubtless  true,  one 
case  being  recorded  of  a  gentleman  who  contem- 
plated poisoning  himself,  but  changed  his  mind  on 
reading  the  directions  for  treatment.  The  general 
"  make  up  "  of  the  book  is  very  good,  and  the 
various  poisons  and  their  antidotes  are  so  arranged 
(being  placed  alphabetically)  as  to  make  reference 
easy.  A  chapter  has  also  been  added  regarding 
the  fee  which  should  be  charged  in  cases  of  poi- 
soning. Altogether  the  work  is  one  of  the  best  for 
the  busy  medical  man,  being  very  concise  and 
compact,  capable  of  being  carried  in  the  pocket  or 
medicine  chest. 


Earth  as  a  Topical  Application  in  Surgery. 
Being  a  full  exposition  of  its  use  in  all  the  cases 
requiring  topical  applications  admitted  in  the 
Men  and  Women's  Surgical  Wards  of  the  Phila- 
delphia Hospital  during  a  period  of  six  months 
in  1869.  By  Addinell  Hfwson,  i\I.D.  Second 
edition,  with  four  photogra]3hic  illustrations. 
Published  by  the  Medical  Register  Company, 
Philadelphia,  1887. 

This  book  contains  numerous  very  concise 
statements  regarding  the  results  of  the  use  of  dry 
earth  as  a  dressing  in  surgical  cases.  Although 
the  author  in  the  first  edition  of  this  work  made 
.several  suggestions  in  regard  to  the  treatment  of 
surgical  affections  by  the  use  of  earth  or  clay,  the 
medical  profession  do  not,  as  yet,  appear  to  have 
taken  much  interest  in  the  subject,  although  the 
results  of  Dr.  Hewson's  experimental  labors,  have 
been  all  that  could  be  desired.  The  writer  appears 
to  have  used  the  dressing  in  some  severe  and 
complicated  cases,  such  as  fractures,  comjiound 
and  comminuted,  ulcerated  wounds,  involving 
joints,  and  in  excisions  and  amputations,  and  has 
evidently  given  the  dressing  a  severe  trial  with  the 
best  results.  The  author  claims  the  following 
beneficial  results  are  to  be  obtained  from  the 
proper  application  of  this  substance,  viz.  :  Relief 
of  pain,  absence  of  inflammation  and  putrefaction, 
deodorizing  properties,  and  promotiun  of  the 
healing  process. 


THE  CANADA  MEDICAL  RECORD. 


Vol.  XV. 


MONTREAL,    JULY,    1887. 


No.  10. 


OOlsTTEnSTTS. 


ORIGINAL  COMMUNICATIONS. 

On  Some  Forms  of  Hysteria 217 

SOCIETY  PROCEEDINGS. 

Medlco-CliinirKlciVl    Sooiely   of  .Mont- 
real    223 

PROGRESS  OF  SCIENCE. 

CLronlc  Catarrhal  Gastritis 230 

The  Management  and  Treatment   oi 
Acute  Bronuhitis  in  Children 232 


Tho  Illeltuy  ol"  IJrlglit's  Diaeasu 

Tlio  Treatment  of  Epistaxis 

The  Treatment  of  Diabetes 

CEdL-ma  in  the  Prepuce 

Krgot  In  Erysipelas 

To  Stop  Toothaclie 

Prescription  for  Headache 

EDITORIAL 

Anntial  M.-etlng  of  tlie  College  of  Phy- 
sicians and  Surgeons  of  Ontario... 


239 


International  Medical  ('ongrc.ss 230 

The  ICnglish  <;ommi«sIon  (>n  }*aBte«r*s 
Method  of  rreventlng  or  Treating 

Hydropbol)la 23'.i 

Beecher's  Voice  In  the  Phonograph —  2'Ul 

Peksonal 240 

Ubview 240 


ON  SOME  FORMS  OF  HYSTERIA. 

By  George  Ross,  M.D,, 

Professor  of  Clinical  Medicine,  McGill  University. 

{Read  before  tin:  Aledico-Chirurgical  Societv  of  Montreal.') 

We  are  all  fully  alive  to  the  freaks  and  vagaries 
of  that  strange  disease,  Hysteria,  and,  in  anoma- 
lous cases,  should  be  on  the  alert  for  the  detec- 
tion of  this  underlying  element.  The  usual  mani- 
festations of  hysteria  are  so  striking,  so  well  un- 
derstood, and  so  easily  recognized,  that  when  they 
exist,  they  give  an  impress  to  the  symptomatology 
that  cannot  escape  the  medical  observer.  But 
when  these  are  wanting,  the  symptoms  may  very 
easily  be,  and  often  are,  mistaken  for  those  arising 
either  from  organic  disease  of  the  nervous  system 
(central  or  peripheral),  or  from  disease  of  very 
various  organs  and  structures.  It  is,  too,  a  mat- 
ter of  common  observation  that  persons  suffering 
from  the  graver  forms  of  hysteria  may  never  have 
presented  any  of  the  common  manifestations  just 
alluded  to,  and  this  valuable  aid  to  diagnosis  is 
frequently  wanting.  This  point  is  worth  establish- 
ing, because  it  is  within  my  experience  that  the 
absence  of  a  history  of  globus,  or  of  convulsions 
or  fainting  attacks,  or  retention  of  urine,  etc.,  is 
often  brought  forward  as  an  argument  against  the 
hysterical  hypothesis  in  a  doubtful  case.  To 
reach  a  satisfactory  diagnosis  in  these  cases,  it  is 
of  special  value  to  consider  the  whole  of  the  symp- 
toms together,  taking  in  the  entire  picture  made 
by  these,  and  studying  them  from  the  standpoint 


of  their  possible  explanation  as  a  whole — for  the 
anomalous  character  of  the  entire  group  of  symp- 
toms often  forms  the  strongest  argument  in  favor 
of  hysteria  ;  and  mistakes  are  often  made  by  want 
of  due  consideration  of  this  procedure,  where  any 
two  or  three  of  the  symptoms,  taken  apart  from 
others,  might  readily  indicate  an  entirely  erroneous 
conclusion. 

As  hysteria  is  pre-eminently  a  disease  of  the 
female  sex,  it  is  mainly  amongst  girls  and  women 
that  we  are  so  apt  to  suspect  its  existence.  That 
it  occurs  amongst  boys  and  men  will  be  admitted 
by  any  medical  man  to  whom  you  put  the  ques- 
tion ;  but  you  will  generally  find  that  the  cases 
they  have  seen  are  limited  to  perhaps  one  or  two 
in  which  the  common  phenomena — emotional  fits, 
or  globus,  or  palpitation — have  occurred.  So  rare 
is  it  to  observe  hysteria  gravior  in  the  male.  But 
it  does  show  itself  sometimes,  and  may  then  be 
the  source  of  grave  alarm  on  the  part  of  both 
friends  and  medical  attendants.  I  have  met  with 
several  examples  of  the  kind  within  the  past  year, 
and  to  illustrate  this  point,  select  two  cases  from 
the  hospital  record  : 

Case  I. — E.  P.,  aged  31,  telegraph  operator, 
admitted  27th  September,  1886,  complaining 
of  spitting  blood,  severe  vomiting,  and  diarrhoea. 
Family  history  good.  Patient  has  always  enjoyed 
good  health  until  4th  July,  18^4,  when,  whilst  on 
a  sea  voyage,  was  suddenly  thrown  from  his  berth, 
striking  his  head  against  a  marble  wash-stand. 
Remained  unconscious  for  half-an-hoiir,  and  no 
bad  effects  followed  until  twenty  days  after  the 
accident,  when  he  had  a  fit,  described  as  follows : 
Unconscious ;    frothing    at  the    mouth ;    tongue 


218 


THE   CANADA   MEDICAL   RECORD. 


bitten ;  limbs  quiet.     Fit  lasted  half-an-hour,  after 
which  he  felt   tired  and  sleepy.     These  fits  came 
on  every  .second  day  about  ii  a.m.,  and  were  pre- 
ceded by  a  feeling  of  ■'  wishing  to  be  alone.  "  The 
fits  continued  for  three  months,  and  at  the  end  of 
this  time  patient    entered   a    hospital   in   Dublin, 
where  the  surgeons  decided  to  trephine  ;  but  patient 
objected  to  this,  and  he  was  given  small  doses  of 
calomel  for  two  hundred  consecutive  hours.     The 
result  of  this  treatment  was    severe   ptyalism  and 
complete  cessation  of  the  fits.     Has  had  no  recur- 
rence since.     Nine  months  later   had   occasional 
attacks  of  cholerine  for  two  months  whilst  in  Mar- 
seilles. In  December,  1885,  began  to  complain  of 
an  easy,  painless,  non  paroxysmal    cough,   gene- 
rally worse  in  the  morning,  attended  with  a  small 
amount  ofgieyish-colored  and  tenacious  sputa.    In 
the  intervals  of  coughing,   patient  sj  at   up  bright 
red,  frothy  blood,  varying  in  quantity  from  a   tea- 
spoonful  to  three  tablespoonfuls,  and,  he  says,  as 
much  as    20   ounces    upon    one    occasion.     Had 
night  sweats  ;  no  diarrhoea;  lost   flesh  somewhat. 
Remained  in  a  hospital  in  Paris  for  two  months, 
where,  under  the  use  of  the  hot  hammer   and  blis- 
ters to  the  chest,    he    improved   very  much,  and 
returned  to  England.  Three  months  later,  through 
having  "  caught  cold,  "  patient  had  a  return  of  the 
above  symptoms  in  about  the  same  degree  of  seve- 
rity.    He  now  entered  the    Brompton  Hospital, 
where,  under  treatment  (cod-liver  oil,  porter,  and 
nourishing  diet),  he  improved  so  much  that  at  the 
end  of  five  weeks  he  left  the  hospital  able  to  resume 
his   usual    occupation.     Shortly    after    there  was 
a  return  of  all  his  previous  symptoms  in  a  slighter 
degree,  and  he  entered  the    Victoria  Park  Hospi- 
tal.    Here,  under  a  similar  course   of  treatment, 
he  improved  much  in  health  and  strength,  and  con- 
tinued to  do  so  until  26th  September,   1886,  when 
after  just  arriving  in  Montreal  was  seized  with,  he 
says,   a   severe  attack  of  diarrhoea,   stools    being 
watery,  yellow,  and  streaked  with  blood,  the  pas- 
sage of  each  stool  being  attended  wiih  a  good  deal 
of  pain  and  tenesmus  ;  complained  also  of  abdom- 
inal   cramps   and  vomiting,  the  ejecta  consisting 
of  food  taken.     Had  a  slight  attack  of  spitting   of 
blood.     No    cough    nor   thoracic    pain.       These 
symptoms  were  preceded  by  chills    and  feverish- 
ness.      Upon  admission,  these  were  the  symptoms 
comi)lained  of  by  patient;  but,  upon  examination, 
the  stools  passed  were  quite  normal  in  appearance, 
and  he  had  no  attack  of  vomiting. 

Examination — Of  average  height;  weight   118 


lbs. ;  sparely,  though  well-built ;  anaemic  ;  dark  com- 
plexioned ;  skin  warm  and  moist ;  muscles  not 
wasted  ;  no  evidence  of  injury  to  head;  no  evident 
ces  of  syphilis  ;  nails  not  incurvated ;  tongue  pale 
and  moist,  coated  in  centVe  with  slight  white  fur- 
edges  indented.  Pulse  84,  regular,  and  of  good 
volume.  Respiration  i8,  regular.  Temperature 
99  '-' .  Physical  exammation  of  the  heart  and  lungs 
is  negative.  Examination  of  the  larynx  by  Dr. 
Major  reveals  nothing  abnormal.  Dr.  Johnston's 
report  upon  the  sputum  (?)  is  as  follows  :  "  A  dark- 
brown  fluid,  odor  aromatic,  contains  traces  of  food, 
considerable  number  of  fat  globules,  and  numerous, 
epithelial  sca'es,  also  a  few  mold  filaments ;  not 
examined  for  bacilli,  as  none  of  the  usual  elements 
of  sputum  were  found  ;  no  blood-cells  to  be  seen 
in  specimen."  Urine  52  ozs.,  very  pale  color  ;  no 
deposit;  1022;  no  sugar,  no  albumen. 

During  patient's  stay  in  the  hospital  his  chest 
was  frequently  examined,  with  negative   results; 
the  spurious  expectoration  was  subjected  to  rigid 
examinations,  with  the  same  result  as  that  at  first 
arrived    at.     He    was    closely  watched  for  these 
attacks  of  spitting  of  blood,  but  never  could  he  be 
caught  in  the  act.     The  symptoms  complained  of 
disappeared    upon  admission ;    his   appetite    was 
good,    the    bowels   regular,    slept  well,   gained  in 
weight,  and  nothing   unusual  developed  until  30th 
October,  when,  at  2  p.m.,  he  was  seized  with  vio- 
lent and  excessive  pain  in  the   umbilical  region, 
and  upon   examination,    even  the  slightest  touch 
caused  excruciating  pain  and  made  him    cry  out. 
The  position  assumed  was  as  follows  :  Recumbent 
posture ;  left  arm  held  closely  to   the   body  and 
forearm  flexed  to  a  right  angle  ;  fingers  of  left  hand 
strongly  abducted  from  the  median  line  and  semi- 
flexed ;  the  left  thumb  was  firmly  adducted  and 
flexed  to  a  right   angle.     The   fingers  and    thumb 
were  easily  straightened,    but  soon    flew  back  to 
their  original  state.     The  act  of  moving  the  fingers 
apparently    pained  him  very    much.       The   right 
upper  extremity  was  not  at  all  affected.  The  lower 
extremities    were    markedly    rigid   and  extended. 
Feet  extended  and  all  the  toes  pointed  forwards, 
except  the  left  great   one,  which  was  bent  back- 
wards and  almost  touched  the  dorsum  of  the  foot. 
Unexpected  tickling  or  pinching   the  lower  extre- 
mities would  cause  the  existing  rigidity  to  pass  off 
and  the  legs  would  suddenly  be  drawn  up.     When 
attention  is  drawn  to  it,  no  amount  of   tickling  or 
pricking  with  a  pin   would  cause  any  starting  of 
the  extremities  or  give  evidence  of  pain.     Patient 


THE   CANADA    MEDICAI,    RECOUD. 


219 


wrongly  locates  the  site  of  any  touch  or  irritation. 
Sight  and  hearing  unafiected.  Pulse  60,  regular ;  res- 
piration 18;  teniiicratiire  98  "^  .  Tiiis  condition 
continued  for  about  one  hour,  and  at  the  end  of  this 
time  iuid  resumed  his  natural  state.  In  the  evening 
of  tlie  same  day  had  a  similar  attack  ;  but  in  addition 
to  the  foregoing  symptoms,  there  was.  as  he  said, 
"  complete  inability  to  see  any  objects  or  even  to 
distinguish  light  from  darkness;''  the  sense  o^^ 
smell  and  taste  were  also  absent,  as  he  did  not 
give  the  slightest  evidence  of  perceiving  a  strong 
solution  ot  ammonia  held  closely  to  the  nostrils, 
nor  of  tincture  of  assafcetida  placed  on  the  tongue. 
Patellar  reflex  was  present,  and  to  a  marked  de- 
gree on  the  left  side.  Pulse  70,  regular  ;  respira- 
tion iS;  temperature  100°.  Patient  said  he 
had  a  fit  during  the  night  of  a  character  similar  to 
those  he  had  when  in  a  hospital  in  Dublin.  Next 
day  all  that  remained  of  his  symptoms  was  anal- 
gassia  above  the  right  eye,  over  an  area  of  2x3 
inches.  His  gait  had  also  changed,  for  when 
walking  he  placed  the  right  foot  in  advance  of  the 
left,  and  rested  on  the  right  whilst  the  left  was  lifted 
in  a  rigid  state  close  to  the  other  foot.  At  times 
when  walking  in  this  manner  he  would  tend  to  fall 
to  the  left  side.  Two  days  later  all  symptoms 
had  entirely  disappeared,  and  the  gait  was  again 
quite  natural.     Patient  left  the  hospital  next  day. 

Now  this  is  a  curious  medical  history.  It  con- 
sists, briefly,  in  "  fits,"  said  to  have  been  cured  by 
calomel ;  repeated  haemoptysis  and  a  cough  ;  diar- 
rhoea for  several  months  ;  return  of  alleged  haemop- 
tysis ;  the  colored  fluid  shown  not  to  have  come 
from  the  lungs ;  sudden  onset  of  spastic  contrac- 
tures in  limbs  ;  analgesia ;  sudden  disappearance 
of  the  same  ;  sudden  and  temporary  interference 
with  the  special  senses.  It  involves  manifest 
incongruities  which  are  not  to  be  explained  except 
upon  the  ground  of  hysteria.  Our  observations 
on  this  patient  whilst  in  hospital  showed  that  he 
possessed  in  a  marked  degree  many  of  the  mental 
characteristics  with  which  we  are  especially  familiar 
in  women  who  suffer  from  this  malady,  viz.,  a  keen 
interest  in  their  own  medical  case — a  craving  for 
a  corresponding  interest  on  the  part  of  those 
around  them — a  readiness  to  furnish  details  con- 
cerning symptoms — close  observation  of  all  treat- 
ment and  its  apparent  effects — a  proneness  to 
exaggerate  or  even  falsify  in  order  to  increase  the 
sympathy  they  so  long  for.  Further  enquiries, 
too,  developed  the  fact  that  this  man's  moral  sense 
had  become  very  obtuse.     He  had  made  fraudulent 


representations  to  certain  persons  with  reference 
to  financial  and  other  matters,  and  had  succeeded 

in  committing  some  petty  acts  of  "swindling." 
A  knowledge  of  this  might,  perhaps,  have  been 
taken  as  invalidating  the  case  entirely,  and  caused 
one  to  say  that  we  were  dealing  with  no  disease  at 
all,  but  with  deliberate  simulation  only.  I  did  not 
take  this  view  of  the  case,  and  I  think  that  a 
consideration  of  the  details  given  will  convince 
any  one  that  a  real  disease  of  the  nervous  system 
was  present.  The  most  important  observation 
bearing  out  this  idea  was  that  pertaining  to  the 
curious  and  rapidly-developed  spastic  phenomena 
with  associated  sensory  disturbances,  a  condition 
which  it  would  take  a  very  clever  imposter  to 
evolve  out  of  his  inner  consciousness.  I  would 
note  the  assistance  derived  here  from  microscojiical 
examination  of  the  bloody  fluid  alleged  to  have  been 
spat  up.  Dr.  Johnston  knew  nothing  of  the  case — 
simply  getting  the  specimen  in  a  numbered  vial 
along  with  several  others  from  the  hospital.  He, 
you  will  have  noticed,  repudiated  it  as  a  specimen 
of  sputum  at  all,  which  fully  confirmed  suspicions 
already  entertained. 

The  next  case,  also  in  a  male,  presents  very 
different  features  : 

Case  II. — J-  W.,  aged  20,  admitted  October  10, 
18S4,  with  high  fever,  delirium  and  cough.  He 
was  found  to  have  been  ill  for  thirteen  days  with 
symptoms  indicative  of  imeumonia,  and  physical 
examination  showed  the  usual  signs  of  consolida- 
tion of  the  apex  of  the  left  lung.  During  the  next 
two  days  he  remained  quite  ill.  Temperature 
101°  to  103°  ;  pulse  120.  Delirious  at  nights, 
no  sleep,  and  required  constant  watching.  On 
the  13th  defervescence  took  place  ;  the  morning 
temperature  being  98  °  ,  and  the  pulse  68.  The 
note  of  this  day,  however,  says  :  "  Will  not  put  out 
his  tongue ;  refuses  to  open  his  mouth  for  a  drink 
of  milk ;  will  not  answer  any  questions."  And 
the  remark  significantly  follows  :  "  Except  for 
this  mental  condition,  is  evidently  much  better." 
I  may  merely  say  that,  as  regards  his  affected  lung, 
the  process  of  resolution  proceeded  rapidly.  No 
further  elevation  of  temperature  occurred,  and  he 
began  to  sleep  a  little  at  nights.  It  was  on  the 
days  subsequent  to  the  13th  that  we  observed  the 
special  symptoms  indicative  of  the  nervous  disor- 
der. On  the  i4tn,  the  note  describes  him  as  "a 
little  more  rational,  and  willing  to  speak  and  to 
explain  his  feelings  and  other  symptoms."  On 
the  15th,  "had  a  good  sleep  last  night,  is' quiet 


220 


THE   CANADA   MEDICAL   RECORD. 


and  fairly  rational.  On  the  i6th,  "  has  fallen  into 
a  lethargic  condition,  which  is  rapidly  deepening, 
so  that  he  is  roused  with  considerable  difficulty. 
By  loud  speaking  can  be  made  to  protrude  his 
tongue  (which  is  dry).  Lies  quite  still  on  his  back, 
with  occasional  twitchings  of  the  hands  and  a 
moderate  talkative  delirium.  No  change  in  the 
pupils.  Urine  passed  in  bed."  On  the  17th,  "  a 
good  night ;  bright,  asked  for  his  dinner ;  spoke 
quite  briskly  at  the  mid-day  visit.  Soon  after 
relapsed  into  a  soporose,  semi-comatose  state  sim- 
ilar to  yesterday.  Can  only  be  aroused  momen- 
tarily with  difficulty."  On  the  iSth,  "a  repeti- 
tion of  the  same  thmg  ;  a  good  night ;  a  bright 
forenoon,  and  at  i  p.m.  a  relapse  into  an  apparently 
insensible  condition."  At  this  time  no  shouting^ 
shaking  or  violent  pinching  succeeded  in  arousing 
him,  and  no  answer  of  any  kind  could  be  obtained 
from  him.  Late  in  the  afternoon  he  was  again 
quite  wide-awake.  19th,  less  stupor  and  delirium. 
20th,  "  Eats  and  sleeps  well  ;  quite  lively  and 
intelligent ;  no  attacks  of  stupor."  From  this  time 
his  convalescence  was  uninterrupted. 

We  learned  from  the  nurse,  during  the  days  of 
his  s  f  uj>  id  alt  icks,  that  these  might  come  onandgo 
off  perhaps  twice  or  three  times  during  the  course 
of  the  day.  That  the  condition  varied  remark- 
ably we  had  sufficient  evidence  from  what  we  our- 
selves observed.  The  most  usual  condition  was 
fair  intelligence  in  the  forenoon,  rapidly  or  even 
suddenly  changing  to  a  state  of  apparently  pro- 
found lethargy  and  stupor  at  about  i  p.m.  An- 
other jjoint  was  that  on  these  days  he  knew  his 
friends  when  they  came  to  visit  him,  but  talking 
to  them  made  him  extremely  excited,  and  he  cried 
profusely  -  so  much  so  that  the  nurse  was  twice 
obliged  to  send  them  away. 

To  recapitulate  the  facts  of  this  case  :  A  deli- 
cate, slim  young  man,  aged  20,  nervous  looking, 
contracts  pneumonia  and  arrives  here  at  the  height 
of  that  disease,  delirious ;  typical  defervescence 
occurs,  and  the  case  ijjiioad  the  pneumonia) 
follows  a  normal  course  towards  resolution.  But, 
instead  of  our  patient  presenting  the  calm  aspect 
and  cheerful  face  of  the  ordinary  pneumonic  con- 
valescent, we  find  him  continuing  to  talk  incohe- 
rently, even  in  the  daytime,  lying  in  a  limp  fashion 
on  his  back  with  his  eyes  shut.  Next  day  found 
in  a  deep  stupor,  lying  quite  still  and  breathing 
quickly  like  one  asleep.  Then,  again,  he  is  found 
wide-awake  and  quite  chatty.  The  sight  of  friends 
excites  him  and  makes  him  weep.  This  condi- 
tion passes  off  in  a  few  days,  and  he  is  well. 


The  facts  detailed  are,  I  think,  sufficient  to  war- 
rant the  diagnosis  made — the  hysterical  condition 
assuming  here  the  form  of  lethargy,  and  having 
been  induced  by  the  debility  resulting  from  the 
acute  disease. 

I  was  recently  consulted  concerning  the  son  of 
a  gentleman  in  a  neighboring  town.  The  lad, 
aged  16,  having  been  suffering  from  toothache  and 
swelled  face,  became  suddenly  apparently  insensi- 
ble, remaining  so  several  days  and  causing  much 
anxiety.  He  then  began  to  rouse  up  at  intervals 
and  appear  rational,  going  off  again  in  a  short 
time  into  the  same  lethargic  state.  At  other  times 
he  would  talk  and  sing  to  himself,  paying  no 
attention  to  what  was  going  on  around  him,  and 
they  feared  his  mind  was  giving  way.  I  received 
full  particulars  from  his  medical  attendant,  and, 
replying,  gave  a  favorable  prognosis,  because 
I  looked  upen  the  case  as  an  odd  form  of  hysteria 
in  an  adolescent.  He  was  subsequently  brought 
to  the  city  to  see  me,  and  from  my  examination  I 
was  still  further  convinced  that  this  was  the  true 
explanation  of  it.  He  quite  recovered  and  conti- 
nues well. 

The  paralyses  of  hysteria  are  always  interesting. 
The  diagnosis  is  often  sufficiently  obvious,  but 
sometimes  it  is  beset  with  many  difficulties.  It  is 
notoriously  the  disorder,  of  all  others,  which 
offers  to  the  charlatan  and  the  faith-cure  people 
the  most  attractive  and  the  most  lucrative  field. 
Some  time  ago  a  lady,  whom  I  had  previously 
treated  for  functional  aphonia,  began  to  complain 
of  certain  indefinite  pelvic  s\mptoms,  and  finally 
lost  power  to  a  considerable  extent  in  both 
lower  extremities.  I  advised  a  stay  in  the  city 
(she  lived  some  distance  away)  for  the  pur- 
pose of  trying  the  effect  of  isolation  from  sympa- 
thizing friends  and  massage.  This  was  not  done, 
however,  and  her  friends  took  her  instead  to  New 
York.  Here  (perhaps  unfortunately)  they  con- 
sulted a  very  eminent  gynecologist.  He  pronoun- 
ced the  verdict  that  it  would  be  necessary  to  re- 
move the  ovaries.  This  terrified  her,  her  friends 
refused  their  consent,  and  she  remained  bed  ridden 
and  hopeless  of  any  relief.  Just  then  a  bright 
light  of  the  "  faith-cure  "  or  "  healing  by  prayer  " 
community  happened  along.  He  found,  on  en- 
quiry, that  she  had  any  quantity  of"  faith,"  and 
he  was,  therefore,  able  to  promise  everything. 
Surely  enough,  she  walked  in  a  couple  of  days, 
and  after  a  few  weeks  returned  home  satisfied  that 
with  her  a  real  miracle  had  been  wrought.     Her 


Tilfe    CAKADA    MEDICAL    RECORD. 


221 


feelings  of  gratitude  took  liie  form  of  a  "  stalc- 
meiit "  contained  in  a  small  pamphlet  headed 
"  modern  miracles,  "  which  was  no  doubt  widely 
circulated,  and  of  which  I  received  a  copy.  Being 
a  very  clever  lady,  her"  statement"  tells  most 
eloquently  of  her  rapid  descent  into  the  confines 
of  the  valley  of  the  shadow  of  death,  and  of  her 
rescue  therefrom  by  the  hand  of  an  angel  in  the 
garb  of  the  "faith-cure  "  man.  It  might  be  men- 
tioned, en  passant,  that  this  ministering  angel  was 
not  above  the  sordid  meanness  of  accepting  the 
very  handsome  fee  of  $i,ooo  presented  to  him  by 
his  grateful  worshipper.  This  lady  is  now  (juite 
well  and  likely  to  remain  so,  having  subsequently 
married  the  man  of  her  choice,  whose  temporary 
defection  was  j)robably  the  cause  of  the  entire 
trouble. 

It  is  quite  justifiable  to  take  a  leaf  out  of  the 
book  of  the  "  faith-curers.  "  Positive  and  dogma- 
tic statements  go  a  long  way  with  patients  of  this 
kind,  and  the  employment  of  some  visible  means 
perhaps  assists  in  bringing  about  the  desired  res- 
toration. This  plan  was  adopted  in  the  following 
cases  with  the  happiest  results  : — 

Case  III. — Hysterical  Hemiplegia T.  S.,  aged 

1 6,  servant,  admitted  to  hospital  8th  November, 
1 886,  complaining  of  weakness  of  left  arm  and  leg, 
and  pain  in  the  left  side  of  head  and  neck.  Three 
days  previous  to  admission  patient  began  to  com- 
plain of  a  dull,  aching,  continuous  pain  in  the 
forehead,  not  worse  at  any  particular  time.  Had 
sensation  of  chilliness  and  slight  attack  of  epis- 
taxis.  Took  to  bed  at  once,  and  next  day  suffered 
from  weakness  in  left  arm  and  leg,  which  gradually 
became  worse  until  admission.  Enjoyed  good 
health  until  two  years  ago,  when  on  waking  up 
one  morning  tbund  her  left  arm  and  leg  completely 
paralyzed.  These  members  were  tender  and  pain- 
ful, and  of  such  severity  as  to  cause  her  to  cry  out 
whenever  touched.  Sometimes  the  right  arm  and 
leg  would  become  clonically  contracted  for  a  few 
minutes,  whilst  the  left  arm  and  leg  would  be  at 
rest.  Was  quite  conscious  all  the  time.  Facial 
expression  and  power  of  speech  were  not  affected. 
Patient  remained  in  bed  until  last  Christmas,  and 
at  this  time  made  some  improvement,  so  much  so 
that  she  was  able  to  go  about  by  the  aid  of  crut- 
ches, and  one  month  later  was  quite  well.  The 
treatment  consisted  in  the  application  of  liniments 
to  the  atfected  parts.  Began  to  menstruate  at  13  i^ 
years  of  age  ;  has  always  been  irregular,  intervals 
between  the  periods  varying  from  fifteen  days  to 


six  weeks.  Appetite  has  been  good ;  bowels 
irregular.  Slept  well.  Patient  says  slic  has  been 
subject  to  fits  of  laughing  and  crying. 

Upon  adtnission.  — Complains  of  a  dull,  aching, 
continuous  pain,  localized  in  the  forehead  ;  of 
numbness  and  weakness  of  the  left  arm  and  leg  ; 
and  of  inability  to  lie  upon  the  left  side.  Patient 
is  of  small  stature  ;  her  features  are  of  an  Indian 
type  (her  father  is  chief  of  an  Indian  tribe  and  her 
mother  a  French-Canadian) ;  is  dark-complex- 
ioned ;  wears  a  heavy,  angry  expression  upon  face  ; 
foce  is  symmetrical ;  assumes  the  dorsal  decubitus, 
but,  forgetting  herself,  turns  over  to  the  left  late- 
ral. Pupils  active  and  equal.  Tongue  moist  and 
clean,  and  protruded  in  the  median  line.  Power 
of  flexion,  extension  and  abduction  of  upper  arm, 
extension  of  forearm  and  hand  grasp  of  the 
left  side  apparently  very  weak.  Whilst  conver- 
sing with  her  she  forgets  the  weak  condition  of  the 
muscles  of  the  upper  extremity,  and  raises  her 
hand  to  brush  her  hair  back.  Flexion  and  exten- 
sion in  left  leg  slightly  weaker  than  that  of  right. 
Muscles  of  affected  parts  are  well  developed  and 
firm.  Tactile  sense  intact  throughout,  though  anal- 
gesia is  present  to  a  slight  degree  in  left  arm  and  leg 
only.  Reflexes  normal.  When  walking,  patient 
limps  on  the  left  leg,  keeping  the  foot  strongly 
everted,  and  puts  it  down  to  the  ground  as  if  afraid 
of  hurting  herself. 

A  faradic  current  was  daily  applied  to  the  affect- 
ed limbs,  and  she  was  encouraged  to  rub  them 
several  times  every  day  with  a  liniment.  She  was 
told  that  this  would  cure  her  in  a  few  days.  At 
each  visit  careful  enquiries  were  made  as  to  the 
regularity  with  which  she  had  carried  out  her 
treatment.  The  weakness  of  the  limbs  steadily 
improved,  the  gait  shortly  became  natural,  and 
she  was  discharged  quite  well  in  a  fortnight. 

CaseIV. — Hysterical  Paraplegia. — M.H.,aged 
22,  servant  brought  into  the  hospital  upon  a  chair, 
complaining  of  inability  to  walk. 

History  of  the  case. — Until  day  previous  to 
admission  patient  enjoyed  good  health,  when, 
upon  awaking  in  the  morning,  she  found  herself 
quite  unable  to  move  her  legs.  Later  on  m  the 
day,  with  assistance,  got  out  of  bed,  but  her  knees 
suddenly  gave  away,  thus  precipitating  her  to  the 
floor.  Returned  to  bed  and  remained  there  until 
brought  to  the  hospital.  Was  quite  conscious. 
No  perverted  sensation.  Complained  of  severe 
and  continuous  frontal  headache,  described  by  the 
patient  herself  as  "  boring"  in  character ;  it  is  not 


222 


THE   CANADA   MEDICAL   RECOKD. 


worse  at  any  particular  time.  Upon  the  morning 
of  admission  to  the  hospital  she  said  her  voice 
had  suddenly  become  weaker,  and  at  times  she 
completely  lost  it.  Also  complained  of  palpita- 
tion, with  tenderness  under  tlie  left  mamma.  Has 
no  vesical  or  rectal  disturbance.  Menses  are 
irregular  in  their  appearance,  small  in  amount,  and 
eich  period  is  generally  preceded  by  pain. 

Examination. — Patient  is  a  healthy-looking  and 
well  nourished  female ;  takes  a  great  deal  of  care 
to  describe  fully  and  dwell  at  length  upon  her 
complaints.  The  breathing  during  this  time  is 
quite  tranquil,  but  when  attention  is  drawn  to  the 
painful  spots  the  respirations  immediately  become 
quickeiied  and  somewhat  sighing  in  character. 
Voice  is  weak  ;  inclined  to  whispering.  Lower 
extremities  are  extended  and  the  feet  are  in  a 
natural  position.  Skin  is  warm  and  moist.  Mus- 
cles not  wasted.  Says  she  cannot  move  the  legs 
at  all.  The  plantar  reflexes,  if  suddenly  tested, 
causes  slight  withdrawal  of  the  feet.  Tactile 
sense  is  normal.  Marked  analgesia  in  the  lower 
extremities  from  the  feet  to  as  high  as  the  knees. 
Pressure  over  and  below  the  left  nipple  causes 
patient  to  wince,  bnt  with  the  attention  misdirect- 
ed these  points  are  no  longer  tender.  It  was 
noiv  insisted  upon  that  the  patient  should  get  up 
and  try  to  walk,  and  this  she  did,  but  her  gait  was 
staggering ;  the  heels  were  placed  firmly  upon  the 
ground,  the  toes  extended,  and  the  plantar  arches 
much  elevated  ;  her  eyes  were  kept  fixed  upon 
the  ground ,  at  times  she  would  appear  as  if  about 
to  fall,  but  this  was  generally  done  when  she  was 
well  within  reach  of  good  support.  Examination 
of  the  larynx  by  Dr.  Major  was  negative  in  its 
result.  Heart  and  lungs  negative.  Urine  54  ozs.  ; 
very  pale,  acid:  specific  gravity  1015  ;  no  sugar, 
no  albumen.  Four  days  later  the  analgesia  had 
entirely  disappeared,  the  painful  spots  no  longer 
present,  and  the  voice  quite  natural,  but  her  gait 
had  changed.  Now  patient's  walk  may  be  des- 
cribed as  follows  :  Walks  on  the  ball  of  the  great 
toe  of  right  foot,  the  heel  is  raised  from  the  ground, 
the  left  foot  is  placed  in  advance  of  the  right,  and 
whilst  resting  upon  it,  the  right  knee-joint  sudden- 
ly gives  away  ;  but  patient  soon  regains  the  upright 
position  and  continues  to  walk  as  before.  She  was 
given  some  bread  pills,  had  electricity  applied, 
and  used  a  stimulating  liniment.  In  about  two 
weeks  the  gait  was  quite  natural,  and  all  pains 
and  aches  had  disappeared.  The  patient  was 
now  discharged  from  the  hospital. 


The  same  precaution  was  taken  here  to  impress 
this  patient  from  the  outset  with  the  idea  that  her 
case  was  quite  curable ;  that  she  would  soon 
regain  the  power  of  her  limbs  ;  and  to  insist  upon 
her  following  certain  prescribed  directions  very 
carefully. 

Case  V — Hysterical  Vomiting. — H.  S.,  aged 
27,  servant,  admitted,  complaining  of  vomiting 
and  of  pains  in  the  abdomen,  legs  and  head. 

Previous  history. — Enjoyed  good  health  until 
six  months  ago,  when  one  morning,  whilst  lying 
down,  patient  was  suddenly  seized  with  a  sharp 
pain  in  the  left  lower  axillary  region,  extending 
throughout  the  body,  aggravated  by  deep  in.spira- 
tion  and  coughing.  Vomiting  set  in,  and  for  the 
first  time.  The  attacks  were  aggravated  by  inges- 
tion of  food,  but  would  also  occur  independently 
of  any  food  taken.  There  was  no  dysphagia. 
The  food  was  rejected  about  an  hour  after  it  was 
taken.  The  ejecta  consisted  of  what  was  eaten. 
Even  fluids  could  not  be  retained.  Never  had 
hffimatemesis.  No  pain  after  eating.  Had  no 
desire  for  food.  Suffered  from  insomnia.  From 
these  attacks  of  vomiting,  which  have  continued 
ever  since  in  a  greater  or  lesser  degree,  patient 
has  lost  much  in  weight  and  strength.  About 
this  time  patient  began  to  suft'er  from  what  she 
calls  fits,  described  as  follows  :  The  aura  consisted 
of  a  sense  of  fullness  in  both  ears,  and  accompa- 
nied with  a  loss  of  hearing.  This  would  last  about 
half  a  minute,  then  patient  would  become  uncon- 
scious and  fall  down  anywhere,  on  one  occasion 
cutting  left  eye,  and,  again  on  another  occasion, 
whilst  in  one  of  these  fits,  received  a  black  eye. 
These  fits  are  not  attended  with  any  tonic  or 
clonic  contractions  of  any  of  the  muscles  of  the 
body.  No  frothing  at  the  mouih.  Has  never 
bitten  the  tongue  whilst  in  one  of  these  fits.  The 
duration  of  a  fit  is  from  a  few  minutes  to  one  or 
even  two  hours.  Has  had  as  many  as  two  fits  in 
one  week.  Says  that  cold  water,  if  thrown  upon 
her  face,  always  brought  her  to  her  senses. 

Patient  is  a  married  woman  and  the  mother  of 
four  children,  all  enjoying  good  health  except  the 
eldest,  a  boy  aged  8  years,  who  is  subject  to  fits 
such  as  his  mother  suffers  from. 

Family  history  .—VloX^xtx  diwd  four  sisters  died 
of  consumption.  One  brother,  at  13  years  of  age, 
had  fits  similar  to  those  patient  suffers  from  for 
fifteen  years,  and  died  from  their  effects. 

Present  history. — At  present  patient  complains 
of  vomiting,  of  pains  in  abdomen,  legs  and  head, 


TllE   CANADA    MKDICAL   RECORD. 


223 


and  of  fits.  'I'lic  attacks  of  vomiting  consist  in 
almost  everything  being  ejected  from  the  stomacii 
within  iialf  an  hour  to  an  iioiir  after  the  ingestion 
of  I'ood.  The  ejccta,  u|)on  examination,  are  found 
to  amount  to  iialf  a  pint  at  any  one  time  of  clear, 
iransi)arent  mucus  fluid,  acid  in  reaction ;  the  mi- 
croscope reveals  detritus  of  food  ;  no  hlood  corpus- 
cles ;  no  sarcina:.  Suffers  no  \mn\  after  the  inges- 
tion of  food;  no  dyspliagia.  Complains  of 
anorexia,  constipation  and  insomnia.  The  pains 
in  abdomen,  legs  and  head  are  very  indefinitely 
located  in  these  regions,  their  site  being  very 
changeable,  and  their  character  altered  from  time 
to  time — at  one  moment  being  dull  aching,  and  the 
next  minute  sharp  and  shooting.  Patient  says 
slie  is  kept  awake  by  these  pains,  and  they  are 
much  increased  by  movement  and  examination. 
The  only  relief  to  the  vomiting  and  pains  was  the 
frequent  use  of  morphia. 

Examination. — Patient  is  of  average  height, 
anaemic-looking,  not  well  nourished ;  muscles  soft 
and  wasted  ;  skin  warm  and  moist ;  assumes  the 
dorsal  decul)itus  ;  evidences  of  recent  injury  to  left 
eye,  no  scar  seen.  Patient  is  very  restless  ;  keeps 
turning  her  head  from  side  to  side  ;  rubs  abdomen 
with  the  right  hand  ;  respirations  all  this  time 
becoming  quickened,  shallower  and  sobbing  in 
character.  This  having  ajjparently  reached  a 
climax  at  the  endofone  minute,  the  patient  begins 
to  cry,  stops  rubbing  the  abdomen,  and  turns  to 
the  right  side,  all  this  time  apparently  suffering 
very  severe  pain.  .Shortly  after  this  the  patient 
sat  up  in  bed,  eructated  a  large  quantity  of  gas, 
and  vomited  about  half  a  jiint  of  thin,  clear, 
watery-looking  fluid.  .She  now  lay  down  in  bed 
apparently  exhausted,  the  respirations  being  rapid 
and  sobbing  in  character.  Pulse  80,  full  and  re- 
gular. Respirations  2,6.  Temperature  97  °  . 
Tongue  moist  and  covered  with  slight  fur  in 
centre.  Abdomen  full,  not  distended ;  tenderness, 
amounting  to  hypersesthesia,  generally  distributed, 
but  more  marked  in  right  and  left  iliac  and  epi- 
gastric regions.  This  hyperssthesia  disappears  en- 
tirely when  patient's  attention  is  elsewhere  directed. 
No  tumor  made  out.  Liver  and  spleen  normal. 
Nothing  unusual  in  the  position  of  the  extremities. 
Muscular  power  is  good.  Gait  natural.  Tactile 
sense  everywhere  present.  Analgjesia  is  limited 
to  the  left  leg  from  the  ankle  to  knee-joint.  Re 
flexes  slightly  exaggerated.  Heart  and  lungs  nor- 
mal. Urine  58  ozs.,  pale  in  color,  acid;  specific 
gravity  1012;  no  albumen,  no  sugar. 


I'or  the  next  forty-eight  hours  the  attacks  of 
vomiting  were  incessant  during  the  day-time,  but 
always  ceased  at  night.  Patient  ejected  all  food 
taken  during  the  day,  but  at  night  the  food  left  at 
the  bedside  partially  disappeared. 

The  evening  after  admission  patient  had  one 
of  her  usual  fits,  and  it  is  described  as  follows  : 
Is  quite  conscious  and  answers  all  questions  quite 
correctly.  The  respirations  are  rapid  (38  per 
minute),  shallow  and  sobbing.  The  arms  are 
extended  and  the  fingers  firmly  closed,  both  arms 
shaking  as  if  patient  had  a  chill.  The  lower  ex- 
tremities are  natural  in  position.  No  disturbed 
sensibility.  This  condition  lasted  for  about  two 
minutes,  and  then  patient  assumed  a  quiet  state. 
Pulse  during  fit  was  72,  full  and  regular.  From 
this  day  until  exit  (6th  December)  patient  had  no 
return  of  tlie  attacks  of  vomiting  nor  of  the  fits, 
and  she  improved  very  much,  the  appetite  return- 
ing, sleeping  well,  and  the  bowels  regular.  The 
treatment  consisted  in  giving  her  a  placebo — viz., 
peppermint  water. 

MEDICO-CHIRURGICAL  SOCIETY   OF 
MONTREAL. 

Stated  Meeting,  March  25//;,  1887. 

J.  C.  Cameron,  M.D.,  President,  in  the  Chair. 

Culture  of  Tubercle  Bacillus. — Dr.  Johnston 
called  the  attention  of  the  Society  to  a  new  method 
of  cultivating  the  bacillus  of  tubercle,  and  exhibit- 
ed several  cultures. 

Extirpation  of  the  Kidney. —  Dr.  W.m.  Gardner 
exhibited  a  kidney  removed  by  lumbar  incision. 
The  patient,  aged  56,  of  intemperate  habits,  had 
been  complaining  since  4th  Dec.  last  (three  and  a 
half  months),  when  she  took  suddenly  ill  with 
rigors,  fever  and  pain  in  right  lumbar  region.  The 
symptoms  were  acute  and  severe — severe  rigors, 
profuse  sweating,  severe  pain,  frequent  vomiting, 
and  continued  so  till  the  operation.  The  urine 
contained  pus  at  intervals,  and  micturition  was 
frequent  and  painful.  The  patient  was  very  fat. 
On  examination,  a  diffuse,  very  tender,  ill-defined 
swelling  in  the  right  lumbar  and  hypochondriac 
region.  No  fluctuation.  On  percussion  over  the 
swelling,  intestinal  note.  Exploratory  abdominal 
incision  over  the  swelling.  Parietes  enormously 
thick.  Omentum  extremely  fat.  By  palpation 
the  tumor  was  now  ascertained  with  tolerable  cer» 


224 


THE   CANADA   MEDICAL   RECORD, 


tainty  to  be  the  kidney.  The  abdominal  incision 
was  closed,  and  the  kidney,  containing  half  a  pint 
of  pus,  was  removed  by  the  lumbar  incision.  No 
calculus  or  any  other  cause  for  the  suppuration 
could  be  found.  The  patient  was  watched  in  hos- 
pital for  two  days  before  the  operation,  when  the 
secretion  of  urine  was  almost  nil.  For  the  first 
twenty-four  hours  40  ounces  were  secreted  and 
passed  naturally  ;  for  the  next  twenty-four  hours 
none  at  all.  On  the  third  day  she  was  distinctly 
s  jporose.  A  small  quantity  of  urine  passed  in  bed. 
The  same  on  the  fourth  day  after  the  operation,  the 
day  she  died.  Just  before  death  four  ounces  was 
drawn  off  by  the  catheter.     No  autopsy  allowed. 

Discussion.—Dr.  Johnston  said  the  kidney 
seemed  to  show  a  condition  of  chronic  hydrone- 
phrosis, accompanied  by  an  acute  nephritis.  The 
collection  of  pus  did  not  apjjear  of  long  standing; 
there  was  no  pyogenic  membrane. 

Dr.  Shepherd  could  not  quite  agree  with  Dr. 
Gardner's  treatment  of  this  case.  Nephrotomy 
seemed  to  be  called  for  in  this  case, not  nephrectomy 
He  did  not  think  a  nephrectomy  should  ever  be 
performed  without  a  previous  nephrotomy,  as  no 
seriously  diseased  kidney  could  be  shelled  out 
readily.  The  history  seemed  to  point  to  pyone- 
phrosis, and  the  large  amount  of  urine  passed  after 
the  operation  might  be  due  to  a  collection  outside, 
the  injured  kidney. 

Dr.  Trenholme  referred  to  a  similar  case  occur- 
ring in  his  practice.  There  was  a  cyst  in  the  neigh- 
borhood of  the  kidney,  wliich  he  tapped  and  drew 
off  about  two  quarts  of  fluid.  Patient's  symptoms 
were  greatly  relieved,  but  the  cyst  returned,  and  on 
again  tapping  three  pints  were  obtained.  The 
patient  gradually  got  worse,  however,  and  the  post- 
mortem examination  showed  an  obstruction  of  a 
valvular  nature  in  the  ureter,  near  the  hilum  of  the 
kidney. 

Dr.  Gardner,  in  reply,  stated  that  the  case  was 
not  an  easy  one  to  diagnose,  as  the  panniculus 
adiposis  was  so  thick  the  nature  and  situation  of 
the  tumor  could  not  be  satisfactorily  made  out. 
The  patient  was  desperately  ill,  and  the  operation 
was  undertaken  as  a  last  resource. 

Extirpation  of  the  Uterus. — Dk.  Gardner  ex- 
hibited a  uterus  he  had  removed  a  week  before. 
The  patient  was  47  to  50  years  old.  Menses 
ceased  two  years  before  ;  occasional  hemorrhages 
continued.  No  serious  pain,  but  a  constant  dis- 
charge. The  case  was  then  regarded  as  one  of 
sarcoma.      The  operation  was  easy.      Dr.    John- 


ston concluded,  however,  that  it  was  carcinoma. 
The  tumor  was  in  the  form  of  series  of  outgrowths 
in  the  cavity  of  the  uterus. 

Dr.  Trenholme  congratulated  Dr.  Gardn^r  on 
the  success  of  his  operation,  and  said  with  regard 
to  extirj^ation  of  the  uterus  for  malignant  disease, 
that  while  he  had  performed  the  operation  some 
seven  or  eight  times  with  much  immediate  success 
yet  in  «// cases  the  disease  rapidly  retuined.     He 

now  no  longer  regarded  the  operation  with  any 
favor. 

Laparotomy. — Dr.  Trknholme  exhibited  a 
cyst,  about  the  size  of  an  egg,  removed  from  a 
patient  19  years  of  age,  confined  of  her  first  child 
eleven  months  ago,  since  which  time  she  has  been 
ill.  Previous  to  her  accouchement  she  had  enjoyed 
good  health,  but  was  attacked  with  a  severe  pelvic 
arthritis  and  peritonitis  three  days  after  she  was 
delivered  of  her  child.  Her  present  state  is  one 
of  constant  suffering,  with  pains  in  body  and  gen- 
eral nervous  and  gastric  derangement.  Tempera- 
ture varies  from  99^^  to  101°  and  102'' ;  pulse  from 
100  to  140.  Lips  and  teeth  exhibit  usual  feverish 
conditions.  On  examination,  find  a  tumor  leve' 
with  Poupart's  ligament  filling  a  good  part  of  pelvis 
on  right  side.  Tumor  was  dense  and  strongly  ad- 
herent to  wall  of  pelvis  ;  not  perceptibly  moveable, 
and  somewhat  nodular. 

Operation. — On  opening  cavity  of  abdomen,  the 
mass  was  found  to  coalesce  with  surrounding 
structures,  and  at  no  point  was  it  at  all  possible  to 
separate  the  mass.  The  specimen  shown  to-night 
was  situated  between  the  bladder  and  the  uterus. 
As  operation  could  not  be  completed,  the  abdom- 
inal wound  was  closed.  The  patient  bore  the 
operation  well,  but  on  the  fourth  day  a  profuse 
and  fcetid  flow  began  to  escape  from  the  abdomi- 
nal woLuid,  and  as  the  state  of  pulse,  high  temper- 
ature, etc.,  gave  little  hope  for  continuance  of  life, 
the  patient  returned  to  her  home  in  the  townships. 
She  bore  the  journey  ( 1  20  miles)  well,  and  at  the 
end  of  two  weeks  was  rather  better  than  when  she 
left  the  city. 

Dr.  Trenholme  remarked  that  this  was  the  fourth 
serious  case  of  abdominal  section  he  had  had  in 
succession,  all  of  whom,  he  was  glad  to  say,  had  so 
far  recovered.  One  was  a  solid  cyst  of  left  ovary 
(8  lbs.)  ;  one  a  suppurating  cyst  of  left  ovary  (12 
lbs.)  ;  one  a  dermoid  cyst  (4  lbs.),  and  the  pre- 
sent case. 

Case  of  Nephro-lithotomy. — Dr.  Shepherd  re- 
lated the  case.     He  said  : — 


TUE   CANADA   MEDICAL   RECORD. 


225 


The  following  case  is  of  interest,  not  only  on 
acroiint  of  the  large  size  of  the  slone  removed, 
but  also  because  tlie  question  of  the  <;onii)arative 
merits  of  nephrotomy  and  nephrectomy  is  raised 
in  such  conditions  of  the  kidney  as  existed  in  this 
case.  'I'he  i)atient  was  sent  to  me  by  Dr.  J.  R. 
Johnston  of  Spring  Valley,  Minnesota,  with  a  letter 
stating  he  susjiected  the  man  was  suffering  from 
stone  in  the  kidney.  The  history  of  the  case  and 
condition  on  entrance  I  quote  from  the  Hospital 
Rei)ort : 

"  VV.  C,  aged  26,  was  admitted  into  tlie  Mont- 
real (ieneral  Hospital  on  the  i8th  of  October, 
1886,  with  a  history  of  long-continued  pain  in  the 
left  lumbar  region  and  pus  in  the  urine. 

"  History. — Family  and  personal  history  good. 
Seven  years  ago  he  first  noticed  that  small  quanti- 
ties of  blood  were  passed  in  the  urine  at  the  end 
of  micturition  ;  four  years  ago,  blood  was  mixed 
with  the  urine,  giving  it  a  smoky  ai>pearance. 
Has  seen  no  blood  in  the  urine  for  two  years. 
During  the  last  seven  years  he  has  been  troubled 
with  continuous  pain,  not  always  very  severe,  in 
the  left  loin,  occasionally  radiating  downward  to 
tlie  crest  of  the  ilium.  He  occasionally  has  pe- 
riods of  very  severe  pain  lasting  for  some  two  or 
tliree  weeks,  after  which  he  is  comparatively  well ; 
of  late  years  these  periods  of  pain  have  not  been 
so  frequent,  and  when  they  do  occur  the  pain  is  of 
a  sickening  character,  and  causes  morning  vomit- 
ing. Sudden  movement,  as  sneezing  and  cough- 
ing, brings  on  an  attack  of  pain.  Five  years  ago 
first  noliced  a  whitish  deposit  in  urine  ;  up  to  a 
few  months  ago  this  was  quite  small  in  amount, 
and  was  passed  with  the  morning  urine.  No  his- 
tory of  renal  colic. 

"  Present  condition. — Is  a  fairly  well  nourished 
young  man,  of  medium  size,  and  with  an  anxious 
expression  of  countenance ;  complains  of  dull, 
aching  pain  in  left  lumbar  region,  and  immediately 
below  the  last  rib,  in  the  axillary  line,  is  a  very 
tender  spot  the  size  of  a  twenty-five  cent  piece. 
He  says  the  pain  radiates  from  this  point.  Urine 
has  a  specific  gravity  of  X015,  and  contains  15- 
25  percent,  of  pus.  Some  days  there  is  only  a 
trace  of  pus.  At  other  times  there  is  as  much  as 
25  per  cent.  Urea,  734  grains  to  an  ounce. 
Amount    of  urine  daily  excreted,  40-50  ounces. 

"By  external  examination  no  tumor  or  fulness 
can  be  detected  on  the  left  side.  " 

On  the  28th  of  October  he  was  put  under  ether, 
and  the  abdomen  thoroughly  examined  by  both 


Dr.  George  Ross  and  myself,  but  no  tumor  could 
lie  made  out.  The  left  loin  was  carefully  ex|)lored 
with  the  long  needle  of  an  aspirator,  but  failed  to 
reach  either  pus  or  a  calculus.  It  was  concluded, 
from  the  history  of  the  case  and  the  syminoms, 
that  a  stone  probably  existed  in  the  pelvis  of  the 
left  kidney;  so,  after  consultation  with  my  col- 
leagues, I  decided  to  cut  down  on  the  left  kidney 
by  lumbar  incision,  and  explore  it. 

Operation. — October  30th,  the  patient,  being 
under  ether,  was  placed  on  his  right  side,  with  a 
hard  pillow  under  the  right  lumbar  region,  and  a 
horizontal  incision  was  made  close  below  the  last 
rib  of  the  left  side,  commencing  at  the  edge  of  the 
erector  spina;  muscles,  and  extending  downward 
and  forward  for  some  five  to  six  inches.  After 
dividing  the  muscles  of  the  abdomen,  the  quadra- 
tus  lumborum  was  reached,  the  lumbar  fascia  divi- 
ded, and  the  kidney  searched  for  ;  the  lower  end 
was  felt  at  a  considerable  depth,  in  fact,  it  could 
be  barely  reached  with  the  fore  and  middle  fingers 
of  the  right  hand,  so  the  opening  in  the  loin  was 
enlarged  by  an  incision  at  right  angles  to  the  first, 
making  the  wound  a  crucial  one.  A  long  needle 
was  introduced  into  the  kidney,  and  a  calculus  was 
immediately  felt.  The  kidney  being  steadied  by 
pressure  from  without,  I  made  an  incision  down  to 
the  stone  in  the  long  axis  of  the  organ,  of  some 
three  inches.  Through  this  incision  an  immense 
stone  could  be  felt  with  the  finger,  but  owing  to  its 
great  fixity  and  large  size  it  could  not  be  dis- 
lodged. Whilst  endeavoring  to  remove  the  stone,  I 
accidentally  ruptured  a  large  artery,  which  ran  to 
the  lower  end  of  the  kidney,  and  was,  no  doubt,  a 
supernumerary  renal ;  the  hemorrhage  was  profuse, 
and  I  immediately  introduced  one  hand  into  the 
wound,  and  so  prevented  further  bleeding,  while 
with  the  other  I  managed  to  catch  the  bleeding 
vessel  with  a  pair  of  long  artery  forceps.  The 
stone  proved  too  large  to  be  grasped  by  a  litho- 
trite,  and  too  hard  to  be  broken  by  a  cutting  for- 
ceps. I  attempted  to  break  it  with  a  chisel  and 
mallet,  but  failed,  because  of  the  difficulty  of  get- 
ting fixation  of  the  kidney.  The  incision  in  the 
kidney  was  now  further  enlarged,  and  the  stone 
gradually  separated  from  the  kidney  tissue  with  the 
finger;  even  now,  owing  to  the  prolongations  into 
thecalices,  the  stone  could  not  be  removed.  With 
considerable  difficulty  I  managed  to  free  the  lower 
end  of  the  stone,  which  blocked  the  entrance  of  the 
ureter,  and  lifting  it  up,  requested  Dr.  James  Bell 
to  grasp  it  with  a  pair  of  large  lithotomy  forceps  ; 


226 


THE   CANADA   MEDICAL   RECORD. 


this  was  done,  and  the  stone  was  brought  away 
after  the  expenditure  of  considerable  force.  On 
examining  the  removed  stone,  it  was  seen  that 
there  were  a  couple  of  projections  on  it,  one  of 
which  appeared  to  have  been  freshly  broken  off; 
so  the  hand  was  again  introduced  into  the  wound 
and  a  large  fragment  removed  from  a  calyx ;  other 
smaller  pieces  were  also  removed.  As  the  patient 
had  been  already  an  hour  on  the  table,  and  was 
becoming  weak  from  shock  and  loss  of  blood, 
no  further  exploration  took  place. 

During  the  operation  not  a  single  drop  of  pus 
was  seen  ;  none  apparently  surrounded  the  stone, 
which  was  quite  closely  embraced  by  the  surround- 
ing kidney  substance.  So  far  as  naked  eye  ap- 
pearances went,  the  part  of  the  kidney  seen  was 
perfectly  healthy.  At  one  time,  I  thought  it  would 
be  necessary  to  remove  the  kidney,  as  it  seemed 
impossible  to  remove  the  stone  without  it,  but  the 
very  healthy  appearance  of  the  portion  of  the 
organ  seen  (the  lower  end),  and  the  absence  of 
pus,  determined  me  to  persevere,  and,  if  possible, 
remove  the  stone  and  leave  the  kidney  till  the 
condition  of  the  other  could  be  ascertained.  At 
no  time  during  the  operation  could  the  kidney  be 
brought  to  the  surface,  and  the  operation  had  to 
be  performed  by  feeling  more  than  sight. 

After  washing  out  the  wound  thoroughly  with  a 
1 :  2000  solution  of  corrosive  sublimate,  and  intro- 
ducing a  large  drainage  tube,  the  wound  was 
brought  together  with  silk  sutures,  and  dressed 
with  sublimate  jute  pads.  At  the  close  of  the 
operation  the  patient  was  in  a  fairly  good  condi 
tion,  and  did  not  show  much  evidence  of  shock ; 
and,  although  he  had  lost  a  considerable  amount 
of  blood,  his  pulse  was  full  and  strong,  and  not 
more  than  80.  The  weight  of  the  removed  stone 
and  fragments  immediately  after  the  operation  was 
4  oz.,  7  drachms.  It  measured  3^.^  mches  in 
length,  and  9  inches  in  circumference,  and  consis- 
ted entirely  of  triple  phosphate. 

After  the  operation,  which  took  place  at  2  p.m., 
the  patient  did  not  pass  any  urine  till  noon  next 
day,  when  he  voided  7  ^i  oz.  As  there  had  been 
a  great  deal  of  oozing,  the  wound  was  dressed  next 
day.  Temperature,  loi  °  .  Pulse,  120.  He  still 
had  vomiting  from  the  ether. 

Nov.  I.  He  passed  32  oz.  of  urine  which  was 
free  from  pus  and  blood. 

For  some  time  the  patient  progressed  slowly 
toward  recovery  ;  his  temperature  ranged  between 
98  °  and  loo  °  ,  and  the  amount  of  urine  from  25 


oz.  to  50  oz.  daily.     The   wound,  which  was  not 
very  sweet,  and  from  which  came  large    quantities 
of  urine,  gradually  healed,  and  the  tube  was  remo- 
ved in  the  early  part  of  December.     He  now  be- 
gan to  have  high  and  irregular   temperature,  with 
some  sweating ;  from  the  loth  to  the  25th  ofDecem- 
ber  his  temperature  ranged  from  98  °  to  102  °  ,  and 
for  several  days  after  reached,  in  the  afternoon,  as 
high  as  104  "^-105°.     Fearing  that  some  collec- 
tion of  pus  was   forming  about  the  kidney,  I  re- 
opened the   wound,  introduced  my    fingers,  and 
explored  the  pelvis   of  the   kidney,    but   without 
result,  except  that  a  few  flakes  of  calcareous  mat- 
ter were  brought  away.     It   was   now  decided  to 
cut  down  and  remove  the  kidney,  but  the    patient 
quite  unexpectedly  took  a  turn  for  the  better,  and 
improved  so  much  that,  in  the  early  part  of  Janu- 
ary, he  was  able  to  go  about  the   ward,  enjoy  his 
meals,  and  gain  flesh.     The  sinus  in  his  right  loin 
never   healed,  but  continued  to  discharge  large 
quantities  of  urine  with  a  small  amount  of  pus.  At 
this  time  my  service  at  the  hospital  having  expired, 
I  only  saw  my  patient  occasionally.     His  tempe- 
rature was  for  several  days  quite  normal,  and  then 
for  a  time    would  range   as  high    as  loi  °  .     The 
amount  of  urine  varied  from  30  oz.  to  40  oz.  daily. 
I  saw  him  early   in   February,  going  about,  and 
apparently  in  fair  condition.     On    the  loth  of  Fe- 
bruary he  suddenly  became  jaundiced,  his  tempe- 
rature rose  to  102  °  ,  and  he  had  severe  sweatings. 
I  saw  him,  and  e.xamined  his  side   carefully,  but 
could  discover  no   evidence  of  any   collection  of 
pus  about  the   wound,   and  the  amount  of  urine 
reached  40  oz.  daily.     The  fistulous  opening  in  his 
side   discharged   urine    freely,   and  a    very    small 
amount  of  pus  stained  the  dressings.     He  gradual- 
ly became  worse,  and  died  comatose  on  the    14th 
of  Februar)-,  three  and  half  months  ofter  the  ope- 
ration. 

The  autopsy  was  performed  by  Dr.  Wyatt 
Johnston,  pathologist  to  the  hospital,  and  the 
following  is  taken  from  his  report :  "  Body  jaun- 
diced. In  left  lumbar  region,  a  depressed  cicatrix, 
about  two  inches  long,  is  seen  with  a  sinus  toward 
the  centre,  from  which  fetid  pus  can  be  squeezed 
out.  On  opening  the  abdomen,  a  large  oval  mass 
is  seen  in  left  lumbar  and  extendmg  up  into  the  left 
hypochondriac  region.  This  mass  has  a  quantity 
of  fibrous  exudation  surrounding  it,  and  is  very 
difficult  to  remove,  being  firmly  attached  to  the 
lumbar  muscles,  spleen,  and  vault  of  the  dia- 
phragm.    The  retro-peritoneal  glands  are  acutely 


THE   CANADA    MEDICAI.   RECORD. 


227 


swollen,  but  show  no  signs  of  suppuration.  The 
aorta  and  vena  cava  are  not  directly  involved  in 
the  mass,  and  can  be  readily  dissected  off.  Near 
the  inferior  extremity  of  kidney,  two  inches  above 
the  crest  of  the  ilium,  a  small  artery,  one  and  a 
half  inches  long,  running  directly  from  aorta  to 
kidney,  is  seen  ;  it  is  obliterated,  apjiarently  from 
a  ligature.  The  fatty  capsule  of  the  kidney  is 
densely  infiltrated  with  fibrous  tissue,  and  cannot 
be  removed  without  tearing  the  kidney  substance  ; 
the  left  kidney  itself  is  greatly  enlarged,  and  forms 
a  fluctuating  mass  weighing  nearly  i,ooo  grammes. 
On  opening  the  pelvis,  a  little  fetid  pus  escapes, 
and  the  sinus  in  the  loin  is  seen  to  open  into  it.  On 
palpation  a  small  calculus  mass  can  be  felt  towards 
the  cortex  in  one  of  the  calices  of  the  kidney  ; 
the  calculus  is  the  size  of  a  hazelnut,  and  appears 
to  be  broken  off  in  one  spot.  It  is  enclosed  in 
a  small  pocket  of  pus.  The  ureter  immediately 
below  the  pelvis  of  the  kidney  is  completely 
obstructed,  and  its  walls  are  much  thickened. 
On  incising  the  kidney  along  its  convexity,  it  is 
found  to  consislin  the  upper  portion  of  a  series  of 
large  communicating  sacs  containing  over  ten 
ounces  of  fetid  pus.  These  cavities  do  not  com- 
municate with  the  sinus  or  the  pelvis  of  the  kidney, 
but  are  completely  shut  off  from  the  rest  of  the 
kidney  by  thick,  fibrous  walls,  showing  that  the 
disease  is  of  long  standing.  Within  these  sacs  lie 
five  or  six  irregular  branched  calculi,  varying  in 
size  from  a  bean  to  a  walnut.  The  lower  fourth  of 
the  kidney  contains  a  considerable  quantity  of 
healthy  renal  structure.  Bladder  and  lower  part 
of  ureter  normal.  Right  kidney  double  normal 
size,  and  looks  to  be  perfectly  healthy.  Liver 
shows  numerous  enlarged  lymph  glands  lying 
beside  the  bile  ducts,  but  bile  can  be  easily  express- 
ed.    Other  organs  healthy." 

There  is  not  the  slightest  doubt  that  this  patient 
died  of  septicaemia,  due  to  the  fetid  abscesses  in  the 
upper  end  of  the  kidney.  These  could  not  be 
diagnosticated  by  external  manipulation,  and  from 
the  fact  that  the  part  of  the  kidney  seen  at  the 
operation  was  healthy  in  appearance  and  contained 
no  pus,  the  condition  of  its  upper  end  was  not 
suspected.  So  far  as  the  operation  itself  went,  it 
was  successful,  but  one  lesson  may  be  learned 
from  this  case,  viz.,  that  with  a  large  stone  in  the 
pelvis,  it  is  almost  impossible  to  have  a  kidney 
which  has  not  undergone  grave  changes,  and  its 
thorough  exploration  by  incision  is  indicated. 
Had  there  been  pus  around  the   stone    and    the 


kidney  tissue  not  looked  so  healthy,  I  should  have 
attemijted  to  remove  the  kidney,  but  I  had  in  my 
mind  a  specimen  in  the  Museum  of  the  Medical 
Faculty  of  McGill  University,  where  the  pelvis  of 
each  kidney,  in  a  man,  is  filled  by  an  enormous 
stone,  while  the  surrounding  kidney  structure  is 
comparatively  healthy,  and  where  there  was  not 
a  drop  of  pus  or  the  sign  of  disorganization.  In 
my  case,  however,  although  in  the  immediate 
neighborhood  of  the  large  calculus  the  kidney  was 
healthy,  stones  unconnected  with  that  in  the 
pelvis.  The  kidney  was  placed  so  deeply  and 
situated  so  high  up  that,  with  even  the  very  exten- 
sive lumbar  incision  which  was  made,  it  could  not 
be  properly  explored,  and  I  very  much  doubt 
if  it  could  have  been  successfully  removed  by 
the  loin.  Its  removal,  owing  to  the  numerous 
adhesions  to  important  organs  and  its  location, 
would  have  been  a  matter  of  serious  difliculty,  if 
not  an  impossibility,  even  by  abdominal  incision 
for  at  the  autopsy  by  the  combined  abdominal  and 
lumbar  incision  it  was  only  by  cutting  freely  the 
surrounding  parts  that  its  excision  was  accom- 
plished. 

In  such  a  case  incising  the  kidney  in  every  part, 
evacuating  the  pus,  and  removing  the  calculi  would 
be  the  proper  procedure.  Diseased  kidneys  which 
enlarge  downward  are  much  easier  to  remove  by 
lumbar,  and  also  abdominal  incision,  than  those 
which  enlarge  upward,  and  are  wholly  under 
cover  of  the  ribs. 

There  is  another  point  about  this  case  which  is 
worthy  of  notice,  and  it  is  this  :  When  a  kidney 
is  highly  placed  it  may  be  enlarged  so  as  to  form 
a  considerably  sized  tumor,  which  cannot  be  detect- 
ed by  the  most  careful  palpation,  even  when  the 
patient  is  placed  under  ether.  The  failure  to  find 
the  stone  by  needle  exploration,  before  the  opera- 
tion, was  due  to  the  same  cause — the  high  position 
of  the  tumor  and  its  great  depth. 

In  connection  with  this  case  I  might  mention 
one  reported  by  Prof.  Guyon,  of  Paris,  which  is 
very  similar  to  the  one  narrated  above.  In 
Guyon's  case,  however,  a  distinct  tumor  could  be 
felt  externally.  After  cutting  down  on  the  tumor 
and  incising  it  he  found  the  pelvis  of  the  kidney 
completely  filled  by  an  enormous  stone,  with 
processes  extending  into  the  calices,  these  pro- 
cesses were  cut  off  with  forceps,  and  the  large 
calculus  extracted  with  difficulty  ;  after  the  removal 
of  the  smaller  pieces,  the  pelvis  of  the  kidney  was 
explored  with  the  finger  and  sound,  and  no  more 


228 


THE   CANADA    MEDICAL   RECORD. 


stones  could  be  felt.  'I'he  patient  died  some  two 
weeks  after  from  hemoptysis,  and  at  the  autopsy 
it  was  found  that  the  kidney  was  so  adherent  to  the 
surrounding  parts  that  it  probably  could  not  have 
been  extirpated.  Several  more  stones  were  found 
in  the  upper  end  of  the  kidney  in  cavities  separated 
from  the  pelvis  by  connective  tissue.  Prof.  Guyon, 
in  the  course  of  his  remarks  on  this  case,  states 
that  here  nephrotomy  was  preferable  to  nephrec- 
tomy, and  that  had  the  kidney  been  properly 
incised  the  other  stones  would  have  been  found, 
that  in  such  cases  the  kidney  should  be  freely 
incised  and  every  nook  and  cranny  explored ;  he 
holds  that  if  this  were  done  in  cases  of  calculous 
pyelitis  nephrectomy  would  never  be  called  for. 

Formerly  it  was  feared  that  free  incision  of  the 
kidney  would  cause  severe  and  dangerous  hemorr- 
hages, but  experience  has  taught  surgeons  that 
the  danger  is  an  imaginary  one,  and  that  kidneys 
which  are  much  disorganized  may  be  incised 
without  fear  of  bleeding,  and  that  even  in  healthy 
kidneys  the  hemorrhage  from  incisions  is  easily 
and  permanently  controlled  by  pressure. 

In  such  cases  as  the  one  above  narrated,  where 
the  stone  is  of  great  size  and  the  kidney  is  enlarged, 
the  mere  extraction  of  the  stone  in  the  pelvis 
should  not  satisfy  the  operator;  he  should  thor- 
oughly examine  the  kidney  in  every  part  by  free 
incisions  so  as  to  be  sure  no  calculus  is  left 
behind.  External  manipulation  of  the  kidney  is 
not  sufficient  to  detect  stone,  and  in  such  cases  as 
my  own,  even  exploration  through  the  kidney 
pelvis  would  fail,  without  further  incision,  to  detect 
calculi  unconnected  with  that  in  the  pelvis. 

Up  to  a  short  time  ago  the  largest  stone  removed 
by  lumbar  incision  was  under  two  ounces  in  weight. 
Lauenstein  reports  a  successful  case  of  removal  of 
a  large  calculus  (weighing  25  grammes  and  com- 
posed of  the  triple  phosphates)  from  the  pelvis  of 
the  kidney.  He  had  to  break  the  stone  with  a 
lithotriie  before  he  could  extract  it.  In  his  paper 
he  states  that  it  was  the  largest  stone  removed  up 
to  that  time,  though  not  the  heaviest.  Three 
months  after  the  operation,  the  sinus  in  the  loin 
had  completely  healed,  and  when  the  article  was 
written  the  patient  was  perfectly  well. 

Dr.  John  Neill,  after  relating  a  case  of  large  renal 
calculus  found  after  death,  quotes  from  Cyclop. 
Pract.  Med.  the  following  case:  "A  remarkable 
instance  of  such  calculus  occurred  in  the  person  of 
a  natural  daughter  of  Sir  Richard  Steele.  No 
nephritic  symptoms  took  place  until  shortly  before 


death,  when  severe  pain  was  left  in  the  region  of 
the  right  kidney,  fever  followed  and  speedily  proved 
fatal.  A  calculus  of  oxalate  of  lime  weighing  7^ 
ounces  was  found  in  the  right  kidney,  which  was 
so  thin  by  absorption  as  to  be  reduced  to  a  mere 
membrane.  In  this  instance  the  stone  could  be 
felt,  during  life,  through  the  loins,  inducing  a  belief 
that  the  kidney  had  become  ossified  (Catal. 
Museum  of  Royal  Coll.  Surg.,  London.  Note  by 
John  Hunter)."  In  this  case  there  was  evidently 
but  little  suppuration,  or  the  stone  could  not  have 
been  so  easily  recognized. 

Mr.  Victor  Horsley,  on  Sept.  16,  1885,  removed 
a  stone  weighing  2]^  ounces  from  the  pelvis  of 
the  kidney  of  a  middle-aged  woman ;  ten  days  after 
she  was  doing  well.  It  was  the  largest  stone 
removed  from  the  kidney  up  to  that  time. 

Mr.  W.  L.  Brown  reported  a  case  before  the 
Birmingham  and  Midland  Counties  Branch  of  the 
British  Medical  Association,  in  May  last,  where 
he  had  removed  from  the  kidney  by  abdominal 
section  a  stone  weighing  1 1  ounces.  The  kidney 
tumor  occupied  the  right  half  of  the  abdomen  and 
contained  three  pints  of  pus.  The  cut  edges  of 
the  cyst  were  stitched  to  the  abdominal  walls  and 
the  cavity  drained.  The  patient  died  suddenly 
eleven  days  after  the  operation  from  heart  clot. 
So  far  as  I  know,  the  stone  in  my  case  is  the 
largest  ever  removed  by  lumbar  incision. 

Discussion. — Dr.  Bell  said  that  he  had  watched 
this  case  with  great  interest  for  some  time,  and 
considered  the  question  of  the  best  method  of 
dealing  with  such  cases  a  very  difficult  one.  It 
would  be  impossible  to  drain  so  many  pus  cavities 
even  if  all  the  outlying  calculi  could  be  removed. 
Excision  of  the  whole  kidney  would,  pjrhaps,  have 
given  better  results,  though  such  an  operation  was 
scarcely  indicated  at  the  time. 

Dr.  Johnston  said  that  the  post-mortem  showed 
that  it  would  only  have  been  possible  to  remove 
the  kidney  by  resecting  two  or  three  ribs,  so  firmly 
attached  was  the  mass  about  the  kidney. 


Stated  Meeting,  April  \^th,  1887. 

T.  J.  Allowav,  M.D.,    2ND  Vice-President  in 
THE  Chair. 

Yeast  Saccharo meter. — Dr.  Reed  showed  a 
neat  and  useful  little  piece  of  apparatus  called  the 
Emhorn's  Yeast  Saccharometer,  for  qualitative  and 
quantitative  estimation  of  glucose  in  urine. 


?fHE   CANADA    MEDICAL   RECORD. 


22*» 


Dr.  RuTTAN  referred  to  the  recent  introduction 

of  ;ili)li:iiia|ihtli(il  and  thymol  as  tests  for  tlie  i)re- 
sencc  of  sugar.  These,  if  reliable,  were  far  too 
delicate  for  clinical  i)urposes,  as  the  sugar  normally 
present  in  the  urine  can  be  shown  when  the  latter 
is  diluted  one  to  two-liundred.  He  also  referred  to 
the  periodic  absence  of  excess  of  glucose  in  diabe- 
tic cases,  when  under  proper  diet,  and  stated  that 
proportion  of  acetone  and  aceto-acetic  acid  is 
usually  increased  during  these  intervals.  The 
iodoform  test  for  acetone  was  probably  the  best, 
but  required  to  be  carefully  made.  Nitro-prussiate 
of  sodium  and  sulphuric  acid  gives  a  fine  rose- 
color  with  urine  containing  acetone.  This  reac- 
tion, however,  has  not  been  shown  to  be  peculiar 
to  acetone. 

Unusual  cases  of  Hysteria. —  Dr.  George  Ross 
then  read  a  ]japer  on  some  unusual  cases  of  hys- 
teria, which  appears  in  full  in  the  present  number 
of  this  Journal. 

Discussion. —  Tir.  Stewart  said  the  first  two 
cases  described  by  Dr.  Ross  were  interesting  and 
very  peculiar.  While  it  may  be  wise,  in  acute 
symptoms  in  young  persons  to  give  positively  a 
favorable  prognosis,  there  is  no  doubt  inany  cases 
of  paralysis  of  hysterical  origin  are  perfectly  incur- 
able. 

Dr.  Shepherd  referred  to  the  case  of  a  young 
student  who  had  hysterical  vomiting,  lasting  for 
months,  and  resisting  all  treatment.  He  was  so 
reduced  in  flesh  that  the  tranverse  duodenum 
could  easily  be  felt  through  the  abdominal  walls. 
He  was  sent  home,  there  got  better  at  once,  and 
returned  well  and  fat.  He  believed  in  a  positive 
statement  of  cure  in  cases  of  hysteria,  and  referred 
to  a  case  of  hysterical  spine  of  long  standmg  that 
had  been  cured  by  the  faith  cure. 

Dr.  WiLKiNS  felt  convinced  that  one  cannot  be 
too  dogmatic  and  positive  in  promises  of  cure  in 
hysterical  casse.  He  referred  to  a  recent  case  in 
hosi)ital  of  hysterical  contraction  of  the  muscles  of 
one  arm.  The  case  was  at  first  very  puzzling,  but 
when  hysterical  symptoms  were  made  out,  a  certain 
cure  was  promised,  and  the  patient  put  under  ether, 
and  on  recovering  from  the  effects  of  the  ansstbetic 
was  completely  cured.  The  mystery  of  what  was 
done  to  them  while  under  ether  often  effects 
a  cure. 

Dr.  Reed  said  that  real  affections  of  the  joints 
inay  occur  with  hysterical  symptoms  in  the  same 
patient.     He   referred  to  a    case  in  the  General 


Hospital  where  hysteria  was  diagnosed,  and  yet 
there  was  a  real  affection  of  the  knee-joint. 

Dr.  Geo.  Ross,  in  reply,  said  that  it  was  very 
difficult,  in  chronic  cases,  to  make  a  positive  i)re- 
diction.  Charcot  states  that  there  are  actual 
changes  in  the  cord  in  many  hysterical  cases  of 
a  chronic  character. 


Stated  Meeting,  April  2^th,  1887. 
Dr.  Trenholme,  in  the  Chair. 
Monobrachial  Chorea,  not  post-Iieiniplegic. — 

Dr.  Wood  exhibited  a  case  of  monobrachial 
chorea,  not  posthemiplegic,  in  a  boy  1 5  years  of 
age.  Had  variola  in  the  winter  of  1885-86.  Dis- 
charged from  hospital  in  January,  1 886,  with  ulcera- 
tion of  right  cornea  ;  otherwise  well.  The  attack 
of  chorea  began  in  March,  two  months  after 
discharge,  and  has  continued  since.  He  never 
had  paralysis,  rheumatism,  or  any  cardiac  trouble, 
and  now  his  general  health  is  good.  When  asleep 
the  choreiform  movements  cease,  and  he  exercises 
a  certain  amount  of  control  over  them  at  will. 
Only  when  he  attempts  to  co-ordinate  his  arm  and 
hand  muscles  is  the  chorea  very  apparent.  He 
cannot  use  his  knife  or  fork  at  table,  but  can  chop 
wood,  move  furniture,  and  do  similar  work.  Pres- 
sure over  the  median  nerve  near  the  elbow 
controls  the  movements.  He  had  been  attending 
the  public  school,  where  the  hours  extend  from 
eight  o'clock  in  the  morning  until  five  in  the  after- 
noon. He  was  kept  at  home  during  the  past  two 
months,  and  he  has  decidedly  improved.  Weir 
Mitchell  says  that  cases  of  localized  or  limited 
chorea  are  not  the  result  of  embolism,  but  are  gener- 
ally due  to  acquired  habits,  and  he  calls  such  cases 
"  habit  chorea."  Dr.  Wood  did  not  see  how  his 
case  could  be  so  classed. 

Discussion. — Dr.  Buller  said  this  case  was 
particularly  interesting  in  view  of. the  recent  theo- 
ries regarding  the  influence  of  eye  lesions  in  pro- 
ducing general  nervous  affections.  One  physiolo- 
gist claims  that  most  nervous  affections  are  trace- 
a.ble  to  ocular  affections.  The  irritation  of  the 
ciliary  nerve  produced  by  a  shrunken  eye-ball  has 
caused  general  epilepsy.  Again,  chorea  has  been 
traced  to  weakness  of  the  ocular  muscles ;  difliculty 
of  co-ordination  of  the  eye  muscles  is  productive 
of  many  nervous  affections  more  or  less  severe. 
It  is  a  common  cause  of  nervous  headache, 
Applying  these  general  principles  to  the  case 
exhibited.  Dr.  Buller  called  attention  to  the  condi- 


I 


2^0 


THE   CANADA    MEDICAL   EECOfeo. 


tion  of  the  eye  on  the  affected  side  ;  the  patient 
was  quite  blind,  tlie  eye  was  shrunken,  and  there 
was  infiltration  of  the  cornea,  though  not  exces- 
sively painful  to  the  touch.  He  concluded  that 
there  was  at  least  a  possibility  that  this  peculiar 
chorea  was  due  to  the  irritation  of  the  shrunken 
eye-ball.  He  suggested  enucleation  of  the  useless 
eye  as  a  possible  means  of  cure.  The  fact  that 
the  boy's  condition  improved  after  removal  from 
school  might  be  due  to  the  relief  thus  afforded  to 
the  ciliary  muscles. 

Dr.  Trenholme  referred  to  the  use  of  arsenic  in 
the  treatment  of  chorea.  As  usually  administered 
(three  to  five  minim  doses)  he  did  not  think  it  was 
of  much  remedial  value,  but  he  had  obtained  good 
results  by  gradually  giving  a  large  quantity.  He 
made  a  practice  of  beginning  with  three  minims 
of  Fowler's  solution  three  times  a  day  after  mealsi 
increasing  this  to  five  minims,  and  continuing  the 
administration  till  the  to.xic  effects  were  visible, 
then  discontinue  for  a  time.  He  usually  preceded 
each  meal  with  a  dose  of  saccharated  carbonate 
of  iron. 

Pathological  Specimens. — Dr.  Johnston  exhi- 
bited some  interesting  specimens  from  a  case  of 
chronic  hydronephrosis.  The  case  occurred  in 
the  practice  of  Dr.  R.L.  MacDonnell,  Dr.  Johnston 
was  unable  to  give  the  history  of  the  case. 

J^j^a^tdS  a/  Science. 

CHRONIC    CATARRHAL   GASTRITIS. 

A  Clinical  Lecture  Delivered  at  the  Hospital  of  the  Univer- 
sity of  Pennsylvania. 

BY  WILLIAM  I'El'PEK,  M.D.,  LL-D., 

Professor  of  the  Theory  and  Practice  of  Medicine,    and  of 

C4inical  Medicine,  in  the  University  of  Pennsylvania. 

Gentlemen  : — I  shall  ask  your  attention  to  a 
case  recently  admitted  into  the  hospital,  in  which 
there  is  some  "obscurity  in  the  diagnosis.  The 
patient,  R.  F.,  age  thirty  years,  a  clerk  by  occupa- 
tion. The  family  history  is  good.  He  is  one  of 
twelve  children,  loof  whom  are  living,  and  all  are 
in  good  health  with  the  exception  of  himself. 
He  had  the  ordinary  diseases  of  childhood,  in- 
cluding the  scarlet  fever.  In  1880,  at  the  age  of 
twenty-four,  he  had  a  spell  of  constipation,  follow- 
ed by  pain  in  the  bowels,  which  was  severe  enough 
to  double  him  up.  This  was  attended  with  high 
fever,  and  his  physician  told  him  that  he  had  in- 
flammation of  the  bowels,  due  to  a  large  collection 
of  fffices.  The  attack  lasted  one  week,  and  since 
then  his  digestion  has  been  feeble.  It  seems  ex- 
tremely probable  that  the   diagnosis   made  at  that 


time  was  correct.  The  man  may  have  had  an 
attack  of  perityphlitis  from  impaction  of  the  cfficum, 
a  very  common  occurrence,  indeed,  and  this  would 
explain  the  symptoms  which  he  has  mentioned. 
In  this  affection  there  is  fever;  the  decubitus  of  the 
patient  is  dorsal,  with  the  thighs  flexed,  so  as  to 
relax  the  abnormal  walls.  Whatever  may  have 
been  the  nature  of  this  attack,  however,  it  was 
noticed  that  after  it  the  digestion  became  impair- 
ed ;  then  he  began  to  have  a  feeling  of  weight  in 
the  pit  of  the  stomach,  and  regurgitated  a  clear, 
watery  fluid.  This  has  continued,  and  other 
symptoms  have  been  associated  with  it.  For  the 
last  three  years  he  has  vomited  frequently,  some- 
times immediately  after  eating  and  sometimes  not 
for  three  or  four  hours  after  taking  food.  On  the 
whole,  the  vomiting  has  been  more  frequent  in  the 
evening,  and  he  then  rejects  partially  digested 
food  which  he  has  taken  during  the  day.  There 
is  marked  flatulency,  ga.s  being  discharged  both 
by  the  bowel  and  by  the  mouth.  The  bowels 
have  been  constipated,  and  he  has  found  it  neces- 
sary from  time  to  time  to  take  a  laxative.  He  has 
lost  flesh  and  strength  and  has  become  very  weak 
and  pale. 

He  was  admitted  to  the  hospital  nine  days  ago. 
On  examination  we  find  a  man  with  a  long,  narrow 
chest,  with  imperfect  expansion  at  its  upper  part. 
There  are,  however,  no  physical  signs  of  disease 
either  of  the  heart  or  of  the  lungs.  The  belly  is 
scaphoid.  On  palpation,  I  find  no  evidence  of 
induration  at  any  point.  The  area  of  hepatic  dull- 
ness is  normal,  the  spleen  is  not  increased  in 
size.  There  is  rather  excessive  pulsation  of  the 
abdominal  aorta,  but  this  is  due  to  the  great  em- 
aciation and  retraction  of  the  abdominal  walls. 
At  one  point  in  the  abdomen  I  feel  a  little  body 
not  larger  than  the  least  joint  of  the  little  finger. 
'I'his  feels  like  a  small  gland.  It  is  probably  of 
no  importance,  and  could  not  be  detected  if  i  t 
were  not  for  the  great  emaciation,  which  enables 
me  to  feel  the  segments  of  the  vertebral  column 
with  the  greatest  ease.  When  he  was  admitted  it 
was  quite  evident  that  the  stomach  was  consider- 
ably extended.  The  tympanitic  resonance  ex- 
tended to  the  lower  border  of  the  sixth  rib  at  the 
left  nipple  line,  and  downward  to  the  transverse 
umbilical  line,  and  laterally  from  the  left  axillary 
line  to  the  right  costal  margin. 

.\s  soon  as  he  was  admitted  he  was  placed  upon 
the  use  of  peptonized  milk,  and  has  not  vomited 
since.  He  feels  better  and  looks  better.  Enu- 
meration of  the  red  corpuscles  of  the  blood  gives 
4,600,000  per  millimetre.  The  haemoglobin  is  re- 
duced to  65  per  cent,  of  the  normal.  In  addition 
to  the  milk  he  has  taken  finely  minced  meat, 
slightly  boiled.  The  only  medication  he  has  re- 
ceived has  been  the  administration  of  five  drops  of 
chloroform  with  half  a  drachm  of  the  compound 
tincture  of  cardamon  four  times  daily.  He  has 
had  no  fever.  The  tongue  is  extraordinarily 
smooth.  There  are  scarcely  any  papilla;  visible 
on  his  tongue. 


THE   CANADA   MEDICAL   EECOED. 


231 


Here  we  have  a  young  man,  coming  from  a  re- 
markably healthy  family,  living  in  a  hcaUhy  dis- 
trict, who,  six  years  ago,  had  an  attack  of  pain  in 
the  bowels,  with  obstruction  and  fever  lasting  a 
week,  leaving  behind  it,  so  far  as  we  can  deter- 
mine, no  organic  change.  Then  his  digestion  fails. 
He  takes  care  of  himself,  he  consults  physicians 
and  regulates  his  diet,  but  fails  to  get  relief.  He 
then  leaves  his  native  country,  Ireland,  and  comes 
to  America,  where  he  jnirsues  a  healthy  occupation 
and  still  goes  down  more  or  less  rapidly  until  he 
reaches  a  degree  of  emaciation  and  anajmia  which 
is  remarkable.  While  it  is  true  that  each  drop  of 
this  man's  blood  contains  almost  as  many  red 
blood  globules  as  it  should,  it  is  also  true  that  he 
is  very  far  from  having  as  many  drops  of  blood 
in  his  body  as  he  ought  to  have.  While  he  has 
not  what  might  be  called  qualitative  anemia,  he 
has  a  high  degree  of  quantitative  aUi'emia.  The 
composition  of  this  man's  blood  is  fairly  good.  It 
is  20  per  cent,  off  in  red  glolniles  and  40  ])er  cent, 
in  haemoglobin,  but  I  should  think  that  it  is  more 
than  50  per  cent,  off  in  the  quantity.  Not  only 
that,  but  during  the  past  three  years  there  has 
been  almost  constant  vomiting.  During  this  time 
he  has  gone  as  long  as  a  month  without  vomiting, 
and  then  he  has  for  weeks,  in  succession,  vomited 
every  day,  in  spite  of  medical  treatment  and  regu- 
lation of  the  diet. 

The  first  thing  thai    would    be   suggested  by  a 
case  of  this  kind  is  grave  organic   diseases.     Has 
he  not  some  malignant  disease  ?     The  patient  has 
not  reached  the  age  at  which  malignant  disease,  as 
a    rule,    appears.       His   good    family    is   against 
it  although  this  joint  is  not   of   much  diagnostic 
value.       The   case    has    lasted  a  long  time    for 
a  case   of  cancer.     It  has   lasted  six  years,  and 
for  three  years  has  been   quite  pronounced.     The 
trouble  appears  to  have  begun  with  an    acute  in- 
flammatory attack,  whereas  mahgnant  disease  be- 
gins insidiously.     Careful  examination  has   failed 
to  reveal  the  presence  of  any  tumor  or   hardness. 
While  the  man  is  very  pale,  he  does  not  present 
the  cachexia  usually   found   in    advanced  cancer. 
Cachexia  is,  however,  so  uncertain  that  it  is  not  of 
very  great  diagnostic    value.     It  is  valuable  when 
present,  but  its  absence  means    little   or  nothing. 
The  matters    vomited    have  consisted   chiefly  of 
partially-digested  food.     The  man  has  never  vom- 
ited blood.     The  obstruction  of  the  bowels  has  not 
been  as  great  as  we  should  expect  to  find  it  where 
there  was  cancer  of  the  stomach,   causing  as  fre- 
quent vomiting  as  this  man  has  presented.      Usu- 
ally, there  has  not  been  much  pain.     Tiiese symp- 
toms are  all  against  the  idea  of  cancer  of  the  sto- 
mach, and  the  direct  physical  examination  fails  to 
show    any     hardening    or  thickening  whatsoever, 
with  the  exception   of  this  little  body,  the  size    of 
a  cherry,  which  may  be  a  little   mass  of  hardened 
faeces,  or  a  hardened  mesenteric  gland.     We  may, 
there-fore,  dismiss  the  idea  of  cancer. 

We  should,  in  the  second  place,  naturally  think 
pf  simple    ulcer  of   the  stomach.     In    regard   to 


that,  we  cannot  be  so  certain  as  in  regard  to  the 
existence  of  cancer.  We  cannot  assert  that  this 
man  has  not  had  ulcer  of  the  stomach.  This 
affection  occurs,  by  preference,  in  young  people, 
and  in  cases  that  are  anremic  and  debilitated,  as  this 
man  has  been.  It  causes  frequent  vomiting,  but 
does  not  produce  obstinate  obstructi'in  of  the 
bowels  ;  but  in  ulcer  of  the  stomach  there  is  nearly 
always  considerable  pain  and  tliis  pain  is  increased 
by  the  ingestion  of  food  and  by  pressure.  There  is 
tenderness  over  the  ulcerated  spot.  The  pain  and 
tenderness  are  often  more  marked  in  simple  ulcer 
than  they  are  in  cancer.  This  man  has  no  tender- 
ness, and  there  has  been  a  marked  absence  of 
])ain.  In  the  course  of  ulcer  of  the  stomach, 
where  the  vomiting  is  as  frequent  as  it  has  been 
in  this  instance,  some  blood  is  very  apt  to  be 
brought  up.  None  has  been  vomited  at  any 
time  by  this  man.  While,  therefore,  we  cannot 
assert  positively  that  ulcer  of  the  stomach  is  not 
present,  yet  the  symptoms  do  not  point  strongly 
in  that  direction. 

What  other  condition  would  explain  such  long- 
continued  and  serious  gastric  disease  ?  Chronic 
catarrhal  inflammation  of  the  mucous  membrane 
of  the  stomach  would  account  for  it.  This  is  far 
more  common  than  either  cancer  or  ulcer  of  the 
stomach — in  fact,  it  is  among  the  most  common 
affections.  It  is  true  that  it  is  usually  met  with 
in  its  milder  forms,  which  we  speak  of  as  catarr, 
hal  dysi-iepsia,  but  it  is  also  true  that  when  chronic 
catarrhal  gastritis  is  present  in  a  marked  form,  it 
produces  very  grave  symptoms  indeed.  The 
constant  irritation  of  the  stomach,  and  the  result- 
ing weakness  of  the  stomach  walls,  induces  relaxa- 
tion and  tendency  to  dilatation  of  the  organ,  not  so 
certain  as  where  there  is  mechanical  obstruction 
of  the  ])ylorus  ;  but  relaxation  and  dilatation  of 
the  stomach  is  a  very  common  result  of  chronic 
gastritis.  If  the  case  has  lasted  a  long  time,  the 
degree  of  dilatation  may  be  enormous.  At  the 
same  time,  it  is  to  be  noted  that  the  dilatation  of 
the  organ,  and  the  interference  with  its  normal 
secretion,  prevents  the  ]uoper  digestion  of  the 
food,  which  undergoes  fermentation  with  the 
development  of  gas  The  stomach  then  becomes 
irritated,  and  vomiting  of  partially  digested  food 
follows.  If  the  case  is  one  where  a  good  deal  of 
nervous  irritation  is  caused,  the  stornach  becomes 
sensitive  ;  then  the  vomiting  may  become  extreme- 
ly frequent.  In  other  cases,  where  the  stomach 
is  not  so  irritable,  the  partially-digested  food  is 
passed  into  the  bowel,  leading  to  irritation,  flatu- 
lency and  diarrhcea.  The  man  has  had  a  good 
deal  of  vomiting,  but  not  much  diarrhcea.  The 
inevitable  result  of  the  irritation  of  the  stomach 
and  interference  with  digestion  is  loss  of  flesh, 
strength  and  color,  imtil  finally  the  patient  reaches 
a  high  degree  of  emaciation,  debility  and  anae- 
mia. 

The  case  is  one  of  extreme  chronic  catarrh  of 
the  stomach,  with  a  high  degree  of  dilatation  of 
that  organ.     There  is  one  condition  which,  of  late 


232 


THE   CANADA    MEDICAL    RECORD. 


years,  we  have  learned  to  look  for  in  connection 
with  cases  of  this  kind,  and  that  is  non-malignant 
obstruction  of  the  pylorus.  The  irritation  of  the 
coats  of  the  stomach  may  extend  to  the  deeper 
structures,  and  the  amount  of  interstitial  thicken- 
ing, followed  by  contraction,  may  lead  to  obs- 
truction of  the  pylorus.  When  such  is  the  case, 
while  there  is  no  tumor  to  be  detected,  there  are 
other  symptoms  of  pyloric  obstruction.  There  is 
vomiting  and  dilatation  of  the  stomach,  with  a 
high  degree  of  emaciation,  weakness  and  anaemia, 
without  cancerous  cachexia.  I  dwell  upon  these 
points  because  it  has  been  proved  that  when  this 
condition  exists,  and  when  dietetic  and  medicinal 
measures  fail  to  give  relief,  it  is  justifiable  to  open 
the  stomach  and  dilate  the  structure  of  the  pylorus. 
This  has  been  done  in  a  number  of  cases,  where 
the  history  has  been  similar  to  that  which  we 
obtain  in  this  instance,  and  where  the  dilatation 
of  the  contracted  pylorus  has  been  followed  by 
great  relief,  and  in  some  cases  by  extraordinary 
cures.  In  some  cases  the  operation  has  resulted 
fatally.  I  do  not  know  whether  or  not  it  will  find 
a  place  for  itself  among  the  recognized  operations 
of  abdominal  surgery,  but  it  is  one  of  the  proce- 
dures which  must  be  considered  in  a  case  of  this 
kind,  where  the  evidence  ];oints  to  the  existence 
of  pyloric  stenosis  of  non-malignant  character. 

How  are  we  to  determine  whether  or  not  such 
stenosis  exists?  Only  by  the  effect  of  treatment; 
for,  as  I  have  said  to  you,  chronic  catarrhal  gas- 
tritis may  produce  all  the  symptoms  that  would  be 
present  if  the  stenosis  existed,  but  in  the  one  case 
treatment  would  give  relief,  while  'n  the  other  it 
would  have  no  effect.  In  treating  a  case  of  this 
kind,  the  first  thing  to  be  borne  in  mind  is  that 
the  food  should  be  administered  in  small  quanti- 
ties, at  regular  intervals,  and  should  be  of  such  a 
character  as  throw  the  least  work  upon  the  diges 
tive  processes.  In  this  case  we  have  employed 
artificially-digested  milk,  giving  three  pints  of  pep- 
tonized milk  during  the  twenty-four  hours.  The 
only  solid  food  allowed  has  been  one  ounce  of 
boiled,  scraped  meat.  I  was  anxious  to,  see  the 
effect  of  this  dietetic  treatment  influenced  as  little 
as  possible  by  the  action  of  drugs,  and  have,  there- 
fore, only  given  him  a  little  chloroform  and  a  sim- 
ple carminative.  The  result  of  this  treatment  has 
been  so  satisfactory  that  we  shall  continue  it.  The 
man  has  not  vomited  once  since  ;idmission,  and 
has  felt  quite  comfortable.  The  development  of 
flatus  has  been  much  diminished  by  the  use  of 
peptonized  milk,  and  the  gastric  tympany  has 
been  lessened.  As  long  as  the  patient  continues 
to  improve,  this  simple  treatment  will  be  ke])t  up. 
• — Polyclinic. 

THE    MAN.XGEMENT   AND  TREATMENT 
OF  ACUTE  BRONCHITIS  IN  CHILDREN. 

By  S.  Henry  Dessau,  M.D.,  Of  New  York. 

Before    speaking  of  the    treatment    proper,    I 
would  like  to  call  your  attention  to  certain  hygienic 


conditions  under  which  the  little  patient  should  be 
placed  as  well  as  the  adoption  of  prophylactic  mea- 
sures, which  in  delicate  children  is  of  prime  impor- 
tance. Regarding  prophylaxis  in  bronchitis,  noth- 
ing can  be  better  than  establishing  the  habit  of  cold 
bathing  for  the  infant.  This  may  be  carefully  re- 
gulated by  the  use  at  first  of  sponging  with  cold 
water  from  the  head  down  to  the  shoulders  and 
spinal  column  while  the  child  is  in  the  tepid  bath. 
Afterward  douches  and  the  whole  bath  should  be 
given  successively  as  age  advances.  The  cold 
bathing  strengthens  the  integuments  and  prepares 
the  body  for  sudden  cold  or  other  atmospheric 
influences. 

Most  of  our  patients,  children  affected  with 
subacute  bronchitis,  are  not  usually  considered 
sick  enough  to  be  kept  in  bed.  The  youngest 
ones  have  to  be  carried  in  the  nurse's  or  mother's 
arms,  even  if  very  sick  ;  while  the  older  ones,  if 
sick  enough  to  be  kept  in  bed,  are  often  allowed  to 
remain  in  their  ordinary  clothes.  I  often  find 
among  the  poorer  classes,  and  occasionally  in 
families  of  the  better  class,  the  little  children  al- 
most suffocated  with  the  number  of  clothes  they 
have  on,  irres])ective  of  the  temperature  of  the 
weather.  I  believe  such  heavy  dressing  only  ex- 
poses the  child  to  contract  an  additional  catarrh 
upon  the  slightest  change  of  the  weather.  If  the 
attack  is  not  severe  enough  to  confine  the  child  to 
the  bed,  I  direct  it  to  be  kept  in  the  '  room  in  its 
ordinary  dress  ;  but  if  sick  enough  to  go  to  bed,  the 
clothes  are  to  be  removed,  and  nothing  but  the 
night-dress  worn.  Infants  while  sick  should  beat 
all  times  loosely  dressed,  and  when  carried  about 
should  be  wrapped  in  a  light  shawl  or  blanket. 
It  is  a  commonly  received  idea  that  children 
affected  with  bronchitis,  however  slight,  should  be 
kept  indoors.  My  experience  in  a  dispensary 
practice  of  twelve  years  in  children's  diseases  has 
shown  me  that,  except  in  severe  cases,  this  is  not 
necessary  for  a  prompt  recovery,  providing  always 
that  the  cliild  is  kept  waim  by  suitable  covering 
while  in  the  ojjen  air.  In  private  practice,  how- 
ever, as  there  is  no  occasion  for  the  child  to  go 
out  of  doors,  it  should  be  kept  in  the  room. 

The  temperature  of  the  room  should  be  kept  at 
from  65  °  F.  to  70  °  F.,  and  jjroper  ventilation 
secured  at  night  by  keeping  one  or  more  windows 
drawn  down  from  the  top  for  about  eight  or  ten 
inches.  One  great  source  of  all  catarrhs  in  this 
city,  in  my  opinion,  is  the  intense  heat  which  is 
kept  up  in  the  dwellings  during  the  entire  winter. 
Even  in  the  rooms  of  tenement  houses  this  is  often 
found  to  be  the  case  in  an  extreme  degree.  The 
sudden  change  experienced  on  going  into  the  street 
or  even  another  room  or  hall-way,  or  coming  from 
the  street  into  tlie  apartment,  will  inevitably  pro- 
duce the  condition  of  "  catching  cold."  This  may 
be  explained,  according  to  Rosenthal,  by  the 
superficial  blood  vessels  of  the  body  becoming 
paralyzed  after  one  has  remained  for  any  length  of 
time  ui  an  overheated  apartment,  while  the  body 
temperature  rises  at  the  same   time.     If  the  over- 


THE   CANADA   MEDICAL   RKCOHD. 


233 


heated  body,  with  its  enormously  dilated  superfi- 
cial blood  vessels,  is  now  suddenly  exposed  to 
cold,  the  body  temperature  descends  below  the 
normal,  and  the  blood  of  the  supeificial  |iarts,  so 
suddenly  cooled,  courses  through  the  internal  or- 
gans and  cools  them  of  more  suddenly  than  would 
he  the  case  from  the  simple  inlluence  of  cold,  with- 
out the  ijrevious  influence  of  greater  heat.  'I'his 
sudden  cooling  ac  s  as  an  injurious  influence  in 
causing  congestion  in  this  or  tliat  organ,  especially 
if  it  is  already  enfeebled,  and  hence  less  resistant. 
It  will  always  be  of  advantage,  if  the  attack  is  in 
any  way  severe,  to  have  a  certain  amount  of  mois- 
ture in  the  shape  of  steam  diffused  through  the  air 
of  the  room.  This  can  be  easily  done  by  keepmg 
water  boiling  over  an  alcohol  stove.  The  addition 
of  a  small  quantity  of  turpentine  will  be  found 
highly  useful  and  refreshing. 

The  therapeutics  of  bronchitis  may  be  regulated 
according  to  ilw.  order  of  the  tubes  involved,  and 
the  rise  of  temperature  which  accompanies  the 
disease.  In  mild  cases,  where  the  catarrhal  pro- 
cess is  limited  to  the  larger  tubes,  and  there  is  very 
little  or  no  increase  of  temperature  occurring  in 
infants  under  six  months  of  age.  I  have  found  such 
remedies  as  the  wine  of  antimony  in  doses  of  one- 
fourth  to  one-half  drop,  in  combination  with  the 
wine  of  ipecac  in  doses  of  one-half  to  one  drop, 
repeated  every  hour,  prove  highly  efficacious. 
Small  doses  of  the  golden  sulphuret  of  antimony, 
one-twentieth  of  a  grain  triturated  with  sugar  of 
milk,  and  repeated  hourly,  have  also  given  satis- 
factory results.  A  stimulating  embrocation,  as 
ec[ual  parts  of  spirits  of  turpentine  and  olive  oil, 
applied  with  a  piece  of  flannel  to  the  back  and  front 
of  the  chest  until  reddening  of  the  skin  is  pro- 
duced, will  prove  of  additional  service.  In  chil- 
dren over  six  months  of  age,  similarly  affected,  the 
dose  of  the  antimonial  and  ipecac  wines  should  be 
increased  to  one  drop  each.  I  have  also  found  the 
tincture  of  bryonia  of  the  German  Pharmacopoeia, 
in  doses  of  one-half  to  one  drop  every  two  hours, 
of  benefit  in  some  cases.  In  a  few  persistent  cases 
of  subacute  bronchitis  in  older  children,  the  inspis- 
sated juice  of  Sal'iil  serru/afa,  or  saw  palmetto, 
has  given  gratifying  results.  The  dose  is  from  five 
to  twenty  drops  three  times  daily.  Where  there 
are  evidences  of  a  strumous  constitution,  the  emul- 
sion of  cod-liver  oil,  with  or  without  the  hypo- 
phosphites  of  lime  and  soda,  will  be  found  all-suf- 
ficient. 

In  severe  cases  of  bronchitis  accompanied  with 

an  elevation  of  temperature, and  where  the  medium- 

, sized  and  smaller  tubes  are  involved,  I  am  in  the 

piabit  of  giving  tincture  of  aconite  root  in  doses  of 

Dne-half  to  one  drop,    according  to  age,  repeated 

every  hour,  with  the  result  of  reducing  the  tempera- 

jture,  and  establishing  resolution.     If  a  spasmodic 

element  of  the  cough  is  manifest    to  any   extent, 

Imuch  benefit  may  be  derived  from  the  tincture  of 

Ibelladonna  in  drop  doses,  given  alternately  every 

lour  with  the  aconite.     It  will  be  remembered  that 

Sn  the  early    stage  of  inflammation  of  a    mucous 


membrane  the  secretion  is  at  first  diminished,  the 
membrane  becoming  dry  and  swollen.  Afterward 
the  secretion  is  increased  in  quantity,  while  at  the 
same  time  it  becomes  altered  in  quality,  being 
viscid  and  tenacious.  Hence  in  the  early  stage  of 
an  acute  bronchitis,  where  dry,  subcrepitant  or 
sonore-sibilant  lales  are  heard,  the  practice  which 
is  often  followed, of  giving  stimulating  exjjectorants, 
such  as  the  carbonate  and  muriate  of  ammonia  and 
squills,  in  free  doses,  can  only  result  in  aggravating 
the  existing  condition. 

Much  more  successful  results,  in  my  opinion, 
will  be  obtained  by  giving  such  remedies  as  will 
relieve  the  congestion  and  swelling  of  the  mucous 
membrane,  through  fPcing  upon  the  force  of  pres- 
sure of  the  blood  circulation,  or  by  derivative  ac- 
tion upon  distant  organs  whose  functions  are  in  a 
measure  compensatory  in  character.  .Such  is  the 
effect  of  aconite  that  I  have  mentioned,  and  vera- 
trum  viride  that  I  have  not  used.  Nitrous  ether, 
which  is  a  depressor  of  arterial  tension,  as  the 
other  nitrites  are  known  to  be,  which  thus  ex- 
plains its  diuretic  effort,  is  a  time-honored  remedy 
in  bronchitis,  and  may  be  cited  as  representing  the 
latter  class.  S])irits  of  Mindererus,  from  its  sudori- 
fic action  upon  the  skin,  is  always  indicated.  A 
favorite  combination  of  mine,  which  has  seldom 
failed  to  render  me  valuable  service,  is  :  Liq.  am- 
nion, acet.,  fSiv  ;  spts.  ether,  nit.,  syr.  ipecac,  aa 
f3iss;syr.  senegce,  f  3  j  ;  syr.  limonis,  f  3  j.  M.  3j 
every  three  hours.  This  formula  has  been  pub- 
lished in  an  incomplete  form  in  Johnson's  Formu- 
lary of  Wood's  Library,  and  I  here  take  occasion 
to  make  correction  of  the  error  due,  no  doubt,  to 
the  printer's  oversight.  I  am  in  the  habit  of  em- 
ploying this  formula  daily  in  my  practice.  Its  use 
is  not  confined  to  the  treatment  of  bronchitis  alone, 
for  I  find  it  equally  serviceable  in  the  whole  range 
of  acute  pulmonary  complaints  as  occurring  in  chil- 
dren. I  do  not  regard  the  small  amount  of  senega 
present  as  having  an  expectorant  action,  but  more, 
if  you  like,  of  a  specific  effect  upon  the  ciliated 
columnar  epithelium  of  the  bronchial  tubes. 

I  seldom  have  to  resort  to  opium  except  in  com- 
bination with  camphor,  as  in  the  tr.  opii  cainph., 
when  it  is  administered  in  five  to  ten-drop  doses, 
principally  at  night,  as  a  sedative  for  the  cough. 

Hot  poultices  of  flaxseed,  sprinkled  on  the  sur- 
face with  mustard,  made  large  enough  to  encircle 
the  entire  chest  and  covered  with  oil-silk,  form  an 
important  addition  to  the  treatment  of  the  severer 
grades  of  bronchitis.  Pieces  of  tape  extending 
across  the  shoulders  should  bet  acked  to  the  cloth 
holding  the  poultice,  in  front  and  behind,  to  pre- 
vent the  poultice  from  slipping  down.  The  effect 
of  the  heat  and  moisture,  together  with  the  coun- 
ter-irritation produced  by  the  mustard,  which  can 
be  regulated  in  amount  to  suit  the  demands  of  the 
case,  are  unquestionably  of  the  highest  benefit. 
Where  the  bronchitis  has  extended  to  the  infundi- 
bula  and  air  vesicles,  and  catharral  pneumonia 
has  developed,  I  have  every  reason  to  believe  that 
a    continuous    mild    counter-irritation,    with    the 


^u 


THE   CANADA   MEDICAL   RECORD. 


flaxseed  poultice  lightly  sprinkled  with  mustard, 
has  often  been  the  j^rincipal  means  of  enabling 
me  to  witness  the  successful  termination  of  my 
cases.  The  poultice  should  be  clianged  about 
three  times  during  the  day  and  once  through  the 
night.  Spongio-piline,  wrung  out  with  hot  water, 
answers  every  purpose  of  the  poultice,  besides 
being  cleaner  and  less  troublesome  to  apply ;  but, 
being  expensive,  it  can  be  afforded  only  by  weal- 
thy families.  West  recommends  the  spongio- 
piline  to  be  sprinkled  with  a  stimulating  liniment, 
such  as  lin.  camph,  co.  ,lj;  tr.  canth.,  tr.  opii, 
aa  3  ij.  M. ,  when  it  is  desired  to  produce  counter- 


irritation  ;  but  I  have  found^e  ordinary  mustard, 
was  wanted. 


lightly  sprinkled  over  the  inflR-  surface,  do  all  that 


When  the  rales  have  become  soft  and  bubbling, 
and  not  disposed  to  clear  up  quickly,  I  have 
found  three  to  five  drops  of  a  saturated  solution 
of  muriate  amtiionia,  given  every  two  hours,  have 
the  happiest  effect  in  clearing  up  the  excessive 
secretion,  notwithstanding  in  some  cases  evident 
signs  of  catarrhal  pneumonia  were  present.  It  is 
important,  especially  in  subjects  of  a  scrofulous 
and  rachitic  diathesis,  to  establish  a  healthy  con- 
dition of  the  mucous  membrane  of  the  bronchial 
tubes  as  soon  as  possible.  In  these  cases  there 
is  a  general  tendency  for  some  large  ronchi  to 
remain  scattered  over  the  lungs  after  the  more 
severe  symptoms  have  disappeared.  The  admin- 
istration of  tonics,  as  quinine  and  iodide  of  iron, 
together  with  cod  liver  oil,  is  here  clearly  indica- 
ted. Counter-irritation  to  the  back,  in  the  inter- 
scapular space,  with  tincture  of  iodine,  should 
be  used,  as  it  is  also  rightly  regarded  as  a  valua- 
ble means  of  promoting  absorption  of  the  enlarged 
bronchial  glands,  which  I  have  shown  are  likely 
to  exist. 

Inhalations  have  recently  been  introduced  in 
the  treatment  of  bronchial  catarrhs,  and  have  been 
found  to  give  valuable  assistance  in  hastening 
a  cure.  I  have  had  little,  if  any,  experience  with 
them  in  children,  but  can  see  no  reason  why 
they  might  not  be  effective  with  those  over  two 
years  of  age.  They  may  be  used  in  the  form  of 
steam  inhalations  from  a  croup-kettle,  the  water 
being  medicated  with  turpentine,  terebene.  iodine 
or  eucalyptus,  or  whatever  article  may  be  desired. 
Older  children  may  .submit  to  the  use  of  the  hand 
atomizer,  in  which  the  wine  of  ipecac,  as  recom- 
mended by  Ringer,  or  Dobell's  solution,  which  is 
alkaline  and  antiseptic,  may  be  employed. 

In  those  cases  where  bronchitis  occurs  together 
with  diarrhoea  as  the  result  of  changes  of  temper- 
ature, the  antimonial  wine  in  drop  doses,  repeated 
hourly,  will  be  found  to  have  a  decided  effect  in 
relieving  both  affections  at  the  same  time.  AVhen 
the  bronchitis  occurs  as  a  complication  of  sum- 
mer diarrhoea,  counter-irritation  to  the  chest  with 
the  flaxseed  and  mustard  poultice,  together  with 
the  administration  of  stimulants,  is  chiefly  to  be 
depended  upon.  In  infants  or  weakly  children, 
where    a    tendency   to    collapse   of    the   lung   is 


apparent,  crying  should  be  provoked  and  encour- 
aged as  much  as  possible,  and  alcoholic  stimulants 
freely  given.  In  such  cases  Day  advises  the 
child  to  be  laid  face  downward,  as  it  assists  breath- 
ing, and  prevents  the  tendency  of  the  secretions 
to  gravitate  to  posterior  aijd  lower  surface  of  lungs. 
The  same  author  also  suggests  that  when  vomit- 
ing becomes  a  troublesome  symptom,  the  medicine 
be  given  immediately  after  a  spell,  in  order  that 
it  may  have  a  chance  to  remain  longer  in  the 
stomach  and  some  portion  of  it  be  absorbed. 

Jacobi  wisely  advises  plenty  of  water  as  a  drink 
for  the  purpose  of  supplying  a  fluid  for  the  lique- 
faction of  the  viscid  secretions,  and  so  promoting 
their  easy  expulsion.  It  will  also  prevent  caseous 
degeneration  by  keeping  the  cells  bathed  in 
moisture  that  will  hasten  absorption. — College  and 
Clinical  Recoril. 


THE  DIETARY    OF    BRIGHT'S    DISEASE. 

BY  J.  MILNER  FOTHERGILL,  M.  D.,  EDIN.,  HON.  M.  D. 
RUSH,  ILL. 

The  importance  of  the  dietary  in  Bright's  disease 
is  all  the  greater  in  that  medicines  exercise  com- 
paratively little  influence  upon  its  jjrogress. 

The  form  of  Bright's  disease  here  treated  is  the 
chronic  one,  where  the  kidneys  are  "granular," 
"contracted  "  "  gouty  "  or  "  cirrhotic."  This  is  a 
slow  development  of  connective  issue  (a  parenchy- 
matous inflammation)  throtighout  the  structure  of 
these  organs,  which  contracting — as  is  its  nature 
destroys  the  secreting  and  tubular  portions.  Some 
portions  are  destroyed  as  regards  function,  while 
others  remain  normal  and  uninjured.  At  last  the 
destruction  is  so  extensive  that  the  kidneys  become 
quite  inadequate  to  carry  out  their  duty,  and  the 
organism  perishes. 

The  opinion  of  the  profession  (as  regards  its 
mernbers  under  fifty  years  of  age)  is  that  the  main 
cause  of  this  chronic  inflammation  is  the  output 
of  urates  by  the  kidneys.  Mammalian  kidneys 
have  the  soluble  urea  as  their  form  of  nitrogenized 
waste,  while  urates  belong  to  animals  with  a  three- 
chambered  heart  and  a  solid  urine.  When,  then, 
the  mammalian  liver  foims  this  primitive  urine 
the  kidneys  become  injured  by  casting  it  out. 
Long  ago  Dr.  George  Johnson,  F.R.S.,  the  res- 
pected professor  of  the  Practice  of  Physic  at  Kin  's 
College,  and  a  recognized  authority  on  Kidney 
disease,  wrote  :  "  Renal  degeneration  is  a  conse- 
qnence  of  the  long-continued  elimination  of  the 
products  o/faulty  digestion  through  the  kidneys." 

Recognizing,  as  we  do,  that  under  certain  cir- 
cumstances (often  mental  strain)  the  liver  falls 
back  upon  this  primitive  urinary  stuff,  it  is  obvi- 
ous that  the  rational  plan  of  meeting  the  difficulty 
is  to  reduce  the  albuminoid  elements  of  our  food 
to  the  needs  of  the  organism  rather  than  die 
cravings  of  the  palate.  That  bite  of  solid  meat  so 
acceptable  to  the  Anglo-Saxon  has  led  him  to 
cultivate  flocks  and  herds  to  a  point  of  excellence 


THE    CANADA    MEDICAL    RECORD. 


235 


iinattained  by  other  races.  The  beef  and  mutton 
in  other  coiintrie.s  will  not  furnish  solid  joints  ; 
lias  to  be  hashed  and  stewed  and  made  into 
ragouts  in  order  to  be  palatable.  Even  a  leg  of 
mutton  stuffed  with  onions  is  but  indifferently 
good.  A  "  Wiener  Schnitzel"  is  a  veal  cutlet, 
and  the  continental  efjuivalent  of  our  steak  and 
chop — not  forgetting  Fitkt  dc  Banf.  'The  "plain 
roast  and  boiled,''  the  pride  of  the  Anglo-Saxon 
housewife  and  cook,  are  largely  responsible  for 
the  jjrevalence  of  this  form  of  Bright's  disease 
amidst  Anglo-Saxon  people. 

'I'his  statement  is  not  rashly  hazarded  as  a 
specious  and  ready  generalization.  It  is  the  out- 
come of  careful  thought  on  the  matter. 

In  England  at  least  the  impression  exists  that 
simple  fare — "  jslain  roast  and  boiled,"  is  innocuous. 
It  is  a  murderous  fallacy  !  It  is  just  the  abundance 
of  meat — sai)id,  palatable,  readily  jjrepared,  stimu- 
lating— that  is  the  bane  of  so  many  men.  It  would 
not  be  too  sweeping  a  generalization  to  say  that 
the  lady  who  dines  at  home  is  comijaratively  free 
from  Bright's  disease  ;  while  the  business  man  who 
takes  his  midday  meal  at  a  restaurant,  and  then 
dines  at  home  in  the  evening,  is  the  victim  of 
Bright's  disease  p-n-  excelh  nee.  As  lie  looks  down 
the  menu  for  his  lunch,  his  eje  lights  upon  dish 
after  dish,  in  the  composition  of  which  lean  meat 
forms  the  integral  factor. 

This  fact  cannot  be  impressed  too  distinctly  on 
the  mind.  To  traverse  the  statement  by  pointing 
to  the  fact  that  many  men  notoriously  consume 
large  and  unusual  quantities  of  such  animal  food, 
with  apparent  impunity,  is  merely  to  state  that  the 
human  liver  is  in  many  instances  equal  to  convert- 
ing into  urea  the  whole  surplusage,  or  Itixus  con- 
sumption of  albuminoid  matter.  It  leaves  unaf- 
fected the  fact  that  when  the  liver  is  unequal  to  such 
complete  conversion,  and  reverts  to  the  formation 
of  urates,  it  becomes  a  wise  and  prudent  measure 
to  reduce  the  albuminoid  elements  in  the  dietary 
to  the  wants  of  the  body. 

There  is  a  strong  impression  abroad  among 
medical  men,  who  have  paid  great  attention  to  the 
subject,  that  the  lean  of  the  larger  animals  has  a 
stronger  tendency  in  the  metabolism  of  albuminods 
to  form  urates  than  any  other  forms  of  albuminoids. 
This  impression  must  just  be  taken  for  what  it  is 
worth.  It  is  sufficiently  a  matter  of  faith  with  the 
writer  to  inspire  conduct,  as  his  butcher  realizes  to 
his  cost ;  while  the  fishmonger  and  the  greengrocer 
benefit  by  it. 

The  entrees  and  made  dishes  of  French  cookery 
are  far  less  pernicious  than  "  the  roast  beef  of  old 
England,"  and  its  congeners.  They  consist  to 
some  extent  of  lean  meat,  true  ;  but  they  ;il30  con- 
tain notable  quantities  of  oil  and  vegetables. 

The  man  who  is  held  to  be  the  subject  of  chronic 
Bright's  disease  should  banish  the  solid  joint  from 
his  table  ;  except  maybe  on  Christmas  Day.  The 
steak  and  chop  should  be  indulged  in  rarely,  and 
when  eaten  not  be  devoid  of  fat.  The  veal,  or 
rabbit,  or  beefsteak  pie  should  not  be  without  a 
due  proportion  of  fat. 


The  same  may  be  said  of  the  meat  pudding, 
the  hash,  or  the  Irish  stew,  and  the  currey.  He 
should  have  one  vegetable  course  at  dinner,  and, 
what  is  more,  ought  religiously  to  ])artake  of  it. 

While  meats,  as  chicken,  are  less  objectionable 
than  brown  meats  ;  but,  after  all,  it  is  but  a  matter  of 
comparison.  One  jjatient  obeyed  his  instructions 
but  giossly  violated  them  in  the  spirit.  He  was 
a  blue-blooded  Patrician,  inheriting  an  insufficient 
liver — illustrating  the  truth  of  the  adage,  "the 
fathers  have  eaten  sour  grapes  and  the  children's 
teeth  are  set  on  edge" — whose  urine  was  laden 
with  lithates.  Meat  being  forbidden  but  fowls 
])ermitted,  he  explained  that  he  "had  passed  the 
joint  but  laid  into  the  turkey,"  as  a  gastronomic 
rule.  A  sharp  attack  of  articular  gout  opened  his 
eyes  for  him. 

Of  what  then  should  the  man  with  chronic 
Bright's  disease  consist? 

Breakfast:  Oatmeal  or  hominy  porridge,  homi- 
ny fritters,  followed  by  a  little  fish  with  plenty  of 
butter  to  it ;  or  a  slice  of  fat  bacon  or  pork.  Fat. 
fish  and  farinaceous  matters.  Hominy  and  fat 
pork  for  the  less  affluent. 

Lunch  or  supper :  .Mashed  potatoes  well  buttered. 
Other  vegetables  well  buttered.  A  milk  pudding 
made  without  an  egg.  Biscuits  of  various  kinds 
and  butter,  with  a  nip  of  rich  cheese. 

Dinner  :  Soup  containing  plenty  of  vegetable  mat- 
ter, broken  biscuit,  orsago  or  vermicelli.  Cream, in 
lieu  of  so  much  strong  stock,  should  lurk  in  the 
soup  tureen  :  especially  in  while  soup.  This  should 
be  followed  by  fish  in  some  form  ;  a  course  of 
vegetables,  as  stewed  celery,  chopped  carrots,  a 
boiled  onion,  leeks,  nicely  prepared  potatoes,  as 
"  browned  potatoes  "  a  la  Marion  Harland,  aspar- 
agus, or"  scalloped  tomatoes  "and  corn  or  "  boiled 
corn."  Then  should  follow  apple-bread  pudding, 
Maud's  pudding,  bread  and  raisin  pudding;  and, 
if  the  digestion  can  be  trusted,  roly-poly  pudding, 
sweet  pudding,  and  fruit  pies.  Stewed  fruit  with 
creeled  rice,  rice  milk,  or  other  milk  pudding  is 
good,  or  better  still,  cream.  Then  comes  the 
biscuit,  or  cnckers  and  butter.  Dessert  with  its 
many  fruits  should  never  be  omitted. 

The  reader  who  prefers  something  tasty  and 
piquant  will  exclaim  this  is  too  much  in  the  "  baby- 
food,"  or  the  "nursery line,"  for  him,  and  asks  for 
some  game,  or  some  toasted  cheese.  Well !  in 
strict  moderation  let  it  be — as  the  tasting  of  for- 
bidden fruit. 

Where  something  more  sapid  is  fancied  let  it  be 
anchovy  toast,  herrings  skinned,  cut  into  inch 
lengths  and  fried  on  toast,  sardines  on  toast;  pos 
sibly,  a  little  caviare,  herring  roes  and  millets,  or 
mushrooms.  Certainly  Pate  de  Foie  Gras — all 
prejudices  to  the  contrary  notwithstanding. 

There  is  a  great  deal  of  toothsome  eating  in  a 
dietary  suitable  for  a  man  of  Bright's  disease,  all 
the  same. 

Eggs,  ordinary  cheese,  and  fish  roes,  are  all  high- 
ly albuminous,  it  must  be  remembered. 

Fowls,    chicken,  game,  are    meats  less    objec- 


236 


THE   CANADA   MEDICAL   RECORD. 


tionable  than  joints ;  but  again  it  is  a  matter  of 
comparison. 

From  what  has  been  stated  above,  it  is  clear 
that  "  hotel  dietary"  is  as  unsuitable  for  the  person 
with  Bright's  disease  as  it  is  to  the  dyspeptic. 
Travel  is  not  prudent  for  either.  They  had  better 
keep  to  a  private  house  with  cookery  adapted  to 
their  special  wants. 

Then  as  to  drink.  The  interest  in  the  matter 
centres  round  alcohol.  Other  than  alcoholic  be- 
verages are  beyond  contention  ;  except,  perhaps, 
milk,  which  contains  a  notable  proportion  of 
albumen  in  the  form  of  caseine.  If  it  be  taken 
as  a  beverage,  or  as  a  food  adjunct,  its  composition 
must  be  borne  in  mind,  and  the  other  foods  be 
sparing  in  albumen. 

Probably  light  wines  are  practically  innocuous, 
that  is  in  moderate  quantities  ;  as  is  cider.  Possi- 
bly the  same  may  be  said  of  the  light  lager  beers, 
as  Pilsener,  but  ales  brewed  on  the  English  plan 
exercise  a  malign  influence  upon  the  liver.  This 
applies  to  the  porter  and  stout.  Then  as  to  spirits 
and  waters,  aeraied  or  other  !  Opinions  may  differ. 
There  is  much  less  Bright's  disease  in  Scotland, 
where  oatmeal  porridge  and  whiskey  go  together, 
than  in  England,  with  its  beef  and  beer.  The 
reader  can  draw  the  inference. 

There  is  no  valid  proof  that  alcohol  in  modera- 
tion tends  to  add  further  to  the  morbid  process, 
which,  bit  by  bit,  is  slowly  and  insidiously  work- 
ing the  ruin  of  the  kidneys.  On  the  other  hand, 
beef-tea  often  does  much  mischief.  The  meat 
extractives  it  contains,  though  not  food,  are  at  the 
head  of  the  descending  series,  ending  in  uric  acid 
and  urea,  and  add  to  the  work  of  the  kidneys. 

One  exquisite  beverage,  palatable  and  nutritive, 
is  made  with  some  malt  extract  and  aerated  water. 
Unfortunately,  in  order  to  prevent  fermentation, 
a  malt  extract  has  to  be  reduced  to  the  consistency 
of  trade.  This  viscidity  renders  it  most  trouble- 
some to  handle.  'I'he  readiest  plan  is  to  get  the 
cook  every  morning,  or  second  morning,  to  dilute 
a  certain  amount  of  malt  extract  with  an  equal 
quantity  of  warm  water,  and  beat  it  to  a  syrup. 
Fill  a  tumbler  one-third  full  with  the  malt  syrup, 
then  fill  with  aerated  water.  This  is  a  glorious 
malt  liquor  for  a  teetotaller — or  any  other  man 
!-  -Juurual  of  Heconsfriictirts. 


THE  TREATMENT  OF  EPISTAXIS. 

By  Charles    h.  Wade,  b.  a.,  Oxon.,  l.r.c.p.    Lond., 
M.R.c.s.  Eng. 

The  embarrassment  too  often  created  by  the 
persistence  with  which  hemorrhage  from  the  nose 
continues  in  some  cases,  notwithstanding  that  re- 
sort is  had  to  the  extreme  course  of  plugging  the 
nares,  renders  any  suggestion  for  effectually  con- 
trolling this  accident  acceptable  to  practitioners. 
Its  occurrence,  moreover,  not  unfrequently  takes 
place  under  circumstances  that  tend  to  increase 
the  concern  naturally  aroused  by  loss  of  blood  so  | 


alarming  in  extent  as  in  many  instances  it  is;  very 
often  the  surgeon  is  hurriedly  called  in  to  arrest 
the  flow  without  having  been  informed  of  the  na- 
ture of  the  illness  he  is  about  to  attend,  and  he  is 
consequently  unprovided  with  the  special  appli- 
ances deemed  necessary  ibr  meeting  such  an  emer- 
gency, and  this,  it  may  be,  at  a  distance  from 
home  much  too  great  to  allow  of  any  steps  on  his 
part  towards  procuring  the  means  of  easily  making 
and  placing  in  position  the  plugs  with  which,  as 
a  rule,  he  would  seek  to  put  an  end  to  the  bleeding. 
This  question  has  recently  been  under  discussion 
at  the  Paris  Acadi  my  of  Medicine,  before  which 
body  M.  Verneuil  has  described  a  method  that  he 
is  disposed  to  regard  as  specific  in  even  grave 
cases,  and  which  consists  in  applying  over  the 
region  of  the  liver  a  counter  irritant  in  the  form  of 
a  large  blister ;  and  he  narrated  three  cases  in  which 
this  plan  of  treatment  effectually  arrested  the  epis- 
taxis,  even  after  trial  with  digitalis,  ergotine,  and 
plugging  had  been  made  in  vain.  However  suc- 
cessful the  proceeding  may  be,  it  is  impossible  to 
regard  it  as  less  than  a  severe  remedy,  and  if  a 
simpler  one  should  prove  to  be  attended  with  equal- 
ly good  results,  the  choice,  in  ordinary  cases, 
would  most  certainly  lie  with  it.  And  that  such 
is  the  case  I  am  led  to  think  from  the  good  effects 
obtained  by  adopting  a  mode  of  treatment  in  these 
cases  for  a  knowledge  of  which  I  am  indebted  to 
iMr.  Jonathan  Hutchinson,  who  has  found  it  equal 
to  the  needs  of  all  occasions  on  which  he  has  em- 
ployed it.  It  consists  in  immersing  the  feet  and 
legs  of  the  patient  as  far  as  possible,  in  water  as 
Lot  as  can  be  borne ;  and  I  can  assert  from  experi- 
rience  that  whoever  will  make  a  trial  of  the  method 
will  have  cause  to  be  thankful  for  so  ready  and 
available  a  remedy  in  trying  emergencies. 

A  case  in  point  occurred  to  me  on  the  evening 
of  Christmas  Day,  1886,  when,  about  8  o'clock,  I 
was  hastily  summoned  to  attend  a  laborer,  ret. 
40,  who,  according  to  the  messenger,  was  ''  bleed- 
ing to  death. "  I  fouiiti  him  seated  on  a  chair 
before  a  large  fire,  in  the  kitchen  of  his  cottage, 
holding  a  duster,  already  saturated  with  blood,  to 
his  nose,  and  surrounded  by  sympathising  rela- 
tives and  friends  ;  while  hard  by  were  evidences,  in 
the  shape  of  blood-stained  rags,  and  a  bowl  of 
reddened  water,  to  the  effect  that  the  haemorrhage 
had  been  continuing  for  a  considerable  time.  On 
inquuy  I  learned  that  it  had  lasted  from  about  one 
o'clock  in  the  day,  and  the  sufferer  himself  volun- 
teered the  information  that  his  condition  might 
have  been  influenced  by  the  fact  that,  m  deference 
to  the  season,  he  had  taken  "  his  beer  "  in  more 
liberal  quantities  than  usual.  On  removing  the 
cloth  with  which  he  sought  to  stay  the  flow,  the 
blood  dripped  freely,  and  the  same  rate  was  said  to 
have  been  maintained  for  several  hours.  The  man's 
appearance  quite  justified!  he  truth  of  this  assertion, 
and  I  determined  at  once  to  fall  back  on  the  hot 
pediluvium,  having,  from  prior  experience, 
complete  faith  in  its  efficacy.  Fortunately  a 
pan  of  water  was  on  the  fire  at  the  time,  almost 


TIIK   CANADA    MEDICAL   KECORD. 


237 


boiling,  and  half  tilling  a  coujile  of  buckets  with  it, 
and  adding  enough  cold  water  to  render  the  bath 
tolerable,  I  jjlacedli  fool  and  leg  of  the  jjatient  in 
each.  I  must  admit  that  my  proceedings  up  to 
this  point  did  not  percejjtibly  impress  my  audience 
with  a  sense  of  my  dignity  as  a  surgeon,  but 
almost  immediately  there  after  the  drop,  drop,  from 
the  nose  of  the  patient  was  arrested,  and  within 
eight  minutes  it  had  entirely  ceased.  It  need  hard- 
ly be  said  that  he  had  previously,  at  my  request, 
been  lifted  in  his  chair,  from  out  of  the  direct 
head  of  the  fire  to  a  cooler  situation,  and  as  he 
showted  a  tendency  to  faintness  he  was  also  for  a 
time  supported  by  bystanders  who  quickly  became 
interested  in  the  virtues  of  hoi  bathing  as  a  s])eci- 
fic  for  epistaxis. 

Having  directed  the  treatment  to  be  continued 
for  half  an  hour,  and  instructed  the  friends  to  put 
the  patient  then  to  bed,  with  the  head  lying  low, 
I  left  the  case  quite  easy  in  my  mind  regarding  it, 
having  first,  however,  told  the  wife,  an  intelligent 
woman,  to  repeat  the  bath  should  the  bleeding 
return  during  the  night.  As  a  precautionary 
measure  also,  a  mi.\ture  containing  iron  alum  was 
given  at  intervals  during  the  succeeding  twenty- 
four  hours,  and  after  that  the  headaclie  and  weak- 
ness were  speeedily  recovered  from  with  the  aid 
of  a  tonic  and  good  feeding.  Ouce  only,  on  the 
day  following  that  of  the  attack,  did  the  haemorr- 
hage recur,  and  it  was  at  once  and  completely 
arrested  by  the  same  means. 

I  do  not  hesitate  to  describe  this  case  at  length 
because  it  illustrates  a  class  of  accidents  more 
common  perhaps  in  general  practice  than  under 
any  other  circumstances  ;  and  also  because  they 
often  give  a  good  deal  of  trouble  and  cause  much 
anxiety  to  those  having  the  treatment  of  them. 
Since  the  time  named  I  have  more  than  once  had 
occasion  to  adopt  the  same  course  of  procedure, 
and  in  one  instance  being  called  late  at  night  to  a 
patient  some  miles  away,  and  being  unable  to  go 
to  him  at  once,  I  gave  the  messenger  careful  in- 
structions what  to  do  ;  and  the  next  day  had  the 
satisfaction  of  learning  that  all  had  gone  well, 
though  the  hajmorrhage  had  lasted  more  than 
twelve  hours. 

It  is  not  difficult  to  understand  the  modus  openni- 
di  of  the  treatment,  the  success  of  which  clearly 
depends  on  the  abstraction  of  blood  from  the 
head  owing  to  the  greater  demand  for  it  in  the 
lower  extremities  under  the  influence  of  the  hot 
water.  Moreover,  it  is  probable  that  the  force  of 
the  outflowing  stream  through  the  no-itrils  being 
once  diminished,  that  coagulation  is  encouraged 
in  the  nasal  vessels  as  a  consequence  of  the  loss 
already  sustained,  for  the  tendency,  even  in  obsti- 
nate cases  of  epistaxis,  is  undoubtedly  to  the  pro- 
duction of  clot  after  a  certain  period  in  tlie  process 
of  bleeding.  The  frequent  uselessness  of  haemos- 
tatics during  the  flow  also  points  to  the  same  con- 
clusion ;  for  these  agents  act  readily  enough  when 
once  the  loss  of  blood  is  arrested,  they  fail  earlier 
because  the  effect  of  their  local  action  is    undone 


by  the  persistence  of  a  current  past  the  points 
affected,  but  which  current  is  slowed  or  even 
stopped  when  a  new  demand  for  largely  increased 
supplies  of  blood  is  set  u[)  in  a  more  dependent 
part  of  the  body. 

It  is  impossible  not  to  see  in  the  plan  of  M. 
Verneuil  a  close  relation  to  the  one  I  have  endea- 
vored to  describe,  though  the  latter  has  many 
elements  of  advantage  to  recommend  a  preference 
for  it,  at  any  rate,  at  first.  Whatever  opinion 
may  be  held  as  to  its  mode  of  action,  however, 
there  can  be  no  question  of  its  extreme  value  as  a 
mode  of  controlling  epistaxis.  It  is  sufficiently 
simple  to  be  tried  in  all  cases  ;  it  will  rarely  or 
never  fail. — Medical  Press. 


THE  TREATMENT  OF  DIABETE.S. 

A  paper  was  recently  read  before  the  Academie 
des  Sciences,  at  Pans,  by  M.  Villemin,  on  a  case 
of  acute  diabetes  which  had  been  treated  by 
means  of  opium  and  belladonna  combined.  The 
patient  was  a  young  soldier,  strongly  built  and 
hitherto  of  good  health,  who  had  suddenly  develop- 
ed intense  diabetes,  passing  twenty-five  pints  of 
urine  daily  with  near  two  pounds  of  sugar.  Two 
grains  of  extract  of  belladonna  with  one  grain  of 
extract  of  opium  were  then  given,  the  patient  at 
the  same  time  being  restricted  to  the  usual  regime 
for  diabetic  patients.  In  the  course  of  a  fortnight 
the  quantity  of  urine  was  not  much  above  normal, 
and  the  sugar  had  disappeared.  Discontinuance 
of  the  treatment,  even  though  the  same  diet  was 
adhered  to,  was  promptly  followed  by  a  return  of 
the  symptoms,  which,  however,  as  promptly  sub- 
sided when  the  treatment  was  resumed.  Later  on 
he  was  allowed  to  return  to  the  ordinary  full  diet 
for  non-diabetic  patients,  but  even  then,  so  long  as 
the  opium  and  belladonna  treatment  (raised  to  3 
grains  daily  of  each)  was  continued,  no  return  of 
the  polyuria  or  glycosuria  occurred.  Under  treat- 
ment the  patient  gained  18  pounds  in  weight. 
Without  being  over-saguine,  it  would  be  interest- 
ing to  see  the  result  of  this  treatment  in  other 
hands. — Dub.  Medical  Press. 


(I:DEMA  of  THE  PREPUCE. 

Dr.  J.  G.  Tajjper  writes  to  the  JVe7Ci  York  Medi- 
cal /ourna/ior'iiov^mhtv  6,  1886,  that  for  several 
years  past  he  has  been  treating  very  successfully 
the  great  oedema  and  infiltration,  attending  many 
cases  of  phimosis  and  paraphimosis  as  the  result 
of  congenital  or  specific  causes.  In  many  cases 
occurring  in  the  adult  we  find  a  perfect  horror  of 
being  confined  to  the  bed.  In  fact,  impleasant 
circumstances  connected  with  the  trouble  render 
it  imperative  that  our  patient  should  engage  in  his 
usual  occupation  during  the  treatment.  These 
requirements  have  led  him  to  the  adoption  of  the 
following  measures  :  He  saturates  a  given  quantity 
of  absorbent  cotton  with  chemically  pure  glycerin 


238 


THE   CANADA   MEDICAL   RECORD. 


in  which  bichloride  of  mercury  has  been  dissolved 
in  proportions  varying  from  i  in  looo  to  i  in  5000, 
according  to  the  amount  of  fcetor  present ;  or,  in 
place  of  the  bichloride,  iodoform,  carbolic  acid,  or 
any  antiseptic  agent  preferred  may  be  used.  With 
the  cotton  so  charged  he  completely  encircles  the 
organ  so  far  as  it  is  involved.  Over  this  a  large 
rubber  condom  is  drawn,  which  is  then  suspended 
from  an  abdominal  band.  This  dressing  is  to  be 
repeated  every  six  hours  until  the  cedematous 
condition  disa]ipears.  At  that  time  a  beginning 
pallor  will  be  observed,  and  often  in  from  twelve  to 
twenty  hours  the  prepuce  will  have  become  very 
pale  and  shrivelled.  The  great  majority  of  cases 
yield  promptly,  and  no  further  progress  is  observed 
after  the  first  application.  If  ulcers  are  present, 
it  will  often  be  discovered  that  they  have  taken  on 
a  healthy  action  before  it  has  been  possible  to  ex- 
pose them,  and  not  infrequently  this  progresses 
until  the  cure  is  completed.  The  advantages  of 
this  dressing  are:  it  is  cleanly  ;  there  is  no  difficulty 
in  applying  it,  patients  frequently  continuing  the 
treatment  at  their  rooms  or  places  of  business  after 
the  first  dressing  ;  it  does  not  expose  or  confine  the 
patient  ;  and  the  results  in  his  hands,  and  in  those 
of  others  who  have  tried  it  at  his  suggestion,  have 
been  very  satisfactory. — Therapeutic  Gazette. 


ERGOT  IN  ERYSIPELAS. 

One  of  the  most  unsatisfactory  processes  to  deal 
with  on  account  of  the  want  of  success  attending 
our  efforts,  is  that  of  rapidly  spreading  erysipela- 
tous inflammation.  It  is  often  found  to  be  the  case, 
that  a  focal  point  existed  early  in  the  disease,  from 
whence  the  redness  and  accompanying  tenderness 
spread  rapidly,  until  large  areas  of  skin  were 
involved,  and  danger  to  life  was  imminent.  In 
these,  as  well  as  others  presenting  features  less 
marked,  in  which  the  tendency  to  spread  is  less 
pronounced,  many  local  remedies  have  been  ap- 
plied, with  varying  success,  and  almost  uniform 
reports  as  to  their  efficacy.  This  last  is  perhaps 
due  to  the  fact  that  most  of  the  cases  of  erysipelas 
are  favorably  influenced  by  iron,  given  internally, 
generally  in  the  form  of  the  muriated  tincture,  and 
which  treatment  is  nearly  invariably  pursued. 
A  local  application  which  is  never  mentioned  in 
text-books  or  papers,  at  least  it  has  escaped  our 
notice  if  it  is,  but  which  has  proved  to  be  of  the 
greatest  practical  value  in  one  of  the  large  institu- 
tions of  this  city,  is  the  Fluid  Extract  of  Ergot. 
This  remedy,  which  answers  all  theoretical  as  well 
as  practical  purposes,  has  been  found  to  far  sur- 
pass all  other  local  remedies  in  the  treatment  of 
this  affection  in  this  institution,  at  which  we  had 
an  opportunity  of  seeing  it  constantly  used  for  a 
year,  in  a  ward,  set  apart  for  those  cases,  which 
was  never  vacant.  It  is  painted  on  with  a  brush 
quite  thickly,  and  rapidly  dries,  protecting  the  skin 
from  the  air,  and  besides,  answering  the  theoretical 
purpose  of  contracting  the  gorged  capillaries. 
Success  with  this  procedure  was  so  pronounced 


and  uniform,  that  nothing  was  ever  used  in  its  place, 
the  case  being  treated  with  the  full  confidence  in 
its  powers  to  allay  the  pathological  process  gained 
by  repeated  success.— 6'i'.  Louis  Medical  Review, 


A  good  motto,  "  In  certis  unitas,  in  dubitas 
libertas,  in  omnibus  charitas,"  in  that  which  is 
proven  let  us  have  unity,  in  doubtful  things  let  us 
have  liberty,  in  all  things  let  us  have  charity. 


TO  STOP  TOOTHACHE. 

Gesell-Fels  makes  the  following  mixture,  which 
is  an  oily  liquid,  and  introduced  in  the  tooth 
cavity  has  proved  very  effective  : 

Camphor,  gr.  Ixxv  ; 
Chloral  hydrati,  gr.  Ixxv; 
Cocaini  muriat.,  gr.  xv. 


PRESCRIPTION  FOR  HEADACHE. 
The  following  is  from  Dujardin-Beaumetz  : 

Ethoxycafeine,  gr.  xii ; 
Sodii  salicylat,  gr.  .xv; 
Aquce  destill.,  ad  3  i. 
Dose. — Teaspoonful  or  tablespoonful. 

Thr  Canada  Medical  Rf.cord. 

A  Monthly  Journal  of  Medicine  and  burgery- 

EDITORS  : 

FRANCIS  ",V.  CAMPBELL,   MA.,  M.D.,  L.K.C.P.  LOND. 

Editor  and  Proprietor. 
E.  A.  KENNEDY,  M.A.,  M.D.,  Managing  Editor. 
ASSISTANT  EDITORS: 
CASEY  A.  WOOD,  CM.,  IBD. 
GEORGE  E,  ARMSTRONG,  CM.,  M.D. 

suHSCiiiPTioN  TWO  dollahs  per  anndm. 

All  cotitmunicolioii:^  ajici  J-Uchiiiiffes  7iiust  be  addrf  lifted  to 
the  Editors,  /Jruwer356,  Post  Office,  Montreal. 

MONTREAL,  JULY,  18S7. 


ANNU  A.L  M  FETING  OF  THE  COLLEGE  OF 
PHYSICIANS  AND  SURGEONS  OF  ON- 
TARIO. 

The  annual  meeting  of  the  Council  of  the  above 
body  was  held  in  the  Examination  Hall  of  the 
Ontario  College  of  Pharmacy,  in  this  city,  on  June 
14th  and  following  days.  Dr.  H.  H.  Wright  in 
the  chair.  The  election  resulted  in  the  appoint- 
ment of  Dr.  Henderson  to  the  presidency,  with  Dr. 
Burns,  vice-president.  The  offices  of  registrar  and 
treasurer  were  continued  to  Drs.  Pyne  and  Aikins. 


THE   CANADA    MEDICAL   KECOUD. 


239 


CANADA  MEDICAL  ASSOCIATION. 

This  Association  holds  its  annual  meeting  at 
Hamilton  on  the  last  day  of  August  and  the  ist  of 
September.  We  trust  the  attendance  will  be  large. 
•We  are  glad  to  know  that  notwithstanding  the 
attractions  of  the  International  Medical  Coniixess 
at  \\'ashington  a  (i:\v  days  later,  Montreal  will  be 
fully  and  ably  represented.  We  predict  a  success- 
ful and  a  useful  session. 


INTERNATIONAL  MEDICAL  CONGRESS. 

On  the  5th  of  September,  this  assembly  long 
looked  forward  to,  with  various  feelings,  by  the 
different  sections  of  the  Medical  profession  in  the 
United  States,  will  open  at  Washington.  Notwith- 
standing the  bitter  feelings,  which  have  been  the 
outcome  of  the  division  which  took  place  among 
its  promoters,  in  its  early  l;islory,  the  attendance 
promises  to  be  large,  and  influential — though 
not  so  much  so  as  unanimity  would  have  secured. 
Prominent  men  from  abroad,  and  from  the  United 
States,  whose  presence  was  most  desirable,  will  be 
absent ;  yet,  others,  possibly  as  earnest  workers, 
have  intimated  their  intention  of  taking  part. 
Montreal  will  also  be  well  represented  at  this  Con- 
gress— although  even  here,  the  division,  so  to 
speak,  compels,  as  a  matter  of  propriety,  the 
absence  of  some.  Reduced  rates  are  offered  by 
the  various  railways. 


THE  ENGLISH  COMMLSSION  ON  PA.S- 
TEUR'S  METHOD  OF  PREVENTING  OR 
TREATING  HYDROPHOBIA. 

The  British  Parliamentary  Commission,  which 
has  been  engaged  in  the  study  of  Pasteur's  work 
for  several  years,  has  finally  jjresented  a  report, 
which  expresses  confidence  in  the  truth  of  Pasteur's 
claims  with  regard  (i)  to  the  presence  of  hydro- 
phobia virus  in  the  spinal  cord  of  animals  djing  with 
the  disease,  (2)  to  its  transmissibility  to  other 
animals  by  inoculation,  (3)  to  the  fact  that  animals 
can  thus  be  rendered  refractory  to  subsequent  ino- 
culations, or  even  the  bites  of  rabid  animals.  Fin- 
ally, it  is  highly  probable,  even  after  such  bites 
have  been  inflicted  upon  unprotected  subjects,  that 
subsequent  inoculation  as  practised  by  Pasteur  is 
of  service  in  preventing  thedeveloj)ment  of  the  dis- 
ease. 


The  committee  observe,  "  Making  a  fair  allow- 
ance for  uncertainties  and  other  questions  which 
cannot  now  be  settled,  we  believe  it  sure  that,  ex- 
cluding deaths  after  bites  by  rabid  wolve.s,  the 
proportion  of  deaths  in  the  two  thousand  six  hun- 
dred and  eiglitytwo  persons  bitten  by  other  ani- 
mals was  between  i  and  1.2  percent.,  a  i^roporiion 
far  lower  than  the  lowest  ever  estimated  among 
those  not  submitted  to  M.  Pasteur's  treatment, 
showing,  even  at  this  lowest  estimate,  a  saving  of 
not  less  than  one  hundred  lives." 

The  value  of  M.  Pasteur's  method  is  further 
confirmed  by  the  results  obtained  in  certain  groups 
of  his  cases.  Of  two  hundred  and  thirty-three 
persons  bitten  by  animals  in  which  rabies  was 
]5roved,  either  by  inoculation  from  their  spinal 
cords  or  by  the  occurrence  of  rabies  in  other  ani- 
mals or  persons  bitten  by  them,  only  four  died. 
Without  inoculation  it  is  more  than  probable  that 
at  least  forty  would  have  died.  Further  illustra- 
tion of  this  successful  result  is  shown  among  other 
additional  groups  of  cases.  Between  the  end  of 
last  December  and  the  end  of  March,  M.  Pasteur 
inoculated  five  hundred  and  nine  persons  bitten 
by  animals  proved  to  be  rabid,  either  by  inocula- 
tion from  their  spinal  cords  or  by  the  death  of 
some  of  those  bitten  by  them,  or  as  reported  on 
by  veterinary  surgeons.  Of  this  number  only  two 
have  died.  One  of  these  was  bitten  by  a  wolf  a 
month  before  inoculation,  and  died  after  only  three 
days'  treatment.  If  we  omit  say  one-half  of  these 
cases  as  being  too  recent,  the  other  two  hundred 
and  fifty  have  had  a  mortality  of  less  than  one  per 
cent.,  instead  of  twenty  to  thirty  per  cent. 

"  From  the  evidence  of  all  these  facts,"  the  com- 
mittee then  say,  "we  think  it  certain  that  the 
inoculations  practised  by  Mr.  Pasteur  on  persons 
bitten  by  rabid  animals  have  prevented  the  occur- 
rence of  hydrophobia  in  the  large  proportion  of 
those  who,  if  they  had  not  been  so  inoculated, 
would  have  died  of  that  disease ;  and  we  believe 
that  the  value  of  his  discovery  will  be  found  much 
greater  than  can  be  estiinated  by  its  present  utility, 
for  it  shows  a  method  of  inoculation  by  which  it 
may  be  possible  to  avert  after  infection  other  dis- 
eases besides  hydrophobia.  His  researches  have 
also  added  very  largely  to  the  knowledge  of  this 
disea.se,  and  have  su])plied  what  is  of  the  highest 
practical  value, — namely,  a  sure  means  of  deter- 
mining whether  an  animal  that  has  died  under  a 
suspicion  of  rabies  was  affected  really  with  the 
disease  or  not." 


240 


THE   CANADA   MEDICAL   RECORD. 


BEECHER'S  VOICE  IN  THE  PHONO- 
GRAPH. 

The  Philadelphia  ATedical  and  Surgical  Reporter 
says :  In  the  house  of  Thomas  A.  Edison,  at 
Llewellyn  Park,  is  a  lemarkable  memento  of 
Beecher.  The  inventor's  plionograph  for  impress- 
ing on  a  soft  metal  sheet  the  utterances  of  the 
human  voice,  and  then  emitting  it  again  by  the 
turning  of  a  crank,  has  never  been  put  to  any  very 
valuable  use,  and  Edison  has  only  gathered  from 
it  a  few  thousand  dollars  in  royalties  from  exhibi- 
tors. But  he  utilized  it  to  make  a  collection  of 
famous  voices.  Since  he  became  famous  his  visi- 
tors have  included  hundreds  of  celebrities.  Instead 
of  asking  them  for  their  autographs  or  photo- 
graphs, he  has  in  two  or  three  hundred  instances 
requested  them  to  speak  a  few  sentences 
into  a  phonograph.  He  has  kept  the  plates 
in  a  cabinet,  and  occasionally  he  runs  some  of 
them  through  the  machine,  which  sends  out  the 
words  exactly  as  uttered.  Edison  is  probably  the 
only  man  who  can  revive  the  silenced  voice  of  the 
great  preacher. 


PERSONAL. 

Dr.  Roddick,  Professor  of  Clinical  Surgery  in 
McGill  University,  is  about  to  visit  Europe  for  the 
benefit  of  his  health. 

Dr.  George  Ross,  Professor  of  Clinical  Medicine 
in  McGill  University,  whose  illness  we  mentioned 
some  two  months  ago,  is  now  at  Rye  Beach.  His 
numerous  friends  will  be  pleased  to  know  that  he 
continues  steadily  to  improve,  and  that  there  is 
every  probability  that  by  September  he  will  be  so 
completely  recovered,  as  to  justify  him  in  resuming 
active  work. 

Dr.  Steding  (M.D.),  Edinburgh,  has  settled  in 
Montreal  as  an  Oculist. 

Dr.  Apostoli,  the  celebrated  French  Gynecolo- 
gist, is,  we  learn,  to  pay  Montreal  a  visit  while  en 
route  to  the  International  Congress  at  Washing- 
ton. Dr.  A.  Lapthorn  Smith,  of  the  Faculty  of 
Medicine  of  Bishops'  College,  has  been  engaged  by 
Dr.  Apostoli  to  translate  his  forthcoming  work 
into  the  English  language. 

Dr.  Laberge,  the  .Montreal  Health  officer,  is 
undergoing  a  kind  of  periodical  castigation  at  the 
present  time.  His  treatment  is  rather  harsh,  and 
while,  perhaps,  not  faultless,  he  has  not  been  the 
listless  idler  his  opponents  would  like  to  make 
him  out. 


REVIEW. 

A    Practical    Treatise   on    Obstetrics.     In   four 
volumes.  Vol.  I,  Anatomy  of  the  Internal  and 
External    Genitals,    Physiological    Phenomena 
(Menstruation  and  Fecundation).  Vol.  II,  The 
Pathology  of  Pregnancy.  Vol.  Ill,  The  Patho-. 
logy  of  Labor.  Vol.  IV,  Obstetric  Operations, 
The    Pathology   of  the    Puerperium.       By   A. 
Charpentier,    M.D.,    Paris.       Illustrated    with 
lithographic  plates  and  wood  engravings.  These 
are  Vols.  I,  II,  III  and  IV  of  tlie  •'  Cyclopedia 
of  Obstetrics  and  Gynecology"  (12  volumes), 
issued  monthly   during   1887.  New  York;  Wm. 
Wood  &  Co.    Price  of  the  set  §16.50. 
We  congratulate  the  editor  and  publishers  on 
the  selection  of  Charpentier's  work  to  represent 
the  obstetric  portion  of  their  Cyclopedia.      The 
editor,  Dr.  E.  H.  Grandin,  has  assuredly  done  his 
work  well,  and,   in  giving  the  book   an   English 
dress,  has  very   properly  placed  in   brackets  the 
views   held  by  the    profession  here,  where  they 
differed  materially   from  the  French  text.     An  ex- 
ample of  this  may  be  found  in  the  chapter  contain- 
ing a  description  of  the  third  stage  of  labor.     Dr. 
Charpentier  advises   traction  on  the  cord,  giving 
minute  details  as  to  the  direction,  etc.     Dr.  Gran- 
din adds  a  description   of  Crede's    method,  and 
very  properly  adds  that  it  is  the  accepted  practice 
in    this   country.     In   another   part  of  the  work, 
however,  we  think  the  text  could  have  been  im- 
proved upon  by  making  the  positions  of  the  child 
in  delivery  correspond  to  that  usually   given  by 
English  and  American  authors. 

There  is  nothing  more  confusing  to  the  student 
of  medicine  than  to  find  that  every  obstetrical  work 
he  picks  up  gives  different  names  to  the  different 
positions.  When  there  is  no  special  advantage  to 
be  derived  from  any  special  nomenclature,  we  cer- 
tainly ought  to  try  to  confine  ourselves  to  one  for 
the  sake  of  simplicity. 

Volume  four  completes  Charpentier's  great  work, 
and  gives  us  the  most  interesting  part  of  all.  Tlie 
variety  of  forceps  described  is  very  large,  from  the 
original  one  of  the  Chamberlen's  to  the  latest 
modification  of  Tarnier's.  All  the  obstetric  opera- 
tions are  minutely  described  and  profusely  illus- 
trated, but  the  wood-cuts  are  not  as  distinct  as  they 
might  have  been ;  this,  no  doubt,  being  due  to  the 
small  cost  of  the  work,  so  as  to  bring  the  price  1 
within  the  reach  of  ail  practitioners.  Puerperal 
fever  is  regarded  as  merely  puerperal  septicaemia, 
and  the  author  is  an  extreme  advocate  of  antiseptic 
obstetrics,  including  the  post  partum  vaginal 
injections  in  all  cases.  The  rest  of  the  book  is 
admirable,  especially  the  chapters  on  dystocia. 
The  work  is  one  intended  more  for  the  use  of  prac 
'  titioners  than  for  students. 


THE'  CANADA'  MEDlCAb  RECORD. 


Vol.   XV. 


MONTREAL,    AUGUST,    1887. 


No.  11. 


COnSTTEItTTS. 


ORIGINAL  COMMUNICATIONS. 

All  Timsiial  (';isn  ol   |t;pilc[isy -11 

A  Word  or  Two  on  lln-  Trt^ntinntl  of 
Acute  roriloiiiiiM,  with  a  (.'oiiblc  of 

C'HSf)*  in  llltisIrHtion '242 

COHKKSpONKKNri'; ... ?  l.f 

PROGRESS  OF  SCIENCE. 

Constip;ilion. 243 

Sonu'  Toiiilsi  in  Minor  Surgery  at  the 

lVnn>ylvftni.'t  Hospital 24(5 

Catarrhal  I'lithiKiB  248 

Minor  Surgery  at  the  Chainbera  Street 

Hranih  I'l  thi' Now  York  Hospital.  251 
The  Trtatinent  of  Ccldii 253 


Tn-atnii-nt  of  l';r\,'tip"las   2W 

un    tilt'    Tre:itnit''nl,    of    I'lenrisy   with 

KduHi-.n  of  Ha.v'B  Method 255 

The  IMnrelie  Action  of  Mercurial  I're- 

parationti 2i7 

Nutrient  Kneniata 258 

Hydro<!yanate    of  Iron    in   the  Treat- 
ment of  Kpllepsy  and  Xeural)j;ias..  258 

KinKWorm 250 

Nhw  Kenioily  for  Cystitis 263 

Tn'atnientot  TrolapsusAni  in  Infants.  251? 
Absorption    from    the    Mucous    Mem- 
brane of  Ih  »  L^rinary  Bl  dder 200 

Treatment  of  Nocturnal  Enuresis 2)i0 

Venesection  iu  Puerperal  iCclaiupeta..  260 


Pcrnuni-ianalr    of    Pota^iHiuin     in    th« 

Trealirierit  of  KfZtUMi. 261 

On  Notrhf.*;  in  the  Upper  Central  In- 
riRor  Teeth  which  Resemble  those 
of  Syphilis 261 

Treatment  of  Nlght-SweHts  with  Phoft- 
of  Lime. 262 

A  Case  of  Kxtraordinary  Fecundity 262 

EDITORIAL 

ChronieLarynt^ilis  and  its  Sequelse  —  262 

Stooping  Forward  263 

An  Unhappy  Mistake 264 

Washing  *Jut  the  Stomach 264 

LiTEiiAHY  Note 264 


AN  UNUSUAL  CASE  OF  EPILEPSY. 

By  Casky  a  Wood  CM.,  M.S.,  Professor  of  Pathology, 
University  of  Bishop's  College. 
[Read  before  the  Montreal  Medico-Chirurgical  Society.] 

Some  years  ago  Dr.  Wm.  Osier  read  a  paper  in 
this  room  in  which  he  spoive  of  a  case  of  Jacksonian 
Epilepsy.  He  was  fortiniate  euough  to  be  able  to 
show  the  brain  of  the  subject  and  the  cortical 
growth  (a  small  glioma)  wjiich  gave  rise  to  the 
epileptiform  seizures.  I  am  unable  to  demonstrate 
the  actual  existence  of  any  disease  within  or  about 
the  motor  zone  of  the  patient  about  which  I  am  go. 
ing  to  speak,  because  he  is  still  alive,  but  I  thought 
it  might  be  interesting  to  introduce  for  discussion 
here,  by  detailing  such  a  case,  the  whole  subject 
of  false  (now-hysterical)  epilepsy.  The  subject  of 
epileptic  aurea  and  the  modes  of  onset  in  epilepsy 
has  always  been  an  attractive  one  to  me,  and  I 
would  like  to  hear  from  members  of  this  society  in 
this  connection. 

Until  18  months  ago,  E.  B.,  aged  70,  was  in  fair 
health.  Had  never  had  syphilis  but  now  suffers 
and  has  suffered  at  times  for  many  years  from 
rheimiatic  gout,  the  great  toe  of  right  foot  being 
the  chief  seat  of  the  trouble.  Has  occasionally  had 
pains  which  were  set  down  as  rheumatism  in  several 
other  joints  of  his  body;  but  has  never  been  laid  up 
with  them.  Has  never  suffered  from  persistant 
headache ;  never  had  any  injury  to  his  head,  and 
his  intellectual  faculties  are  well  preserved.  There 
is  no  history  of  family  neuroses.  His  digestion  is 
fair  and  his  heart  and  kidneys  are  in  normal  condi- 


tion. He  had  his  first  attack  18  months  ago,  and 
the  half  dozen  attacks  which  he  has  had  since  then 
are  similar  to  that  one,  only  they  seem  to  be  get- 
ting worse.  He  first  noticed  twitching  of  the  mus- 
cles of  the  left  forearm  and  face.  These  twitchings 
increased  its  violence, and  although  he  made  efforts 
to  control  them  they  went  on  getting  worse.  He 
then  began  to  experience  feelings  of  fear  as  of  im- 
pending danger,  and  in  about  a  quarter  of  an  hour 
after  the  first  muscular  contraction  he  thinks  he 
became  unconscious  for  a  few  moments,  but  is  not 
certain  of  it.  In  half  an  hour  the  whole  attack 
was  over,  and  with  the  e.xeeption  of  a  feeling  of 
weakness  in  the  arm  he  was  all  right  again. 

He  has  hud  since  then,  but  at  no  regular  interval, 
some  half  dozen  attacks,  varying  little  in  character 
from  the  first  one.  Nearly  every  attack  has  been 
witnessed  by  his  fellow  workmen  or  his  wife,  and  I 
have  been  able  to  get  a  pretty  fair  account  of  them. 
The  loss  of  consciousness  lasts  but  a  few  moments. 

Sometimes  he  has  had  what  he  calls  double 
attacks.  That  is,  he  will  have  a  second  attack  a 
few  minutes  after  the  first,  which  is  not  as  severe 
as  the  first  and  is  not  accompanied  by  uncon- 
sciousness. He  knows  when  he  is  going  to  have 
an  attack,  and  will  grasp  his  left  wrist  in  his  right 
hand  and  do  his  best  to  prevent  the  spasm  from 
getting  worse  or  from  attacking  his  face.  I  saw 
the  latter  half  of  one  of  these  attacks  which  he  de- 
clares he  can  bring  on  at  will,  or  rather  (because 
the  man  suffers  much  from  the  dread  of  approach- 
ing danger  which  accompanies  the  attack)  he 
thinks  that  where  he  has  a  second  attack  it  is  due 
to  ]Hitting  the  arm  or  his  body  in  some  un- 
comfortable position.     I  was  talking  to  him  one 


242 


THE   CANADA   MEDICAL   RECORD. 


day  (having  reached  the  house  shortly  after  a 
sei2ure)  when  he  said  "There,  I  am  going  to  have 
another  attack."  He  grasped  his  left  wrist  firm- 
ly, but  jerking  began  in  the  arm,  the  muscles  of 
the  upper  arm  being  most  affected.  This  was 
shortly  followed  by  twitching  in  the  other  muscles 
of  the  arm,  all  growing  worse,  until  the  forearm 
became  flexed  upon  the  upper  arm.  Then  the 
muscles  of  the  face  began  to  twitch  and  both  sides 
seemed  affected  just  as  in  true  epilepsy.  The 
man  meantime  made  violent  efforts  to  control  the 
spasms,  and  called  to  his  wife  to  prevent  the  flexion 
of  the  forearm.  She  succeeded  in  straightening  it 
with  some  difliculty.  In  five  minutes  the  attack 
was  over  and  I  am  unable  to  say  whether  he  was 
unconscious  or  not. 

For  several  days  afterwards  he  complained  of 
weakness  in  the  affected  arm.  The  spasm  in  this 
instance  and  in  every  other  attack  was  distinctly 
confined  to  the  left  arm  and  face,  beginning  first 
in  the  arm  and  extending  to  the  facial  muscles. 
Without  the  dynaomometer  test,  the  grasp  of  the 
left  hand  several  days  after  an  attack  appears  to 
be  as  firm  as  that  of  the  right.  I  do  not  know 
why  It  should  be  so,  but  the  jiatellar  tendon  refle.x 
is  wanting  in  the  left  leg  and  is  faint  in  the  right 
side.  The  only  doubt  it  appears  to  me,  in  the 
diagnosis  of  this  case  as  one  of  Jacksonian  epil- 
epsy, or  in  other  words  of  disease  affecting  the 
face  and  arm  centres  about  the  fissure  of  Rolando 
is  that  matter  of  loss  of  consciousness.  It 
seems  to  me  however  that  the  tonic  muscular 
contractions  confined  to  such  related  groujis  of 
niu.scles  as  those  of  the  arm  and  face,  the  gradual 
onset,  the  loss  of  consciousness  if  at  all  but  very 
slight  and  coming  on  near  the  end  of  the  attack, 
after  the  patient  has  been  able  to  make  vain  but 
intelligent  efi"orts  to  prevent  the  involvement  of  the 
other  arm  and  facial  muscles,  the  absence  of  any 
history  of  his  falling  down,  all  these  point  to  a  local 
brain  lesion  and  not  to  true  epilepsy.  There  was 
no  paralysis  in  this  case  not  any  tonic  contractions 
of  the  muscles,  although  the  patient  complains  of 
weakness  in  the  arm  for  a  day  or  two  after  an 
attack.  One  must  conclude  that  there  is  no  actual 
destruction  of  the  cortea  within  the  motor  area,  but 
that  some  growth  or  induration  in  a  situation  out- 
side of  it  irritates,  upon  occasions,  the  centres  that 
preside  over  the  fiice  and  arm  muscles. 

In  Dr.  Osier's  case  there  was   a   long   standing 
contraction  of  the  right  foot. 

Regarding  the  treatment   of  tljis   case  he   has 


been  taking,  for  several  months,  5  grs.  of  potassic 
iodide,  10  grs.  of  potassic  bromide  and  15  grs.  of 
j)otassic  bicarbonite,3  times  a  day  on  alternate  days, 
and  so  far  he  has  been  free  from  attacks.  I  am 
watching  the  case  and  awaiting  developments. 
Thinking  for  obvious  reasons,  that  it  was  advisable 
to  have  his  eyes  examined  1  sent  him  to  Dr.  Proud- 
foot,  and  I  conclude  with  his  report  : 

"  I  send  you  the  following  notes  of  E.  B's.  case. 
I  am  sorry  he  could  not  come  to  see  me  again  as  I 
wish  to  examine  his  color  perception  and  visual 
powers  which  I  could  not  do  before. 

"  At  the  time  I  examined  him  I  found  the  humors 
of  the  eye  perfectly  transparent  and  nothing  abnor- 
mal, with  the  exception  of  the  "disc"  which  was 
somewhat  greyish  in  color,  and  there  were  two  or 
Miree  small  collections  of  pigment  at  the  upper  and 
outer  margin  ;  and  a  narrow  atrophic  ring  extend- 
ing romid  the  lower  and  inner  third,  with  a  slight 
depression  of  the  vessel  in  that  region. 

"  There  was  no  hyperoemia  or  other  evidence  of 
any  very  recent  trouble,  and  the  patient  informed 
mc  that  his  sight  was  as  good  then  as  it  had  been 
for  some  time  back." 


A  WORD  OR  TWO  ON  THE  TREATMENT 
OF    ACUTE  PERITONITIS.    WITH  A 
COUPLE  OF  CASES  IN  ILLUSTRA- 
TION. 
By  a.  D.  Stevens,  M.D.,   iHinliam,  Quebec. 
It  IS  not  necessarily   the   rare  and   obscure    in 
practice  that  possess  the  most  interest  to  the  class 
of  men  who  read  journals  like  your  own.     When 
a  point  can  be  emphasized — even  a  well  known 
one — it  is  well  to  do  so.   With  this  end  in  view,  I 
send  a  condensed  account  of  treatment  of  a  couple 
of  cases  of  typical  acute  peritonitis. 

G.  W.,  aged  about  40  years,  of  robust  constitu- 
tion, and  carpenter  by  trade,  fell  ill  on  the  22nd 
of  January  last,  from  exposure  to  cold,  while 
working  upon  the  outside  of  a  building.  Two  days 
later,  symptoms  of  acute  peritonitis  developed.  I 
gave  him  a  few  giains  of  hyd.  c.  creta  and  a  saline 
cathartic,  whicii  emptied  the  bowels.  The  next 
day  the  increased  tenderness  of  the  abdomen,  the 
tvmpanites,  the  elevated  temperature  and  otiier 
well  known  indications  more  fully  confirmed  the 
di.ignosis.  Fiom  30  to  50  drojis  of  tinct.  of  opium 
(^accoiding  as  could  be  tolcialed)  were  then 
ordered  him  every  three  hours,  and  turpentine 
stupes  to  be  freely  applied  to  the  abdomen.  Al- 
though the  stomach  was  irritable,  he  managed  tQ, 


THE   CANADA    MEDICAL   RECORD. 


243 


kcc]5  down  more  or  less  iced  milk  and  water.  This, 
witlioiit  intfrruptioii,  constituted  liis  treatment 
until  the  seventeenth  day  from  the  date  of  my 
attendance,  and  during  the  whole  time,  he  had  no 
movement  of  the  bowels.  On  that  day,  the  indanv 
mation  having  to  a  certain  extent  subsided,  I  gave 
him  an  enema  of  lukewarm  water,  secured  an  eva- 
cuation of  the  intestinal  tract,  increased  the  quan- 
tity and  f|uaiity  of  food,  and  again  locked  up  the 
bowels  with  the  tinct.  opii  for  four  days  more.  At 
the  end  of  that  time,  the  exceedingly  tense,  painful 
and  tympanitic  abdomen,  having  to  a  still  larger 
extent  given  way,  another  enema  was  ordered, — 
l)Ul  here  my  patient  and  1  parted  comi)any,  but 
not  before  I  had  left  him  a  couple  of  ounces  of 
laudanum  to  be  used  as  he  might  require,  and 
directions  in  general  as  to  future  management.  It 
'Was  midwinter,  fearfully  cold,  and  the  home  of  the 
patient  in  a  mountainous,  snowy  locality,  and  we 
did  not  meet  again  until  he  turned  up  at  my  place 
two  months  later,  all  right,  with  the  cxcejition  of 
a  swelled  or  oedematous  leg,  which  1  attributed  to 
a  i)hlebitis  occurring  subsequent  to  my  leaving  him. 
In  April  last,  O.  S.,  aged  thirteen  years,  of 
healthy  parentage  and  himself  likewise  healthy, 
went,  with  several  boys,  to  a  neighboriaig  sugar 
bush  to  get  some  warm  sugar  and  enjoy  themselves 
generally.  After  satisfying  their  api>etites  for  new 
maple  sugar,  and  to  carry  out  the  ])r<:M;ramme,  they 
all  took  off  their  booti,  and  went  home  bare-footed 
through  the  snow.  'J'he  next  day  the  hero  of  my 
tale  became  sick,  and  luckily  the  parents  gave 
him  a  cathartic — on  the  day  following  I  had  no 
trouble  in  diagnosing  acute  peritonitis.  As  the 
bowels  had  been  previously  well  opened,  I  gave 
the  little  fellow  a  half  dozen  grains  lijd.  c.  creta 
and  fifteen  drops  tinct.  opii,  the  latter  to  be  given, 
more  or  less,  according  to  the  effect,  every  three 
hours.  This  (the  laudanum),  with  turpentine 
stupes,  was  all  the  medication  he  received  until 
the  sixteenth  day,  when  it  was  found  that  the  in- 
flammation had  sufficiently  given  way  to  warrant 
an  enema,  which  jiroduccd  the  first  movement  of 
the  bowels  he  had  had  during  the  whole  fifteen  or 
sixteen  days.  The  case  went  on  well  enough  for 
a  short  time,  when  a  sort  of  relajise  set  in,  accom- 
panied by  typhoid  or  adynamic  symptoms.  These, 
however,  after  many  "  ups  and  downs  "  yielded 
to  quinine,  opium,  brandy,  milk  and  the  like.  To- 
day he  is  as  well  as  any  boy  in  this  Township.  It 
will  be  observed,  by  the  foregoing,  that  I  kept  the 
first  patient's  bowels  continuously  quiet  and  locked 


up  for  seventeen  days,  and  the  last  one  for  fifteen 
days.  In  my  judgment,  if,  at  any  time  during 
these  anxious  days,  I  had  yielded  to  the  urgent 
solicitations  of  friends  and  given  even  the  mildest 
enema  there  would  have  been  just  two  persons  less 
now  living  in  this  community,  and  that  is  really 
all  the  point  I  wish  to  draw  attention  to. 

If  called  early  enough,  empty  the  jirima  via. 
with  a  mercurial  laxative,  and  then  shut  down 
closely  and  persistently  with  tinct.  opii  (not  mor- 
jjhia)  until  the  inflammation  subsides.  If  the 
jiatient  is  not  seen  soon  enough,  don't  give  even 
the  mildest  laxative  at  first,  but  close  uj)  at  once 
and  k('cp  unflinchingly  closed  up  until  that  time 
arrives,  no  matter  how  long  the  subsidence  may  be 
in  coming.  The  important  fact  intended  to  be 
made  prominent  herein  may  or  not  be  an  old  story, 
but,  according  to  my  observations,  the  oftener  it 
is  reiieated  the  better  for  all  concerned.  The 
patients  will  certainly  not  all  die  of  this  dangerous 
inflammation,  if  the  extensive  and  roughened 
peritoneal  surfaces  are  «<?/ disturbed  by  cathartics, 
or  other  means,  from  the  very  time  the  inflamma- 
tion sets  in,  to  the  time  of  yielding. 

Winnipeg,  Man.,  Aug.  15th,  1887. 
To  the  Editor  of  the  CANADA  Medical  Record. 

Dear  Sir, — In  your  July  number,  page  238,  I 
observe  an  article  from  the  St.  Louis  Medical  Re- 
view, on  "  Fluid  Extract  of  Ergot "  as  a  local 
application  in  "  Spreading  Erysipelas." 

A  few  days  ago  I  had  a  case  in  the  Fort  under 
my  charge,  which  was  Erysipelas  of  the  foot  and 
rapidly  extending  up  the  leg.  I  used  Fluid 
"  Extract  of  Ergot,"  jjainting  the  foot  and  leg 
thoroughly  and  administered  Tinct  Ferri.  M  x  x 
ter  die  internally.  In  twenty-four  hours  after  the 
apjilication  I  was  considerably  surprised  to  find  my 
patient's  fool  free  from  pain,  swelling  and  arrest  of 
the  extending  inflammation.  He  expressed  great 
relief  and  desired  to  return  to  duty,  this  I  decline^ 
to  allow  him.  I  repeated  the  application  of  Ergot 
four  times,  covering  the  leg  with  cotton  wopl.  On 
the  fourth  day  from  the  outset  of  the  inflammatiori 
he  returned  to  duty  cured.  It  would  be  interesting 
to  hear  from  others  more  of  the  results  of  this 
treatment  ifl  Erysipelas. 

Yours,  etc.,  Alfred  Codd,  M.D.,  C.M- 
Surgeon,  R.  S.  M.  Jn/antr^,  Winnipeg, 


244 


THE   CANADA   MEDICAL   RECORD. 


J^pQ^'dS  of  Sdeme. 

CONSTIPATION, 

By  J.    MlLNER   FOTHERGIIX,   M.    D.,   EDINBURGH, 
Physician  to  the  City  of  London  Hospital  for  Diseases 
of  the  Chest  (Victoria  Park). 

In  the  constant  round  of  daily  practice  the  phy- 
sician commonly  encounters  cases  where  the  bowels 
are  not  properly  open.  Both  sexes  and  all  ages 
are  liable  to  this  imdesirable  condition.  Frequently 
the  constipation  is  very  obstinate,  and  refuses  to 
yield  to  the  measures  employed  ;  or,  in  other  cases, 
is  only  kept  at  bay  by  the  constant  resort  to 
laxatives  or  even  cathartics. 

The  bowel  is  not  only  the  recipient  of  the  waste 
and  undigestible  matters  of  our  food,  but  has  its 
own  glands,  which  are  not  all  absorbent.  Whether 
the  offensive  odor  of  the  fteces  is  due  to  mere 
fermentive  or  putrefactive  change  in  the  contents 
of  the  lower  bowel,  or  the  glands  situated  thereon 
lend  some  of  the  fcetor,  it  may  not  be  easy  to 
perfectly  determine  :  but  any  one  familiar  with 
obstetrics  knows  how,  when  the  fcetal  head  is 
distending  the  perineum,  the  glands  situated  near 
the  anus  can  be  distinctly  felt  like  so  many  small 
shot,  and  their  secretion  is  as  offensive  as  it  is 
difficult  to  reinove-from  the  hands.  The  e,\creta 
possess  an  offensive  odor  which  secures  their 
disposal,  and  thus  one  good  sanitary  end  is  served 
Dy  the  unsavory  secretions  of  these  glands.  These 
glands  serve  to  lubricate  the  mucous  lining  of  the 
intestine  and  thus  expedite  the  passage  over  it  of 
the  contents  of  the  bowel. 

Any  loss  of  activity  in  the  muscular  movements 
cf  the  intestine  will  favor  the  tendency  to  a  consti- 
pated condition.  This  is  met  with  at  all  stages  of 
life,  but  perhaps  it  is  rriost  markedly  seen  in  the  case 
of  young  females.  A  natural  delicacy  impels  them 
to  avoid  the  proximity  of  the  closet,  and  gradually 
the  bowels  are  taught  to  carry  a  greater  and 
accumulating  load.  The  pouches  of  the  bowel 
become  distended,  and  the  feces  which  ]iass  them 
are  alone  voided,  and  are  of  more  or  less  flmd 
consistency;  so  that  a  girl  may  believe  her  bowels 
open,  or  even  think  herself  the  subject  of  looseness 
of  the  bowels,  when  in  reality  her  abdomen  is 
filled  with  fajces.  One  ontoward  result  of  such 
chronic  constipation  in  young  girls  is  disjilacement 
downwards  of  the  ovaries,  and  these  organs  may 
become  glued  down  to  their  new  habitant  by  adhe- 
sive inflammation.  Two  unfortunate  outcomes  of  this 
displacement  of  the  ovaries  are  (i)  sterility,  and 
(2)  irritable  ovary.  The  most  marked  case  of 
this  kind  which  ever  came  under  my  notice  was 
that  of  an  American  lady.  For  the  sterility  of 
course  nothing  could  be  done,  the  ova  being  hope- 
lessly beyond  the  reach  of  the  fertilizing  zoosperms. 
For  the  irritable  tender  ovaries  something  could 
be  done,  but  the  effects  of  treatment  were  so  little 
satisfactory  that  the  removal  of  the  offending  and 
useless  organs  was  discussed. 


Such  a  condition  of  chronic  overloading  of  the 
bowels  is  furthered  by  the  lack  of  bodily  exercise 
during  school-life.  The  school-girl  is  busy  with 
her  lessons  and  absorbed  in  lier  work  ;  she  scarcely 
gives  a  thought  to  her  bowels,  and  perha|)s  is 
rather  glad  that  they  do  fiot  force  themselves  upon 
her  attention.  The  resultant  consequences  are 
that  the  large  bowel  becomes  distended,  while  the 
muscular  fibres  become  attenuated,  and  the  bowel 
becomes  incapable  of  properly  unloading  itself 
when  the  opportunity  is  offered.  The  uterus  is 
forced  down  upon  the  floor  of  the  pelvis,  and,  as 
we  have  seen,  the  ovaries  may  be  dis|)iaced.  Until 
physiological  aspirations  arouse  the  idea  of  matri- 
mony, and  a  marriageable  age  is  reached,  little 
attention  is  given  to  the  physical  state  ;  and  then 
a  confirmed  condition  is  discovered  and  one 
requiring  considerable  attention  and  trouble  for 
its  removal. 

In  selecting  remedial  agents,  the  choice  must  be 
guided  by  the  precise  requirements  of  the  morbid 
condition.  To  restore  the  muscular  activity  is  as 
important  as  to  excite  the  secretion  of  the  intestinal 
glands.  The  ordinary  catharsis  does  both,  and 
so  sweeps  the  contents  of  the  bowels  out  by  the 
anus.  But  every  physician  of  experience  knows 
well  that  the  recurrent  resort  to  active  purgation 
gives  about  as  imsatisfactory  results  as  well  could 
be  attained.  In  the  first  place  women  of  all  ages 
bear  active  jjurgation  very  badly.  The  griping 
pains  are  ill  borne  and  depress  very  acutely.  When 
the  bowels  are  cleared  out  by  a  violent  action  the 
process  of  loading  u]3  again  sets  in  immediately, 
and  another  catharsis  is  soon  required  with  all  its 
attendant  discomfort.  In  this  respect  women  are 
closely  approximated  by  men  of  feminine  type. 
Active  purgation  is  only  well  tolerated  by  robust 
persons.  In  others  it  shotild  only  be  adopted 
when  there  is  some  distinct  end  to  be  served  by 
it. 

An  occasional  clearance  of  the  bowels  may  be 
desirable  ;  but  the  treatment  should  consist  of  a 
small  amount  of  laxative  materials,  taken  with 
perfect  regularity,  persistently  and  steadily.  Two 
classes  of  laxative  agents  present  themselves  for 
notice  :  these  are  vegetable  substances  and  miner- 
al substances.  P'requcitly  they  can  be  combined 
with  advantage.  For  women  the  vegatable  laxa- 
tives are  best.  As  compared  to  men  they  do  not  . 
bear  well  mineral  purgatives,  whether  as  natural 
waters  or  artificial  solutions.  Fortunately  veget- 
able extract.s  readily  lend  themselves  to  pill  form. 
The  first  laxative  to  come  into  general  use  was 
rhubarb.  But  unfortunately  rhubarb  has  a  second- 
ary binding'  tendency  following  the  primary 
purgative  action.  Thus,  it  is  tmsuitable  for  habi- 
tual use,  though  this  action  gives  it  a  peculiar 
value  when  the  bowels  are  to  be  unloaded  previous 
to  an  opcraiion  on  any  of  the  contents  of  the  pelvis.. 
(In  cases  of  dianhfjua  set  up  by  a  railway  journey 
such  use  of  rhubarb  is  most  excellent.)  The 
persons  who  adopt  rhubarb  for  the  relief  of  habi- 
,  tual  conslipatjou  are  not  likely  ever  to  be  cured. 


THE  CANADA   MEDICAL  RECORD. 


245 


It  has  fallen  to  my  lot  to  see  such  a  case  quickly 
relieved  by  siibstiluling  for  the  rhuharl)  some  other 
lax.itive.  Next  in  rrei|ueiu;y  of  resort  is  aloes. 
Aloes  acting  upon  the  lower  portion  of  the  bowels 
is  in  great  vogue  in  constipation  linked  with 
anienorrluea  (partial  or  complete).  In  conse- 
(luenee  of  this  localized  action  aloes  in  tiill  doses 
are  not  exhibiietl  in  |)regnancy,  except  from  igno 
ranee  or  criminal  intent.  I'brdyce  Jkirker  sees  a 
certain  utility  in  this  localized  at:tion,  and  has  from 
experience  found  that  the  stimulent  action  of  aloes 
upon  the  area  supplied  by  the  hemorrhoidal  arteries 
is  good  in  the  piles  of  pregnancy.  Certainly  the  use 
of  aloes  in  small  doses,  in  comliination  with  other 
laxatives,  is  rational  practice.  A  certain  anmunt 
cif  aloes  should  furm  a  factor  in  the  remedial  agents 
employed  in  all  forms  of  constipation  in  women, 
whether  pregnant  or  not. 

'I'hen,  beyond  these  two  familiar  laxatives,  a 
host  of  others,  which  are  more  or  less  in  use. 
Colocynth,  gamboge,  jalap,  scammony,  cascara 
sagrada,  are  perhaps  those  most  in  vogue.  Castor- 
oil  is  rarely  resorted  to  for  constant  use  ;  while 
croton-oil  might  be  more  prescribed  than  is  at 
present  the  case  with  advantage. 

One  matter,  especially  with  female  ]jaticnts, 
must  never  be  forgotten,  and  that  is  to  dmunish  as 
far  as  possible  the  griping  ])ains  which  activity 
in  the  muscular  hbre  of  the  uitestine  sets  up.  When 
the  vermicular  action  is  roused,  violent  contraction 
produces  a  grijiing  pain  very  commonly  ;  yet  the 
muscular  activity  is  essential  to  cure.  To  prevent 
this  griping  it  is  usual  to  add  carminatives  to  the 
laxati\es;  black  pepper,  cayenne,  and  the  essential 
oils  all  possess  the  property  of  taking  away  to  a 
great  extent  these  painful  contractions,  and  so  can' 
be  incorporated  in  the  pill  with  advantage.  One 
point  must  be  borne  in  mind  about  the  griping 
pains  produced  by  the  exhibition  of  laxative 
medicines,  and  it  is  this:  griping  may  be  due  to 
violent  contractions  of  the  muscular  fibre,  which, 
however,  may  be  ineffectual;  and  then  the  remedy 
is  to  increase  the  dose,  when  effectual  efforts  bring 
with  them  the  desired  relief.  When  the  patient 
complains  of  griping  pains  it  becomes  necessary 
to  ascertain  whether  the  bowels  are  freely  open  or 
not ;  if  not,  a  larger  dose  must  be  given.  But  if 
the  bowels  are  freely  open  then  the  dose  may 
probably  be  reduced  with  advantage. 

In  order  to  secure  more  energetic  action  in  the 
muscular  fibre  of  the  intestine,  it  has  become  usual 
to  add  a  little  strychnia  to  the  habitual  laxative ; 
and  a  very  good  practice  it  is.  The  steady  use  of 
such  a  compound  pill  will  be  found  in  time  to  put 
the  bowels  in  a  more  desirable  condition.  But — 
in  my  experience  at  least — persons  who  suffer  with 
habitual  constipation  lack  pterseverance.  They 
either  contrive  to  forget  their  medicine,  or  they 
give  it  up  as  soon  as  they  are  partially- relieved, 
and  do  not  continue  it  (in  lessened  doses)  until 
the  new  order  of  things  is  firmly  established.  And 
if  the  palate  is  offended  by  the  medicine,  abandon- 
ment of  it  prematurely  is  almost  certain  to  happen. 


Conseriuently  humanity  has  declared  for  pills  as 
the  form  of  remedy /ij/-  excellencem  constipation. 

A  good  cornbinatiim  would  be  provided  by 
something  of  this  kind  lor  hal)itual  use  : 

Slr)i  hnix  .  .  .  .    gr.  i. 

Pulv.  aloes  .  .  .  .  3  i 
I'ulv.  piper,  nig.  ,  .  .  3  i- 
Kxt.  cascara  sagrag.         .         .     3i.j. 

In  pil.  xxiv  div.  i  bis.  in  die. 

\\  hen  the  bowels  have  become  more  regular, 
tlu  n  mstead  of  a  pill  night  and  mornnig.  one  at 
bedtime  alone  would  be  sufficient ;  and  al"ter  a 
time  the  pill  might  be  given  u|)  entirely,  having 
Inlfillrcl  its  purpose.  If  something  more  [lotent  is 
rei|iiiu(l,  then  half  a  dra(  hm  of  croton-oil  may  be 
added  to  the  pill  mass. 

.Some  practitioners  are  fond  of  giving  hyoscyamus 
to  relieve  griping. 

\\  here  the  condition  is  not  very  pronounced  a 
laxative  pill  at  bed  time  once  or  twice  a  week  is 
sufficient.  Where  the  patient  is  of  a  rheumatic 
nature,  or  there  arc  dejiosits  in  the  urine,  it  is 
well  to  add  a  mercurial  to  the  laxative.  Something 
of  this  kind  would  be  found  serviceable  : 
Calomel  .  .  .  .      3i 

Ext.  hyoscyami  .  .  .  3iss 
Pil.  coloc.  CO.         .         .         .      3i 

In  pil.  xii  div.  i  p.  r.  n. 

When  such  a  pill  is  found  not  quite  potent 
enough,  it  may  be  well  to  assist  its  action  by  a 
draught  of  cold  water  on  getting  out  of  bed  next 
morning— often  itself  very  efficacious.  Or  some 
form  of  purgative  water  may  be  preferred,  or  a 
seidlitz  powder,  or  some  effervescing  preparation, 
of  which  the  name  is  legion. 

If  one  line  of  attack  fails,  then  try  another.  Some 
victims  to  constipation  try  a  variety  of  compounds 
before  they  find  what  diey  desire.  In  one  case  it 
is  a  proprietary  medicine,  in  another  an  orthodox 
prescription.  One  old  lady  who  for  half  a  century 
had  been  in  search  of  a  remedy  paid  me  the  com- 
pliment of  asking  me  what  I  could  suggest.  It 
was  in  my  early  days,  and  the  range  of  my  know- 
ledge was  limited,  but  I  hazarded  the  suggestion 
that  a  draught  of  cold  water  on  rising  often  proved 
a  very  good  remedy.  She  adopted  the  suggestion 
with  the  most  satisfactory  results,  and  prophesied 
a  career  of  usefulness  for  me. 

When  something  is  taken  in  the  morning  it  is 
uncomfortable,  and  for  business  men  in  cities  well 
nigh  impossible  to  have  the  bowels  acting  during 
the  day.  To  secure  prompt  action  it  is  well  to 
take  the  dose  of  ])urgative  water  (or  its  equivalent) 
with  hot  water,  or  tea  or  other  warm  vehicle.  This 
will  usually  produce  the  desired  effect ;  and,  if  taken 
on  getting  out  of  bed,  secures  the  desired  operation 
by  the  time  breakfast  is  over,  \^'hen  a  pill  has 
been  taken  previously  at  bed  time  the  bowels  are 
usually  ready  to  operate  soon  after  the  morning 
draught  is  taken  ;  and  then  a  motion  before  break- 
fast, followed  by  a  second  when  that  meal  is  over, 
fits  the  bilious  business  man  for  his  day's  work. 
Where  a  person  is  depressed  and  liverish,  to  sweep 


24  C) 


THE  CANADA   MEDICAL  RECORD. 


all  spare  bile  and  all  offensive  matters  out  of  the 
intestine  is  to  give  a  mental  cheerfulness  which 
contrasts  with  the  gloom  which  reigned  before. 

Where  children  are  subject  to  constipation 
something  palatable  is  required.  Children,  even 
more  than  adults,  resent  what  has  an  objectionable 
taste.  Castor-oil  is  detested  in  the  nursery,  and 
not  without  reason.  Tincture  of  senna  in  a  little 
tea  is  preferable.  But  of  ail  forms  of  laxative  a 
sweet  ginger  biscuit  or  cracker,  containing  a  few 
grains  of  jalap,  is  the  least  repugnant  to  the 
childish  palate.  It  should  not  be  too  hot,  else  the 
ginger  offends.  If  such  toothsome  sweetmeat  be 
granted  as  a  reward  for  good  behavior,  the  ruse 
will  usually  be  successful ;  but  if  a  shadow  of  a 
suspicion  be  excited  that  medicine  lurks  in  the 
sweetmeat,  a  new  line  of  attack  at  once  becomes 
necessary.  In  other  cases  a  little  oatmeal  or  mai^e 
porridge  to  breakfast  is  enough.  At  other  times  a 
little  stewed  fruit,  as  figs,  French  plums,  or  even 
ordinary  garden  fruit,  is  found  efficacious. 

With  many  adults  some  treacle  on  whole-meal 
bread  relieves  the  conditions  which  renders  life  a 
burden.  The  mechanical  irritation  set  up  by  the 
particles  of  bran  excites  the  vermicular  action  or 
the  intestine,  and  all  is  well.  Brown  bread  eaters 
are  common  everywhere.  When  travelling,  such 
persons  are  liable  to  the  presence  of  their  bane, 
because  brown  bread  is  not  always  to  be  had.  It 
will  be  well  for  these  individuals  to  lay  in  a  stock 
of  pills  in  a  travelling  medicine  chest,  the  now 
fashionable  compound  liquorice  powder,  or  a  bottle 
of  some  granular  effervescent  preparation. 

When  constipation  is — as  it  very  commonly  is 
linked  with  inadequate  action  of  the  liver,  the  pure 
laxative  should  be  linked  with  a  hepatic  stimulent. 
In  the  second  edition  of  my  Fractitiouer's  hanj- 
hook  of  Treatment^  many  of  the  prescriptions  were 
altered,  and  the  sulphate  of  soda  substituted  for 
sulphate  of  magnesia  ;  the  latter  being  a  pure  lax- 
ative, while  the  former  possesses  also  a  distinct 
action  upon  the  liver.  A  certain  very  august  per- 
sonage is  said  to  repose  unlimited  confidence  in 
sulphate  of  soda,  and  certainly  time  has  fully 
justified  that  contiJence  and  demonstrated  that  it 
has  not  been  misplaced.  Others  again  find  that 
phosphate  of  soda,  familiarly  known  as  "  tasteless 
aperient  salts,"  meets  their  requirements.  Carlsbad 
salts  also  are  in  vogue. 

The  administration  of  an  habitual  laxative  and  the 
decision  as  to  what  agent  or  combination  of  agents, 
and  what  doses  shall  be  employed,  is  one  of  the 
trials  of  prescribing.  If  the  dose  agrees  at  first 
in  a  week  or  a  month  it  is  either  too  potent  or  it 
looses  its  effect,  and  then  an  alteration  of  the  dose, 
or  the  employment  of  some  other  agent  or  combi- 
nation of  agents,  becomes  inperative.  Some  persons 
have  to  keep  "ringing  the  changes"  and  going  a 
certain  rounds  once  more  reverting  to  some  com- 
pound that  had  lost  its  effect  in  past  times.  When 
a  laxative  has  to  be  combined  with  tonics  (or  any 
drugs  which  have  to  be  taken  for  some  time )  it  is 
often  well  to  give  two  prescriptions,   one  more 


laxative  then  the  other,  and  then  let  the  patient 
arrange  the  doses  as  he  or  she  requires.  If 
this  gives  the  patient  a  little  trouble — well,  the 
patient  after  all  is  the  person  who  is  benefited,  and 
the  trouble  brings  with  it  its  own  reward. — Phil. 
Mc-d.  Beh:istfr. 


SOME  POINTS  IN  MINOR  SURGERY   .\T 

THE  PENNSYLVANIA  HOSPITAL. 

By  Thomas  S.  K.  Morton,  M.  D., 

Senior  Resident  Surgeon. 

Shock  is  combated  usually  by  warmth  and  stim- 
ulants. The  former  is  applied  by  nif-ans  of  hot 
baths  or  water  bags,  generally  the  latter.  The 
patient  is  surrounded  by  rubber  bags  filled  with 
hot  water.  These  we  have  had  made  for  the  pur- 
pose. They  are  round,  from  one  and  a  half  to 
two  and  a  half  feet  long,  from  four  to  six  inches 
in  diameter,  and  have  a  filling-hole  with  a  screw 
cap  at  one  end,  and  a  handle  at  the  other.  Atropia 
is  freely  used.  Whiskey,  ether,  digitalis,  aromatic 
spirits  of  ammonia,  or,  in  desperate  cases,  aqua 
ammonia  itself,  are  given.  The  injection  of  pure 
ammonia  is,  of  course,  always  followed  by  local 
sloughing.  Mustard,  hot  fomentations,  large  ene- 
mas, and  drinks  of  warm  fluids  do  good  service. 
Previously  warmed  blankets  are  a  great  comfort  as 
well  as  of  benefit. 

Ether  is  our  standard  anesthetic,  although  the 
A.-C.-E.  mixture  is  often  employed  ;  chloroform 
very  seldom.  A  small  amount  of  the  latter  is 
found  useful  to  relax  the  muscular  spasm  which 
often  remains  in  drunkards,  even  when  ether  is 
fully  pushed.  A  few  drops  will  often  permanently 
stop  it,  when  the  ether  can  be  continued.  A.-C- 
E.  has  given  rise  to  no  alarming  symptoms  in  at 
least  two  hundred  administrations  from  my  hands, 
and  I  know  of  no  untoward  circumstance  attend- 
ing its  use  here.  All  general  ana3sthetics  are 
administered  from  small,  square-folded,  very  absor- 
bent towels.  Cone  or  apparatus  are  not  used. 
The  "  rapid  "  and  rectal  methods  have  long  since 
been  abandoned  as  dangerous.  The  patent  ink- 
bottle  stopper  is  found  convenient  to  pour  ether 
from  the  bottle. 

During  the  local  anaesthetic  action  of  cocaine, 
we  have  performed  many  minor  amputations, 
circumcisions,  and  other  small  opeartions ;  but 
with  us,  at  least,  the  field  of  the  drug  in  this  direc- 
tion is  becoming  quite  limited.  Most  eye  opera- 
tions, however,  are  performed  under  its  influence. 

Divided  or  torn  muscles,  tendons,  and  nerves,  if 
their  ends  can  be  seen,  are  sutured  with  catgut. 
If  not  visible,  they  are  freely  cut  for,  and  like- 
wise sutured.  Good  function  is  the  ainiost  inva- 
riable result. 

Subcutaneous  operations,  such  as  tenotomy, 
aspiration,  and  even  exploration  by  needle,  are  per- 
formed with  as  much  antiseptic  precaution  as  if  a 
large  wound  were  made,  for  death  has  been  known 
to  occur  from  wound  complication  following  each  of 


TilE   CANADA   MEDICAL   KECOBD. 


247 


these  procedures.  Therefore,  knowing  that  there 
is  some  risk,  no  matter  how  trivial,  it  liccomcs  one's 
duty  to  avoid  it. 

In  the  ani|)iitation  of  fingirs  and  toes  bilow 
the  mclacarpoor  tarso-|>halangcal  jf)inls,  riil>lx-r 
iimt>rclla  rings  arc  used  as  ti)urni(|uets.  'I'hc  Taps 
are  closely  stitched,  and,  if  there  be  any  bleeding 
when  the  ring  i«  taken  off,  a  deep  ia'cai  stitch 
back  of  the  line  incision  on  one  or  both  sides  will 
always  effectually  control  it.  We  never  put  a  liga- 
ture upon  these  arteries,  finding  the  above  method 
.uni)ly  secure,  and,  so  far  as  our  last  few  hundred 
such  aoiputations  show,  unattended  with  disadvan- 
tage. 

In  exartii'ulations  at  the  metacarpo  or  tarso- 
jihalangeal  joints,  ligatures  are  applied  if  possible; 
but  if  tlie  bleeding  is  obstinate,  a  deep  stitch  into 
the  palm  or  sole  can  be  made  to  control  the 
ap])ropriate  vessel.  These  operations  receive  the 
usual  house  dressing  and  a  palmar  s|)lint.  They 
are,  as  a  rule,  not  dressed  from  ten  d.avs  to  two 
weeks,  when  solid  and  complete  union  is  expected 
and  usually  found. 

Catgut  sutures  are  passed  through  finger  and  toe- 
nails, without  fear,  if  by  so  doing  crushed  or  cut 
parts  can  better  be  brought  into  shape,  and  also  in 
operations  for  ingrowing  nails. 

We  have  saved  nianv  fingers,  ears,  and  noses, 
which  came  in  hanging  by  mere  shreds  of  tissue  by 
promptly  sewing  them  in  place,  and  treating  anti- 
septically.  No  opportunity  has  occurred  by  which 
to  test  the  saving  of  those  parts  when  entirely 
severed  from  the  body. 

Abrasions  and  brush  burns  are  carefully  cleansed 
and  treated  with  either  boracic  acid  ointment,  or 
the  standard  house  dressing. 

The  latter  consists  of:  protective  :  Lister  gauze, 
wrung  out  of  i  :  looo  HgCl..  solution,  and  its  skin 
surface  thickly  dusted  with  iodoform  ;  a  pad  of  dry 
I :  looo  cotton,  and  moist  i  :  looo  gauze  bandages 
over  all.  We  have  found  that  Lister's  boracic 
acid  ointment  makes  up  better  if  wax  be  substi- 
tuted for  the  paratfine  of  his  formula.  Our  receipt 
is:  boracic  acid  and  yellow  wax,  each  i  part, 
cosmoline  4  parts. 

Ligatures  are  never  applied  except  in  the  largest 
operative  and  accidental  wounds. 

Sutures  run  under  or  through  the  bleeding  points 
effectually  control  them.  No  trouble  is  experi- 
enced in  tying  catgut  sutures  or  ligatures,  when  the 
first  tie  of  the  knot  is  made  as  for  a  surgeon's  knot. 
Catgut  is  invariably  used  for  these  purposes.  In 
treating  some  hundreds  of  scalp  wounds,  no  matter 
how  extensive,  I  have  never  applied  a  ligature, 
always  finding  that  caretully  placed  sutures  will 
stop  all  hemorrhage. 

Stitches  are  placed  verv'  close  together  in  all 
wounds  ;  this  presupposes  proper  drainage  if  it  is 
necessary.  If  so,  it  is  secured  by  a  few  strands  of 
finest  catgut,  placed  along  the  bottom,  and  brought 
out  at  one  end  of  the  wound. 

Small  or  superficial  wounds  as  rarely  require 
drainage  as  ligature.     Scalp  wounds  are  not  drained 


unless  extensive.  If  the  edges  are  much  contused 
or  torn,  they  are  excised.  Quite  small  wounds  of 
the  scalp  or  elsewhere,  and  sometimes  larger  ones, 
are,  after  antiseptic  closure,  covered  in  with  a 
minute  pad  of  biciiloride  cotton,  ind  plastered  down 
with  either  pure  collodion  or  combinations  of 
it  with  >in  h  drugs  as  eva|x>rated  tincture  of  ben- 
zoineU-\;ip.  fl.  |  ij  tr.  benz.  conii>.  tort.  3  ij,  and 
make  to  ri.  3  ij  "''ih  collodion),  iodoform  (10  per 
cent. ),  s.dicylic  acid,  etc.  Wounds  too  small  for 
stitches  are  similarly  treated.  Large  wounds,  of 
course,  receive  the  house  dressing  and  possibly 
drainage. 

Very  tense  hematomata  are  freely  incised,  the 
clotortluid  blood  curetted  out,  any  bleeding  vessel 
stitched  or  tie<l  if  it  can  easily  be  found,  and  the 
whole  sewn  up  with  or  without  a  drain,  according 
to  size,  and  dressed  with  some  com]>ression. 

Slowly  resolving  hematomata,  or  those  in  which 
suppuration  is  present  or  incipient,  are  manipulated 
in  exactly  tie  same  way. 

Punctured  wounds  are  laid  open,  curetted,  wash- 
ed with  I  :  1000  HgCL  solution,  and  closed  as  above. 
If  the  bottom  cannot  be  reached,  a  small  drain 
should  be  carried  as  deep  as  possible,  and  the  best 
hoped  for. 

Gunshot  wounds  are  treated  in  much  the  same 
manner.  If  it  can  readily  be  done,  the  ball  is 
extracted  through  the  wound  or  by  counter-open- 
ing. The  entrance  and  exit  (if  there  be  one) 
wounds  are  excised,  the  tract  of  the  ball  curetted, 
thoioughly,  a  small  gut  drain  carried  all  the  way 
through,  and  the  external  wounds  treated  as  simple 
incised  ones. 

Compound  fractures,  if  the  skin  wound  is  small, 
are  freely  cut  into,  washed  with  i  :  1000,  curetted 
accurately  stitched,  and,  if  extensive,  drained  with 
catgut. 

Some  of  them  are  dressed  more  frequently  than 
the  actual  wounds  require  in  order  that  good  posi- 
tion of  the  bones  may  be  secured. 

Wounds  of  joints  are  treated  in  precisely  the 
same  manner,  save  that,  unless  they  are  dirt),  we 
are  satisfied  with  thorough  washing  with  i  :  1000, 
and  omit  the  curette.  Cure  in  one  dressing  is 
here  attempted  and  good  function  expected. 

Poisoned  wounds  are  also  treated  somewhat 
similarly,  but  the  utmost  care  is  taken  to  get  to  the 
bottom  of  the  wound  itselfand  into  all  ramifications 
and  sinuses  with  the  curette  and  strong  antiseptic 
solution  (i :  500).  If  the  wound  is  very  bad  and 
cellulitis  present  or  threatening,  continuous  anti- 
septic irrigation  (I  :  2000)  is  started  as  soon  as  the 
cleaning  out  is  eftected. 

Large  glass  percolating  jars,  with  glass  stop- 
cocks, or  other  regulating  device,  suspended  over 
the  part,  give  best  satisfaction.  Whilst  thus  em- 
ploying irrigation  any  wounds  should  be  well 
covered  with  protective,  the  whole  part  covered 
with  lint,  and  the  solution  allowed  to  drip  upon  it. 

Suppurating  wounds  might  be  classed  as  poison 
wounds,  for  the  treatment  is  almost  the  same, 
namely:  curette  and  antiseptic  solution  (i :  1000 


248 


THE   CANADA   MEDICAt   RECOrA, 


or  I  :  500),  excision  of  wound  edges  and,  usually, 
accurate  approximation,  with  or  without  a  drain, 
as  circumstances  indicate. 

Punctured,  gunshot,  supjiuration,  poison,  and 
compound  bone  and  joint  wounds,  when  thus  dealt 
with,  as  a  rule  heal  by  primary  intention  and  under 
but  one  dressing. 

Felons,  buboes,  simple  and  suppurating  cysts, 
inflamed  bursa;,  and  large,  small,  and  diffused 
eradicable  abscesses  are  treated  by  exactly  the 
same  method  and  usually  with  like  result. 

Ineradicable  abcesses,  such  as  the  psoas,  are 
treated  by  this  method  as  it  can  be  made  to  go, 
and  are  then  drained  into  an  antiseptic  dressing  by 
means  of  a  rul)ber  drainage  tube  ;  through  which 
they  are  from  time  to  time  washed  out  with  anti- 
septic solution.  Care  must  be  taken  in  so  doing, 
however,  whether  it  be  these  or  other  cavities,  not 
to  let  any  of  the  solution  remain  in.  It  should  be 
displaced  by  a  weaker  solution  or  distilled  water. 

In  cutting  into  abscesses,  old  hematomata,  etc., 
a  better  result  is  secured  by  opening  them  from 
one  side  through  sound  tissue. 

Simple  cellulitis  is  treated  like  the  complicated 
form  as  described  above. 

Burns,  if  small  in  area,  or  confineed  to  an 
extremity,  are  treated  by  the  regular  antiseptic 
dressing.  All  easily  removed,  dead  skin,  etc.,  is 
taken  away;  the  parts  washed  with  i:  1000 
bichloride  solution  or  iodoform  sprinkled  on(in  part 
for  its  analgesic  eflect),  then  protective  in  narrow 
strips,  and  the  dressing  and  cotton.  Angesthesia 
may  be  required  to  do  this  properly. 

Extensive  burns  are  covered  in  with  boracic  acid 
or  oxide  of  zinc  ointment,  the  surface  of  which  is 
sprinkled  with  iodoform  and,  if  there  is  much  pain, 
smeared  thinly  with  oleate  of  morphia.  This 
dressing  is  covered  in  with  cotton  batting  and  a 
bandage  or  binder. 

Just  here  it  may  be  well  to  speak  of  sloughs, 
granulations,  and  skin-grat"ting,  but  what  is  said 
applies  to  all  wounds  as  well  as  burns. 

Under  the  antiseptic  dressing  sloughs  are  very 
slowly  thrown  off.  It  is  our  custom  to  excise  them 
as  soon  as  they  become  demarked.  If  pro])erly  done 
this  causes  scarcely  any  pain  or  bleeding  and  places 
the  wound  days,  and, perhaps, weeks  nearer  closure. 
By  picking  up  the  edge  of  the  slough  with  a  pair  of 
forceps, and  cutting  with  knife  or  scissors  through  its 
readily  apparent  junction  with  healthy  tissue,  it  is 
easily  accomplished.  By  this  same  process  I  have 
successfully,  and  without  pain  or  hemorrhage, 
amputated  even  fingers  and  toes  which  we  had 
attempted  to  save. 

All  forms  of  exuberant  granulations  are  usually 
shaved  off  with  a  sharp  knife.  The  moist  bichloride 
dressing,  applied  without  the  intervention  of  protec 
tive,  is  found  to  produce  ample  stimulation,  if  such- 
is  indicated. 

If  skin-grafting  becomes  necessary,  a  patch  of 
thin  skin  is  selected  and  made  aseptic,  as  is  also 
the  granulating  surface,  if  it  is  not  so  already. 
Almost  microscopic  pieces  of  the  cleansed  skin  are 


then  cut  out  by  means  of  a  purified  needle  and  a  pair 
of  scissors,  and  planted  among  the  granulations. 
Narrow  strips  of  protective  are  applied,  and  upon 
this  is  placed  either  the  "  house  dressing,"  or 
simply  a  pad  of  dry  1  :  1000  cotton.  Any  bichlo- 
ride solution  remaining  about  he  parts  should 
be  washed  off  with  distilled  water  before  the  grafts 
are  cut  and  set,  and  strong  solutions  should  not  be 
used  while  the  islets  of  epithelium  are  forming. 

Leg  ulcers,  when  small,  are  stimulated,  if  neces- 
sary by  scoring  with  a  sharp  knife,  nitrate  of  silver 
stick,  etc. ;  dusted  with  iodoform  ;  accurately  fitted 
with  a  piece  of  protective,  and  a  gauze  dressing 
put  on  with  a  firm  roller.  If  they  are  large,  and 
have  callous  edges,  these  latter  are  trimmed 
off,  the  sore  curetted,  perhaps  straps  applied 
after  the  iodoform  and  i)rotective,  and  then  the 
same  dressing.  By  this  method  they  can  always 
be  kept  perfectly  sweet  and  clean  ;  the  discharge  is 
but  slight,  and  the  pain  still  less.  If  the  ulcers  are 
very  irritable,  and  will  not  bear  the  gauze  dressing, 
boracic  acic  ointment  is  substituted  for  it. 

Those  painful,  nonulcerative  conditions  of  the 
legs  so  often  met  with  behave  excellently  under 
one  or  the  other  of  the  above  dressings. 

In  such  regions  where  it  is  impossible  to  apply 
or  retain  a  regular  dressing,  great  pains  are  taken 
in  the  cleansing  before  and  after  an  operation,  and 
iodoform  in  conjunction  with  frequent  corrosive 
sublimate  irrigations  is  freely  used  afterwards. 
Especially  are  these  applications  valuable  about 
the  genitourinary  organs  and  rectum.  In  females, 
after  most  operations  thereabouts,  the  vagina  is 
washed  with  i :  1000,  and  thenyf //<?</ with  iodoform. 
Beyond  an  occasional  irrigation  of  the  external 
parts,  nothing  more  need  be  done  until  the  stitches 
— if  they  have  not  been  of  catgut — are  ready 
for  removal. 

Chancroids  heal  wonderfully  if  kept  buried  in 
iodoform  ;  sometimes  they  are  previously  brushed 
over  with  acid  nitrate  of  mercury,  etc.  No  treat- 
ment is  directed  to  hard  chancres  unless  compli- 
cated. 

Body  parasites  are  destroyed  with  i :  500 
corrosive  sublimate  solution.  No  unpleasant  effects 
have  been  known  to  follow  even  the  freest  use  of 
the  solution  in  this  way.  If  the  ear  has  been 
invaded,  it  is  syringed  with  that  solution,  and  then 
fiilled  with  oleate  of  morphia  and  a  little  wad  of 
cotton  put  on  top. — Medical  News. 


CATARRHAL    PHTHISIS. 

By  Thos.  J.  Mays,  M.D. 

There  are  three  forms  of  pulmonary  phthisis  : 
the  catarrhal,  the  tubercular  and  the  fibrous.  Of 
all  these  forms  the  catarrhal  is  by  far  the  most 
frequent,  and  plays  a  most  prominent  role  in  the 
history  of  the  other  two.  It  is  important,  both 
from  a  prognostic  and  therapeutic  point  of  view, 
to  distinguish  between  these  several  varieties  ; 
hence,  while  catarrhal  phthisis  will  principally 
and  mainly  engage  our  attention  to-day,  that  much 


THE   CANADA.   MEDICAL   RECORD. 


k9 


ofllie  tuliercular  and  fibrous  forms  will  enter  into 
llu:  discussion  as  is  consistinl  with  a  compk-te 
umJcrsliincling  of  the  subject.  A  great  deal  of 
loose  and  indclinitu  material  his  been  thrown 
aroimd  the  subject  of  phthisis,  which  has  very 
mu(  h  interfered  with  a  true  conception  of  its  rela- 
tions, and,  in  order  to  avoid  a  similar  difliculty,  and 
to  make  an  intelligent  discrimination  between  the 
different  varieties  autl  their  tr\ie  etiology,  we  will,  in 
the  fust  ))hice, devote  a  fewthoughis  to  the  elemen- 
tary structure  of  the  pulmonary  organs.  'I'lie  parts 
of  the  respiratory  organs  which  are  princip^illy  affei  - 
ted  in  pulmonary  phthisis  are  the  alveoli  or  air 
cells.  'l"he  walls  of  the  air  cells  are  composed  of 
fibrous  connective  tissue,  which  is  comi)lelely 
ramified  by  capillary  blood  vessels  and  lymphatics. 
On  their  external  surface,  or  the  surface  which  is 
in  contact  with  the  atmos])liere,  they  are  lined 
with  a  tlat  or  [invemcnt  epithelium,  and  these  are 
the  elementary  bodies  which  are  principally  invol- 
ved in  catarrhal  phthisis.  Between  these  epithe- 
lial cells  there  are  stomata,  or  true  orifices,  which 
communicate  freely  with  the  lymphatic  vessels  in 
the  alveolar  wall,  and  it  is  through  these  openings 
that  carbon  [inrlicles  and  other  foreign  materials 
in  a  fine  state  of  subdivision  gain  access  into  the 
lymjihatic  circulation,  and  produce  the  well-known 
discoloration  of  the  lungs.  'I'he  lymphatic  \essels 
are  distributed,  in  their  course,  around  the  blood 
vessels  and  the  bronchi  ;  those  which  wind  around 
the  blood  vessels  are  called  the  peri-vascular, 
and  those  which  wind  aroimd  the  bronchi  are 
called  the  peri-bronchial  lymphatics.  These  are 
the  structures  wliich  play  such  a  pronounced  part 
ill  the  production  of  true  tuberculosis,  and  their 
importance  must  not  be  lost  sight  of.  We  have, 
then,  presented  for  consideration,  in  this  connec- 
tion, the  alveolar  walls,  covered  on  their  outside 
with  epithelium  and  ramilied  internally  with  blood 
vessels  and  lymphatics. 

Now,  catarrhal  phthisis  is  generally  an  extension 
of  chronic  Ijronchiiis  into  the  alveoli,  or  is  the 
product  of  acute  catarrhal  pneumonia.  In  either 
case  it  im[)lies  a  catarrhal  affection  of  the  alveolar 
epithelium.  The  blood  vessels  become  engorged, 
and  the  epithelial  cells  multiply  and  accumulate 
and  clog  up  the  alveoli  with  their  products.  The 
filling  nj)  of  the  alveoli  with  these  catarrhal  aggre- 
gates produces  small  bodies  which  partake  of  the 
shape  of  these  cavities.  In  this  way  one  alveolus 
fills  up  after  another,  until  a  whole  group  or  clus- 
ter of  them  is  involved,  giving  rise  to  roundish 
nodular  bodies  which  are  so  frequently  mistaken 
for  true  tubercles.  They  are  not  tubercles  in  the 
technical  meaning  of  that  term,  but  are  merely 
accumu/afdl  inflainDiatory  or  caiarrhalpioducts. 
This  train  of  pathological  changes  is  due  to  a  dis- 
turbance of  the  relationship  existing  between 
the  production  and  expulsion  of  epithelial  pro- 
ducts, i.  c'.,  the  expectoration  did  not  keep  pace 
with  the  proliferation.  If  such  a  relationship  were 
preserved,  or  could  by  any  means  be  restored,  it  is 
evident  that  the  disease  would  be  at  once  called 


into  a  state  of  abeyance.  But  the  continued  accu- 
mulation of  excretory  products  exerts  a  pressure 
on  the  capillaries  in  the  walls  of  the  alveoli  and  in 
the  interlobular  septa,  and  in  due  course  of  time 
these  infiltrated  spots,  thus  cut  off  from  llieir  source 
of  nourishment,  will  give  rise  to  changes  of  a 
different  pathological  character,  which  will  be 
discussed  after  we  have  disposed  of  another  ques- 
tion which  has  an  important  bearing  on  our  sub- 
ject. 

It  has  already  been  stated  that  catarrhal  phthisis 
is  evolved  from  catarrhal  pneumonia,  and  the 
question  arises  Ikic,  why  only  from  catarrhal,  and 
not  from  croupous,  pneumonia?  As  well  as  the 
other  question,  when  does  catarrhal  imeumonia 
become  catarrhal  phthisis?  In  regard  to  the  tirst 
question,  it  can  be  answered  that  croupous  imeu- 
monia seldom,  if  ever,  passes  into  catarrhal  phthi- 
sis, because  its  etiology  and  pathology  rest  on  an 
entirely  different  basis  from  that  of  catarrhal  pneu- 
monia, as  the  following  comparison  of  their  chief 
characteristics  will  show  :  In  croupous  pneumonia 
the  blood  pressure  is  suddenly  elevated,  the  blood 
vessels  become  intensely  turgid  and  injected,  the 
heart-beats  become  vigorous  and  powerful,  fibrin 
leucocytes  and  red  corpuscles  exude  from  the  more 
porous  arterial  walls  into  the  alveolar  ctivities, 
where  the  whole  assumes  a  semi-solid  infiltration, 
undergoes  a  retrograde,  fatty  metamorphosis, 
becomes  resoh  ed  and  expunged  in  a  short  time, 
after  which  the  disease  comes  to  an  abrupt  termina- 
tion. Catarrhal  pneumonia  pursues  a  different 
course.  The  disease  comes  on  gradually  and 
does  not  pass  through  the  well-defined  stages 
which  mark  the  course  of  the  croupous  form ;  the 
tone  of  the  circulation  is  reduced,  and  the  whole 
constitution  is  in  rather  an  adynamic  condition  ; 
there  is,  as  a  rule,  no  exudation  of  fibrin,  but 
instead  the  alveoli  becomes  filled  with  cast  oft' 
epithelium,  leucocytes  and  some  red  corpuscles. 
These  products  have  a  strong  tendency  to  undergo 
cheesy  degeneration,  and  owing  to  its  undecided 
progress  and  course  it  is  very  apt  to  become 
chronic,  ;.  e.,  to  leave  a  vestige  of  disturbance 
here  and  there  throughout  the  lungs,  which,  upon 
the  slightest  provocation,  is  fanned  into  freshness 
again.  Again,  it  is  important  to  observe  the  res- 
pective portions  of  the  res|)iratory  organs  which 
are  attacked  by  the  two  diseases.  It  is  but  rare 
that  pure  croupous  pneumonia  attacks  an  apex, 
unless  it  involves  a  whole  lung,  but  it  always  shows 
a  preference  for  the  basic  portions  of  the  lungs, 
and  involves  either  a  whole  or  two  lobes.  On 
the  other  hand,  catarrhal  pneumonia  shows  a  dis- 
position to  attack  small  portions  of  lung,  such  as 
one  or  two  lobuli,  and  if  it  shows  a  decided  prefer- 
ence for  any  locality,  it  is  the  middle  or  upper 
portions  of  the  lung.  This  is  particularly  true  of 
its  chronic  form. 

Whether  the  difference  in  the  nature  of  the 
pathological  products  in  the  two  diseases — the  one 
being  a  fibrinous  exudation,  and  the  other  a 
catarrhal  secretion —  has  any  influence  in  determin- 


S5() 


THE  CANADA  MEDICAL   RECORD. 


ing  the  particular  seat  of  attack,  or  not,  it  is  very 
probable  that  one  reason  why  the  lower  lobes 
throw  off  the  catarrhal  products  more  easily  than 
the  apices  is  that  the  moisture  contained  in  the 
catarrhal  secretion  of  the  a])ices  gravitates  to  the 
base,  leaving  that  in  the  latter  dry  and  unyielding, 
while  that  of  the  base  possesses  greater  fluidity, 
and  is  therefore  more  readily  expectorated.  Then, 
again,  it  is  evident,  if  other  things  are  equal,  that 
catarrhal  deposits  are  thrown  off  more  easily  in 
localities  where  the  lungs  are  active  than  where 
they  are  quiet,  and  it  is  well  known  that  the  apices 
have  less  respiratory  motion  than  any  other  por- 
tion of  the  lungs,  hence  this  weakness  also  contri- 
butes to  the  danger  of  the  retention  of  infiltrated 
products,  which  become  nuclei  for  still  futher 
accumulation.  It  thus  appears  why  it  is  that 
croupous  pneumonia,  so  seldom,  if  ever,  terminates 
in  phthisis,  and,  why,  even  in  catarrhal  pneumonia, 
the  infiltrated  products  at  the  base  are  thrown  out, 
and  those  in  the  apices  are  left  behind,  which 
makes  the  latter  so  vulnerable  to  phthisis  in  tliis 
disease. 

1  think,  if  what  has  been  said  is  true,  it  follows 
that  a  catarrhal  infiltration  in  an  apex,  in  the  vast 
majority  of  cases,  if  not  in  all  of  them,  comes  to 
stay,  /.  e.,  it  is  a  chronic  affection,  and  tends 
towards  disintegration  and  excavation  from  the  very 
start.  In  other  words,  such  a  case  is  not  one 
that  belongs  to  the  domain  of  catarrhal  pneumonia, 
but  is  one  of  catarrhal  phthisis  from  the  very 
beginning.  If,  therefore,  an  infiltration,  or  even 
a  prolonged  expiration,  occur  in  an  apex  without 
involving  any  other  portion  of  the  limg,  we  are  un- 
doubtedly justified  in  calling  it  a  case  of  incipient 
pulmonary  consumption,  of  the  catarrhal  form. 

In  taking  up  the  thread  of  our  argument,  when 
digressing  to  discuss  the  comparative  ])athology 
of  croupous  and  catarrhal  pneumonia  and  their 
relations  to  catarrhal  phthisis,  it  must  be  remem- 
bered that  we  had  not  traced  the  pathological 
process  of  catarrhal  phthisis  any  futlier  than  the 
stage  of  accumulation  and  pressure  of  catarrhal 
elements  upon  the  alveolar  walls  and  interlobular 
septa.  The  infiltration  very  seldom  involves  a 
whole  lung,  or  a  whole  lobe  of  a  lung,  but  is  gen- 
erally scattered  throughout  an  apex,  and  affects 
isolated  groups  of  alveoli,  or  of  lobuli.  Thus  far 
the  process  is  principally  limited  to  the  alveolar 
walls,  their  epithelium  and  their  blood  vessels,  and 
the  interlobular  septa,  but  the  continued  accumu- 
lation of  the  catarrhal  secretions  will,  through 
their  pressure  on  the  surrounding  circulation,  cut 
off  their  blood  supply,  and  hence  become 
circumscribed  foreign  masses,  which  undergo  a 
slow  process  of  cheesy  degeneration,  soften  from 
the  centre  to  the  periphery,  are  expelled,  and 
leave  behind  cavities,  large  or  small,  in  proportion 
to  the  amount  of  tissue  destruction. 

It  is  during  this  stage  of  excavation  that  the 
true  tubercle  is  generated.  Probably,  in  virtue  of 
a  specific  element  derived  from  the  decaying 
catarrhal  masses,  a  new   poison  originates  here, 


which  is  chiefly  absorbed  by  the  lymphatics  in  the 
surroundings  of  the  affected  parts.  These  vessels 
carry  the  ])rison  along  their  ascending  courses  as 
as  they  arise  in  the  alveolar  wall,  and  twine  around 
the  bronchioles  and  blood  vessels  ;  and  it  is  here, 
in  the  beginnings  and  in  ihe  channels  of  the  lym- 
phatics, that  this  ])oison  incites  new  nodular 
growths,  which  are  genuine  tubercles,  but  differ 
from  those  yellow  aggregates,  or  nodules,  which 
are  found  in  catarrhal  phthisis,  both  in  genesis 
and  structure.  They  are  evolved  from  interstitial 
connective  or  lymphatic  tissue,  and  are  growths, 
or  a  hvperplasia,  and  not  mere  accretions,  like  the 
so-called  yellow  tubercles.  These  nodular  growths 
first  manifest  their  appearance  in  the  alveolar  wall, 
the  surface  of  which  they  force  into  the  cavity. 
By  and  by  the  continuity  of  the  alveolar  wall 
breaks,  and  the  newly-formed  interstitial  connec- 
tive tissue  cells  are  forced  into  the  cavity  of  the 
air  cells.  A  number  of  nodules  following  such  a 
course  will  very  soon  overcrowd  and  over-distend 
the  vesicles,  and,  very  naturally,  those  infiltrated 
areas  will  be  cut  off  from  their  blood  supply  and 
disintegrate,  in  the  same  way  as  those  of  catarrhal 
infiltration.  This  is  the  stage  in  which  the  tuber- 
cular growth  is  so  liable  to  be  mistaken  for  the 
catarrhal  infiltration,  and  vice  versii.  Both  forms 
occupy  the  alveolar  cavity,  but  on  minute  examina- 
tion it  will  be  found  that  one  is  composed  of 
interstitial  connective  tissue  growth,  and  the  other 
chiefly  ol  catarrhal  products.  Frequently,  how- 
ever, the  two  processes  are  so  intermixed  that 
their  respective  products  are  indistinguishable. 
Thus,  then,  after  catarrhal  infiltration  has  once 
brought  on  cavitation,  and  reinforces  itself  by  tuber- 
cular infiltration  and  cavitation,  it  is  evident  that  the 
destruction  of  lung  tissue  is  very  materially  accel- 
erated ;  and  this  ex])lains  why  it  is  that  a  patient 
enjoys  almost  comparative  imnumity  from  the 
disease  as  long  as  the  continuity  of  the  lung  is  not 
broken,  and  why  the  disease  advances  more  rapidly 
after  this  period  has  been  reached. 

This,  then,  is  the  tubercular  form  of  pulmonary 
consumption,  and  differs  from  the  catarrhal  form, 
inasmuch  as  it  usually  is  secondary  to  it.  It  is 
decidedly  an  affection  of  the  lymphatic  or  connec- 
tive tissue,  while  the  catarrhal  form  is  an  affection 
principally  of  the  epithelium  of  the  alveoli. 

Fibrous  or  interstitial  jjhlhisis,  as  it  is  sometimes 
called,  differs,  both  in  course  and  in  duration, 
from  the  catarrhal  and  tubercular  forms.  It  is 
essentially  a  hyperplasia  of  the  fibrous  connective 
tissue,  or,  in  other  words,  an  affection  of  the 
framework  of  the  lung  and  the  pleura.  It  is  slow  in 
its  progress,  and  is  usually  preceded  by  bronchitis 
and  bronchiectasy.  It  is  thus  often  induced  or 
preceded  by  a  catarrhal  inflammation  of  the 
bronchial  tulies.  Tubercles  also  form  an  integral 
element  in  fibrous  phthisis,  but  the  slowness  of  the 
disintegrating  process  allows  time  sufficient  for  its 
products  to  become  better  organized,  and,  hence, 
there  is  less  danger  of  caseation  and  destruction  of 
tissue. 


ii 


TUE   CANADA    MEDICAL    RECORD. 


251 


Catarrhal  phthisis  is,  therefore,  not  only  the 
most  frcciiicnt,  but  also,  in  many  instances,  the 
harljingcr  or  the  pioneer  of  the  other  two  forms  ; 
hence  we  will,  in  conclusion,  offer  a  few  remarks 
in  regard  to  its  therapeusis.  When  we  reflect  that 
all  portions  of  the  lung  are  liable  to  catarrhal  infiltra- 
tion, and  that  resolution  occurs  more  readily 
anywhere  else  than  in  the  ajx'x,  the  inference  is 
at  once  forced  upon  us,  that  some  close  relation- 
ship must  exist  between  infiltration  and  the  ai)ex. 
I  think  tliese  ])roducis  remain  because  there  is  less 
circulatory,  lymphatic  and  respiratory  activity  in 
the  apex  than  in  any  other  jjortion  of  the  lungs, 
and  hence  there  is  less  ficility  for  carrying  them 
off.  This  assumption  is  further  confirmed  when 
coupled  with  the  fact  that  in  mitral  disease,  where 
lliere  is  an  almost  constant  hvpera-mia  or  fullness 
ol  blood  in  the  pulmonary  circulation  in  conse- 
■  |uence,  catarrhal  infiltration — or  tuberculi/.ation, 
for  that  matter — is  almost  entirely  unknown,  'i'lie 
continual  hyperajmia  does  not  allow  an  o])portuiiily 
for  the  accumulation  of  these  products,  since  lliey 
are  constantly  \vashed  a\vay  by  the  serous  transu- 
dation present  in  these  cases.  It  is  evident, 
therefore,  that  any  agent  \yhich  has  the  power  of 
transfusing  a  greater  degree  of  activity  into  the 
circulatory,  lymphatic  and  respiratory  function  of 
the  lungs  will,  just  in  that  measure,  clear  up  the 
infiltrated  alveoli  and  restore  the  apex.  Fulfilling 
these  theoretical  indications,  I  have,  for  a  number 
of  years,  applied  moist  heat  over  the  apex  in  these 
cases,  and  have  certainly  derived  some  very 
favorable  results,  as  my  former  communications  on 
this  subject  show.  I  believe  that  by  stimulating 
the  affected  spot  and  its  surroundings  with  a  hot 
poultice,  the  blood  and  lymph  flow  become  accel- 
erated, and  an  increased  interchange  and  absorp- 
tion of  the  fluids  and  solids  of  the  part  follow. 
— Polyclinic. 


MINOR  SURGERY  AT  THE  CHAMBERS 
STREET  BRANCH  OF  THE  NEW  YORK 
HOSPITAL. 

By  G.  B.  Pheli's,  M.D., 
Surgeon  To  Out-Patienls,  Chambers  Street  Hospital. 

The  Out-Patient  Department  of  the  Chambers 
Street  Hospital  is  for  the  treatment  of  surgical 
cases  only.  There  is  a  class  for  pathological  cases 
and  fractures  (except  those  of  the  bones  of  the 
hand  and  foot),  under  the  care  of  Dr.  Powers,  in 
which  about  eighteen  patients  are  treated  daily  ; 
one  for  traumatic  cases  and  the  fractures  above  ex- 
cepted, where  about  one  hundred  and  thirty-six 
patients  are  treated  daily  under  my  supervision  ; 
and  a  class  for  yenereal  diseases,  under  Dr.  Fullei's 
care,  where  about  sixty-five  patients  are  treated  on 
Monday  and  Friday  evenings. 

As  a  rule,  the  patients  pay  very  little  regard  to 
cleanliness,  and  many  are  almost  tramps.  The  dis- 
pensary assistants  are,  besides  two  of  the  house-staff, 
either    third-year    students  or  recent   graduates. 


The  work  in  the  traumatic  class  is  done  almost 
wholly  by  gaslight.  These  conditions  are  men- 
tioned to  show  under  what  circumstances  the  work 
is  carried  on. 

Fresh  cases  have  the  surface  about  the  wounded 
part  washed  with  soap  and  water,  and,  if  covered 
with  oil.  cleansed  with  ether.  The  wound  is  then 
thoroughly  irrigated  with  a  i  :  looo  solution  of 
l)i<liloride  of  mercury.  If  there  is  hair  about  the 
]jaii,  this  is  removed  with  a  cli[)ping  machine  or  a 
ra^or. 

Incised  and  lacerated  wounds  of  the  scalp,  after 
checking  the  hemorrhage  by  clamping  and  tying 
any  bleeding  points,  or  by  pressure,  are  sutured 
with  catgut,  without  drainage,  unless  the  wound  is 
very  extensive.  Contused  wounds  are  similarly 
treated,  tinless  there  is  much  contusion  of  the  edges, 
when  the  wound  is  packed  loosely  with  wet  bi- 
chloride gauze.  Over  the  wound  a  compress  of  plain 
absorbent  gauze,  freshly  wrung  out  of  a  i  :  looo 
l)ichloiide  solution,  is  placed,  with  a  small  amount 
of  boracic  acid  ointment  (twelve  and  a  half  per 
cent,  boracic  acid  in  cosmoline)  spread  on  it  just 
over  the  wound.  Over  this  a  thin  layer  of  absor- 
bent cotton  is  placed  and  bandaged  on.  Such  cases 
report  in  twenty-four  hours,  but  the  dressing  is  not 
changed  unless  it  is  soiled  or  there  is  pain.  These 
wounds  usually  do  perfectly  well,  but  a  dressing 
can  be  rarely  left  on  more  than  four  days,  because 
it  becomes  soiled,  many  patients  reporting  with  ban- 
dages almost  black.  For  three  months  there  has 
not  been  a  case  of  cellulitis  of  the  scalp  that  has 
arisen  while  the  patient  was  under  treatment, 
though  primary  union  is  not  always  obtained,  in 
some  few  cases  there  being  slight  suppuration. 
These  wounds  are  then  opened  and  allowed  to 
granulate. 

In  wounds  of  the  fingers,  an  effort  is  made  to 
save  as  much  of  the  member  as  possible,  and  sur- 
prising successes  are  often  obtained.  Wounds  that 
admit  of  suture  are  drained  with  a  few  horsehairs 
or  catgut  strands.  A  dressing  similar  to  that  for 
scalp  wounds  is  applied.  The  advantage  of  such 
a  dressing  over  a  dry  dressing  of  either  iodoform, 
iodoform  gauze  or  bichloride  gauze,  is  that  it  feels 
more  comfortable,  and  that  when  it  is  removed  it 
comes  off  without  sticking  or  causing  pain,  while 
a  dry  dressing  is  usually  so  firmly  held  by  the  slight 
bloody  discharge,  that  it  requires  some  time  and 
much  trouble  to  remove  it  painlessly.  In  this 
dressing  we  depend  upon  the  bichloride  for  antisep- 
sis, the  boric  ointment  being  used  to  prevent 
sticking.  Iodoform  we  do  not  use  in  this  dressing, 
knowing  that  we  have  a  reliable  antiseptic  in  the 
bichloride  of  mercury,  the  only  indication  for  the 
addition  of  iodoform  powder  being  to  relieve  pain. 
But  an  aseptic  wound  causes  little  pain,  hence  the 
iodoform,  which  is  expensive,  is  omitted. 

From  this  dressing  I  have  seen  only  one  case  of 
eczema,  but  the  majority  of  our  cases  are  wounds 
of  the  hand,  in  which  the  skin  is  tough.  In  wounds 
in  which  there  is  much  laceration,  we  think  it  very 
important,  eitlter  to   rnak-e   Kownter-openings   for 


252 


THE   CANADA   MEDICAL    RECORD. 


drainage,  if  there  is  a  large  pocket,  or  simply  to 
pack  with  moist  gauze  where  this  is  small. 

Divided  tendons  and  nerves  are  sutured  with 
fine  catgut,  and  many  excellent  results  follow. 
Ether  is  given  in  these  cases,  as  a  rule,  for  before 
operating  it  is  often  impossible  to  know  how  ex- 
tensive a  wound  must  be  made.  A  heavy  dressing 
is  applied,  and  a  splint  to  keep  the  parts  at  rest  in 
extension  or  flexion,  as  the  case  requires. 

Cellulitis  has  developed  while  the  patient  was 
under  treatment  very  rarely,  in  only  two  cases  in 
three  months ;  but  a  small  number  apply  for  treat- 
ment with    cellulitis   already  well   marked.     The 
history  in  these  cases  almost  always  is,   "  I  didn't 
thmk  it  would  amount  to  anything,  and  went  to 
the  druggist,  who  put  this  bit  of  plaster  on."     Too 
much   cannot  be  said  against  applying  strips  of 
plaster  to  fresh  wounds.     If  a    bandage   is    not 
needed,  we  put  a  small  compress  of  gauze  over  the 
wound,   and  hold  this  in  place  by  means  of  |jlas- 
ter.     If  a  cellulitis  is    just    starting,  and     there 
is  very  little  tension,  or  no  particular  point  of  pain, 
the  original  wound  is  opened,  thoroughly  washed 
with  I  :    looo  bichloride  solution,    and  the    parts 
then  wrapped  in  a  large  compress  wrung  out  in  i  : 
40  carbolic  acid,  a  piece  of  rubber  tissue  placed 
over  this,  and  a  bandage  api)lied,  leaving  one  end 
open  so  that  the  patient  can,  from  time   to  time, 
pour  on  a  small  amount  of  the  carbolic   solution. 
The  carbolic  solution  is  preferred  to  bichloride,  as 
the  latter,  applied  as  a  wet  compress  over  a  large 
surface,  is  very  apt  to  cause  an  eczema.     From  the 
carbolic  acid  solution    I  haue  seen   three  cases  in 
three  months  in  which  large  blebs  formed,  and  the 
epidermis  was  loosened  from  a  large  part  of  the 
hand,  but  this  accident  is  very  rare.     For  women 
and  children  I  :  60   carbolic   soluiion  is    used.     If 
the  cellulitis  has  gone  further,  and  there  is  evidence 
of  pus,  or  there  is  much  tension,  incisions  are  freely 
made.      Where     possible,    counter-openings    are 
made,   and  a  small  rubber  drain    inserted.     The 
treatment  of  cellulitis  is  considered  of  the  greatest 
importance,  and  free  and  early  incisions  are  de- 
manded in  the  interest  of  the  jjatients.     We  never 
wait  for  distinct  fluctuation,  or  "  pointing." 

In  the  treatment  of  this  trouble  cocaine  is  of 
the  greatest  value,  and,  when  properly  used, 
always  gives  admirable  results — that  is,  mjected 
I >i(o  the  skin  (/loi  beneath  it)  at  the  point  "of  in- 
cision, or  beneath  the  skin  on  the  proximal  side  of 
the  point  to  be  incised.  For  example,  to  open  an 
abscess  on  the  palmar  surface  of  the  distal  phalanx, 
inject  about  ten  or  fifteen  minims  (fa-flj'  into  the 
middle  of  the  palmar  surface  of  the  proximal  phal- 
anx ;  then  wait  two  or  three  minutes  before  making 
the  incision.  These  points  in  the  use  of  cocaine 
were  demonstrated  to  me  by  Dr.  R.  I,  Hall, 

In  one  case,  five  minutes  after  the  injection  of 
fifteen  minims  of  cocaine  about  the  elbow,  the  pa- 
tient vomited  freely,  and  three  or  four  oiheis  have 
complained  of  nausea  or  faintue.ss  after  the  use  of 
from  fifteen  to  twenty  minims.  As  many  ])atients 
f^\nt  when  the^  tirst  come  to  the  dispensary, (;iil)er 


from  looking  at  their  own  wounds  or  those  of 
others,  it  is  not  easy  to  know  how  much  effect 
cocaine  had  in  producing  the  faintness  in  these 
cases. 

When  wounds  are  granulating,  balsam  of  Peru 
en  strips  of  gauze  is  found  to  be  very  valuable  in 
stimulating  granulations.  Nitrate  of  silver  is  some- 
times, with  advantage,  alternated  with  this.  If 
there  is  an  offensive  odor  from  a  sloughing  wound 
balsam  will  speedily  destroy  it. 

Particular  attention  is  required  to  prevent  granu- 
lations from  becoming  excessive,  and  when  they 
tend  to  grow  above  the  cicatricial  edge  they  aie 
removed  with  a  pair  of  curved  scissors,  which  can 
be  done  without  causing  pain.  This  is  much  bet- 
ter than  attempting  to  keep  them  down  wilh  caus- 
tics. The  bleeding  is  stopped  by  ])iessure,  and  die 
ulcer  then  strapped,  if  the  skin  about  it  is  heaiiliy, 
or  small  pieces  of  rubber  tissue  are  placed  across 
the  wound,  and  held  in  position  by  a  dry  compress 
and  bandage.  For  this  purpose  rubber  tissue  is 
nearly  as  good  as  green  protective,  and  much 
cheaper. 

Burns  are  treated  first  with  iodoform-ointment 
(twelve  and  a  half  per  cent,  of  iodoform),  if  not  too 
extensive  (as  on  hand  and  wrist),  later  with  an 
ointment  of  starch  25  parts,  oxide  of  zinc  25  parts, 
salicylic  acid  3  parts,  and  cosmoline  50  parts. 
.Some  cases  do  better  under  powdered  subnitrate  of 
bismuth. 

.Sprains  are  treated  at  first  with  iodoform-oint- 
ment, spread  on  gauze,  which  is  covered  with  com- 
mon cotton,  firmly  and  smoothly  ajiplied.  If  at 
the  wrist,  a  dorsal  s|jlint  is  used.  Iodoform  cer- 
tainly relieves  pain  in  these  cases  very  much.  The 
part  is  kept  at  rest  about  four  days,  and  then,  if 
pain  persists,  or  there  is  much  effusion,  Paquelin's 
cautery  is  lightly  applied,  and  the  part  bandaged 
after  rubbing  on  a  little  vaseline.  The  cautery  is 
used  at  a  dull  red  heat,  and  applied  .so  as  produce 
a  uniform  redness  over  the  joint,  and  should  leave 
almost  no  scar.  Iodine  ointment  (U.  S.  P.)  is  used 
sometimes,  as  a  counter-irritant,  and  to  hasten  ab- 
sor])tion.  The  tincture  is  rarely  used,  as  it  soon 
produces  a  hard,  thick  layer,  so  that  the  next  ap- 
plication produces  no  effects  on  the  parts  beneath. 
We  find  the  actual  cautery,  as  used  above,  pro- 
duces excellent  results  in  strains  of  the  back,  old 
contusions,  and,  especially,  in  teno-syuovitis  crepi- 
tans of  the  extensors  of  the  hand  when  combuied 
with  rest. 

Of  ulcers  of  the  leg  many  are  syphilitic,  and  in 
these  constitutional  treatment  is  the  chief  measure 
in  producing  a  cure.  In  chronic,  indolent,  and 
varicose  ulcers  every  effort  is  made  to  prom]itly 
jjlace  the  ulcer  in  a  healthy  conditton.  If  the 
granulations  are  pale,  flabby,  and  above  th;  sur- 
face, they  are  cut  down  with  scissors  and  the  ulcer 
stia;3ped  for  a  few  d.iys  with  yellow  adhesi\'e  plas- 
ter, If  the  base  of  the  ulcer  is  below  the  level  of 
the  surface  of  the  skin,  presenting  the  ■'  mucous 
Appearance,  "  it  ig  scraped  with  a  shar]j  sjjoon  and 
fjrgsged  with  balsam  of  Peru.     If  the  skin  about  th^ 


THE   CANADA   MEDICAL   RECORD. 


253 


ulcer  is  cczematoiis,  an  ointment  of  iodoform  or 
lioracic  acid  is  ap|ilicd.  'I'licse  last  cases  do  lifllcr 
when  given  modciaie  doses  of  iron  and  ([iiinine. 
,\t  present  the  following  trealmenl  is  heijig  rein- 
trodiued,  as  a  few  years  ago  it  was  used  here  with 
success.  'I'he  surface  is  washed  with  i  :  40  carbo- 
lic acid  solution  and  covered  witli  narrow  strips  of 
lublier  tissue  which  liave  been  dipped  in  the  same 
solution.  'I'heii  a  large  comi)ress  wrung  out  in  a 
saturated  solution  of  boracic  acid  i.s  applied  ;  over 
this,  rubber  tissue  and  crinoline  bandage  are  added, 
and  the  dressing  i.s  left  on  from  four  to  eight  days. 

Patients  with  varicose  veins  are  advised  to  wear 
Martin's  bandage. 

Chancroids  with  an  active  erosive  tendency  are 
treated  by  cauterization  with  nitric  acid  and  95  per 
cent,  carbolic  acid.  The  latter  causes  only  slight 
pain  and  an;estheli/.es  the  part,  but  is  often  too 
superficial  in  its  action,  and  nitri<;  acid  is  then 
applied  to  the  sore,  which  is  dried  and  dusted  over 
with  lodotorm  powiler,  and  a  ])iece  ol  absorbent  cot- 
ton packed  into  the  ulcer.  The  patient  is  instructed 
to  wash  the  parts  about  the  sore  daily  with  water, 
and  then  dry  them  thoroughly  before  ajiplying 
iodoform  and  compress.  Chancroids  which  are 
simply  indolent  are  touched  v.'ith  cupric  sulphate 
and  then  dressed,  as  before  mentioned,  with  iodo- 
form. 

Chancres  are  not  cauterized  or  excised.  An 
"expectant  treatment"  is  followed  until  the  erup- 
tion appears,  when  murcury  is  given  by  inimction, 
the  ointment  or  oleate  being  used.  The  stomach 
is  thus  imdisturbed,  and  tonics,  usually  indicated, 
are  readily  taken  and  well  borne.  When  the  inunc- 
tions are  commenced  the  patient  is  made  to  use  a 
tooth-brush  and  castile  soajj  to  keep  the  teeth  clean. 
In  addition  a  gargle  of  chlorate  of  potash  is  given. 
Unless  the  precaution  of  cleanliness  is  obser\  ed  the 
gums  soon  become  teuder  and  bleed  readily,  but 
with  it,  these  symptoms  rarely  develop. 

'I'he  majority  of  jiatienls  being  forced  to  keep  at 
hard  work  no  attempt  is  usually  made  to  abort  a 
bubo.  In  some  few  cases  when  rest  can  be  obtained 
pressure  is  applied,  and  in  a  majority  of  cases  su[j- 
puration  is  avoided.  As  soon  as  there  is  redness 
and  much  pain  in  the  bubo,  an  incision  is  made 
without  waiting  for  signs  of  fluid  to  appear.  The 
incision  is  made  after  the  injection  into  the  skin  of 
cocaine,  and  very  little  pain  is  felt.  The  incision 
is  a  free  one,  parallel  to  Poupart's  ligament,  and 
opens  the  whole  of  the  tissues  involved.  The 
finger  is  then  iVitroduced  into  the  incision,  and 
the  spongy  mass  thoroughly  broken  down  and 
enucleated,  a  steel  curette  being  frequently  needed 
when  the  mass  is  firm.  To  open  freely  the  pockets 
on  either  side  of  this  cut  several  others  are  made  at 
angles  to  the  primary  incision.  The  bubo  is  then 
packed  with  iodoform-gauze  and  heals  by  granula- 
tion.— Philadelphia  Medical  News. 


THE  TREATMENT  OF  COLDS. 
(J.  H.  Whelan.  M.  D.,  R.  N.,  in  The  Practition- 
-er.)0{  all   disagreeable  constitutional    tenden- 


cies, the  tendency  to  ''catch  colds"  is  the  most 
disagreeable  to  the  individual,  and  besides  its 
unpleasantness  there  is  always  the  danger  that  a 
catarrh  may  outslep  its  usual  limits  and  develop 
into  some  grave  inllamniation. 

Is  the  nature  of  common  catarrhs  generally 
understood?  To  a  certain  extent  I  think  it  is,  but 
not  fully.  Let  me  enunciate  broad  characteristics 
of  colds.  Catarrhs  are  excited  de  iio~'0  by  expo- 
sure to  wet,  colds  and  draughts.  This  is  a  truism. 
Most  frequently  they  develop  in  delicate  and  high- 
ly neurotic  individuals,  in  fact  in  the  classes  which 
furnish  martyrs  to  common  neuralgia.  I  believe, 
moreover,  that  when  once  a  catarrh  is  ])roperly 
established  the  affected  person's  breath  is  infec- 
tious, in  the  acute  stage  of  the  disease  at  least. 
AVhat  than  is  th.e  nature  of  the  affections?  (1)  Is 
it  a  specific  poison  comparable  to  thai  of  the  infec- 
tious fevers?  (2)  Does  the  affection  start  as  an 
idiopathic  inllamniation  and  develop  a  specific 
jxiison  which  is  given  off  by  the  breath?  (3)  Is  it 
of  nervous  reflex  origin  purely? 

Burger  has  discineied  mii  nxocci  in  catarrhal 
secretions,  and  they  are  (lossibly  factors  in  the 
afre<tion.  Let  us  supjxjse  that  these  micrococci 
or  these  spores  are  distributed  nearly  universally 
in  the  atmosphere,  and  are  carried  in  fomites. 
Let  us  suppose  them  in  their  usual  state  to  be 
unable  to  attack  the  healthy  buccal,  nasal,  or 
mucous  membranes.  Let  us  presume  that  there 
is  a  condition  in  which  the  trophic  nerves  of  those 
membranes  become  depressed  and  lose  their  tonic 
action  by  the  action  of  poor  blood,  or  from  the 
periodical  neurasthenia  of  hereditary  neurotics. 
Here  the  result  of  section  of  the  trigeminus  on  the 
eye  is  recalled  to  one's  mind,  and  the  fact  pointed 
out  by  Snellen  that  ophthalmia  did  not  ensue  if 
the  eye  was  carefully  covered  with  cotton-wool, 
thereby  to  a  great  extent  excluding  micro-organ- 
isms, before  the  nerve  section  was  made.  Let  us 
suppose  that  by  feeling  in  such  pastures  the  pro- 
geny of  the  attacking  micrococci  become  so  viru- 
lent as  to  be  able  to  attack  successfully  the  healthy 
membranes.  We  know  by  Pasteur's  experiments 
the  intensive  effects  of  culture  on  some  microorgan- 
isms. On  these  not  unreasonable  supjjositions 
then  all  the  peculiarities  of  catarrhs  are  explainable. 

Influenza  epidemics  would  be  explained  by 
supposing  that  within  large  tracts  of  country  all 
catarrhal  micrococci  became  suddenly  virulent, 
owing  to  some  climatic  or  telluric  fostering  cause, 
or  to  some  law  of  heredity  or  evolution  of  the 
organisms  themselves.  This  would  account  for 
the  e-xtensive  and  sudden  outbreaks  which,  on  first 
view,  seem  so  surprising. 

The  usual  "codding"  treatment  of  colds,  except 
in  the  very  old,  very  young,  or  very  delicate,  is  a 
mistake.  A  person  suffering  from  a  catarrh  should 
certainly  be  warmly  clothed  and  avoid  draughts  ; 
but  by  shutting  himself  up  in  a  warm  room,  by 
taking  warm  air  baths  and  lowering  medicines,  he 
only  promotes  the  development  of  the  exciting 
cause  of  the  affeetign, 


254 


THE   CANADA   MEDICAL   RECORD. 


"  Feed  a  cold,  starve  a  fever."  There  is  a  deal 
of  wisdom  in  the  first  part  of  this  advice.  A  per- 
son with  a  catarrh  should  take  an  abundance  of 
light,  nutritious  food,  and  some  light  wine,  but 
avoid  spirits,  and  above  all  tobacco. 

Now  as  to  medicines.  All  depressants  should 
be  avoided.  For  some  time  I  was  in  the  habit  of 
taking  a  mixture  recommended  by  Dr.  Jules 
Styrap,  comijosed  of  minute  doses  of  morphine, 
antimonial  wine,  and  potassium  citrate.  This 
beyond  doubt  always  subdued  the  acute  inflamma- 
tory stage,  but  I  have  no  hesitation  in  saying  I 
was  depressed  by  its  action,  and  rendered  liable 
to  relapses  and  renewals.  Personally  I  have 
found  the  large  dose  of  an  opiate  in  the  earl}' 
stages,  as  e.xtolled  by  Sir  Thomas  Watson  and 
Dr.  George  Johnson,  very  unpleasant  and  of  but 
little  use. 

'I'rying  to  avert  an  atack  by  a  large  dose  of 
potassium  iodide  failed  in  my  hands.  The  brom- 
ides were  useless  through  all  stages.  Antiseptic 
inhalations  and  spraying  afforded  temporary  relief 
from  the  distressing  symptoms,  but  failed  to  cure. 

Belladona.  quinine,  arsenic  I  have  found  useful 
when  given  separately — not  so  much  in  large  as  in 
small  doses.  When  combined  1  believe  them  to 
be  nearly  specific — prophylactically  and  therapeu- 
tically, if  I  may  so  speak. 

The  formula  I  invariably  use  is  as  follows  : — 

IJ .     Quininffi  sulphatis,  gr.  xviij  ; 

Liquoris  arsenicalis, wxij  : 

Liquoris  atropine, wj  : 

Extracti  gentianai gr,  xx. 

Pulveris  gummi  acaciae,  q.  s.  ut  fiant  pilulse 
xii. 

Sig.  One  every  three,  four,  or  six  hours,  accord- 
ing to  circumstances.  If  these  pills  be  commen- 
ced in  the  early  stage  of  a  common  cold,  /.  e.  ,when 
the  affection  is  as  yet  confined  to  the  nose  and 
pharynx,  the  affect  on  will  be  nipped  in  the  bud. 
At  starting  one  jiill  should  be  taken  every  three 
or  four  hours,  and  later  on  every  six.  If  a  catarrh- 
al subject  has  a  box  of  these  pills  always  at  hand, 
he  has,  I  believe  a  weapon  wherewith  to  meet 
and  defeat  his  enemy.  The  longest  I  have  seen 
a  cold  last  whilst  the  patient  was  fairly  taking 
these  pills  was  three  days.  How  the  remedy  acts 
I  do  not  know,  except  it  be  as  a  powerful  nervine 
and  general  tonic,  bracing  the  patient's  tissues 
up  to  resist  the  attacks  of  the  exciting  cause  of 
the  affection. 


TREATMENT  OF  ERYSIPELAS, 

ROBERT  POLLOK,  M.  B. 

The  treatment  of  erysipelas  is  most  varied, 
nearly  every  practitioner  who  sees  much  of  this 
affection  having  formulated  a  certain  line  of  action 
for  lumsclf.  This  arises  to  some  extent.  I  tiu'nk, 
from  the  fact  that  simple  erysipelas  has  a  tendency 
to  subside  spontaneously  in  about  5  or  6  days,  and 
often  the  treatment  adopted  obtains  the  credit 
while  nature  does  the  work.     I  am  of  opinion  that 


the  treatment  must  depend  upon  the  type  of 
the  disease.  In  all  the  cases  I  have  seen,  the 
treatment  demanded  was  a  stimulating  one.  I 
refer  to  simple  general  erysipelas.  But  in  locali- 
zed erysipelas  affecting  the  throat,  ear,  and  pha- 
ranx,  aconite  in  small  doses',  frequently  repeated 
as  recommended  by  Ringer,  has  been  productive 
of  the  happiest  effects  when  administered  at  the 
beginning  of  the  attack.  I  will  take  as  a  typical 
example  of  simple  cutaneous  erysipelas  that  form 
which  we  so  commonly  see,  commencing  over  the 
root  of  the  nose,  and  spreading  over  the  face  and 
forehead.  In  such  cases,  I  immediately  begin  the 
administration  of  20  to  30  minims  of  tinct.  ferri 
mur.  (diluted  of  course  with  water)  every  two 
hours  ;  and  as  a  protective  and  palliative,  I  use  : 
R.  Gutta  Percha,  5ii:Chlorof.  Meth.,  ^  ii  solve; 
Zine.  Olcati,  3  '•  !  Iodoform!,  3  ss.  M.  Sig. — 
'lobe  painted  over  the  part  affected.  The  avan- 
tage  of  this  preparation  over  the  powdered  starch, 
zinc,  or  Hour,  is  its  comeliness.  Of  course,  previ- 
ously to  applying  this  preparation.  I  have  the 
parts  carefully  washed  with  tepid  water,  and  often 
when  there  is  much  pain  I  use  the  decoction  of 
pop])y  heads  as  a  fomentation.  This  treatment 
usually  effects  an  amelioration  of  the  symptoms, 
and  the  disease  subsides.  But  in  some  cases  the 
course  of  the  disease  does  not  stop  here,  it  runs 
riot  all  over  the  head  and  neck,  and  the  medicinal 
treatment  then  pursued  is  ammonia,  bark,  iron 
and  quinine,  with  perhaps  a  grain  of  solid  opium 
to  obtain  rest.  I  am  happy  to  state  that  I  have 
never  lost  a  case  of  erysipelas,  although  the  dura- 
tion and  severity  of  the  complaint  have  varied 
much.  The  rafiorm/  o(  ihe  local  application  above 
mentioned  must  be  purely  protective  and  pal- 
liative by  excluding  the  irritating  effects  of  the 
cold  air,  and  not  by  excluding  specific  germs.  The 
latest  researches  prove  that  the  schizomycetes  or 
streptococcus  erysipelatosus  is  annerobic,  or  flour- 
ishes wliere  air  is  excluded,  living  in  and  upon  the 
tissues  aflected.  I  may  note  the  many  methods 
of  treatment  recommended,  such  as  compression, 
or  ligatures  applied  above  the  seat  of  the  affection, 
advocated  by  Velpeau;  the  application  of  a  solu- 
tion of  nitrate  of  silver  in  the  form  of  a  ring 
around  the  redness  (Higginbotham's  method)  ;  the 
application  of  tincture  of  iodine,  white  paint, 
solutions  of  tannin,  silicate  of  soda,  used  by  Alva- 
renga  of  Lisbon  ;  the  subcutaneous  injection  of 
carbolic  acid  or  salicylic  acid  directly  into  the 
])art,  and  the  internal  administration  of  quinine  in 
large  doses,  or  salicylate  of  ammonium,  suggested 
by  Dr.  Barclay  of  St.  George's  Hospital.  These 
may  all  be  good,  but  so  satisfactory  have  been  the 
results  by  the  iron  and  the  antiseptic  anodyne 
externally  applied,  that  I  have  had  no  reason  to 
depart  from  that  treatment.  I  earnestly  look  after 
the  hygienic  surroundings  of  the  patient,  and  give 
eggs,  milk,  beef  tea,  and  other  stimulating  and 
light  diet.  The  disease  may,  however,  pass  into  a 
stage  when  surgical  treatment  must  be  adopted.  If 
simple  bullai  or  vesicles  form,  I  relieve  the  tension 


THE  CANADA  MEDICAL  RECORD. 


25§ 


by  cvaciKiting  tlicni,  ami  dress  the  surface  with 
tartrate  of  |)(jtash  and  iron  lotion  in  tlie  strength 
of  lo  grains  to  the  ounce  of  water.  When  slough- 
ing and  supjjuration  take  place  I  make  free  inci- 
sions; the  ])us  and  sloughs  thus  obtain  a  free  exit ; 
the  separation  of  the  mortified  parts  may  be  accel- 
erated by  the  scissors.  I  then  ap]jly  an  antise])- 
tic  solution  by  means  of  the  syringe  or  douche,  dry 
the  parts  thoroughly,  and  dress  with  sublimated 
wood  wool.  The  best  antiseptic  lotion  is  corro- 
sive sublimate  one  grain  in  five  ounces  of  water,  or 
nearly  in  the  |)roi)ortion  of  i  to  2,000.  Koch's 
solution,  as  it  is  now  called,  is  the  same  as  the  old 
"  M'Kenzie's  "  colloyrium.  An  important  point 
which  should  not  be  overlooked  in  the  treatment 
of  erysipelas  as  well  as  in  so  many  other  affections, 
is  the  effectual  clearance  of  the  prima:  via  by  a 
good  purge,  administered  at  the  commencement 
of  the  attack.  If  erysipelas  assume  a  typhoid 
form,  alcoholic  stimulants  are  strongly  indicated. 
Infantile  erysipelas  I  treat  on  the  general  lines 
laid  down,  although  the  tincture  of  iron  is  not  so 
admissible  owing  to  its  griping  tendency  ;  acetate 
of  iron  is  less  irritating.  When  erysipelas  com- 
mences in  the  throat,  inhalation,  or  the  steam 
atomizer,  with  some  antiseptic,  should  be  used. 
I  watch  carefully  for  cedema  of  glottidis.  If 
it  does  occur,  tracheotomy  is  the  only  resource. — 
Glasgow  Medical  Joii  ma  I. 


ON     THE    TREATMENT    OF     PLEURISY 
WITH   EFFUSION  BY  H.W'S  METHOD. 

Ab>tract  of  a  Clinical  Lecture,  delivered  at  the  Hospital  of 
the  University  of  Pennsylvania, 

BY  WILLL-VM  OSLER,  M.D., 

Professor  of  Clinical  Medicina  in  the  University  of  Penn- 
sylvania. 

Gentlemen  ;  You  have  had  in  the  ward  classes 
during  the  past  month,  several  interesting  cases  of 
pleurisy,  which  have  familiarized  you  with  the 
clinical  history  and  physical  signs  of  the  disease, 
and  I  shall,  to-day,  first  direct  your  attention  to 
certain  points  in  the  plan  of  treatment  which  we 
have  followed.  Let  me  briefly  summarize  the 
history  of  the  cases. 

Ca.se  I. — A.  B.,  aged  twenty-three  ;  admitted 
on  the  21st.  He  had  been  a  healthy  man.  Three 
days  before  admission  he  was  caught  in  a  rain- 
storm and  remained  all  day  in  his  wet  clothes. 
The  following  morning  he  had  pain  in  the  head, 
neck,  and  right  side;  in  the  latter  situation  the 
pain  was  of  a  sharp,  stabbing  character,  and  in- 
creased by  drawing  a  deep  breath.  He  had  fever, 
lost  appetite,  had  also  a  sore  throat  and  diarrhoea. 
When  admitted  the  face  was  flushed,  the  rcs|iira- 
tions  34  in  the  minute,  pulse  100,  and  temijerature 
101°.  He  lay  on  the  left  side.  E.xamination 
showed  deficient  expansion  on  the  right  side,  with 
jerky,  inspiratory  movements.  There  was  a  dis- 
tinct friction  fremitus  to  be  felt  and  heard  below 


the  right  nipple,  and  there  was  slight  dulness  in 
lower  axillary  aiul  iiifrascapular  regions.  On  the 
fourth  day  the  temperature  was  normal,  and  there 
were  signs  of  effusion  to  the  level  of  the  fifth  rib. 

CAsrc  II. — J.  M.,  aged  twenty-four,  a  well- 
nourished  young  man,  was  admitted  on  November 
12.  In  1883  he  was  poisoned  with  arsenicand  is 
now  ata.xic,  the  result,  a|jparently,  of  a  jjcripheral 
neuritis.  His  present  trouble  began  three  weeks 
before  admission.  Four  or  five  days  after  ex- 
posure to  cold  and  wet,  he  felt  a  jiain  in  the  right 
side  and  had  a  cougli,  with  fever  and  occasional 
sweats.  He  did  not  go  to  bed,  but  gradually  got 
sliort  of  breath,  and  for  this  symptom  he  sought 
relief  at  the  hospital.  Shortly  after  his  admission 
I  called  your  attention  to  the  characteristic  physi- 
cal signs  in  this  case.  The  effusion  was  in  the 
left  side  and  reached  as  high  as  the  lower  border 
of  the  second  rib.  The  heart  was  displaced  and 
there  was  an  impulse  near  the  right  nipple.  You 
saw  him  in  clinic  two  weeks  ago  to-day. 

Case  III. — William  G.,  aged  twenty-three, 
admitted  to  the  Philadelphia  Hospital  October 
1 2th  with  shortness  of  breath.  He  had  been 
ailing  for  seven  weeks.  Had  never  had  a  chill  or 
pain  in  the  side.  Had  been  feverish  at  times, 
had  sweated  and  had  been  gradually  getting  short 
of  breath.  Though  not  able  to  work,  he  kept 
about  and  had  not  been  in  bed.  There  was  left 
pleural  effusion  with  absolute  dulness  reaching  to 
the  clavicle  and  displacement  of  the  heart  to  the 
right ;  with  the  hypodermic  needle  the  fluid  was 
determined  to  be  serous.  He  had  been  drinking 
before  admission,  and  for  nearly  ten  days  there 
was  mild  delirium  tremens. 

The  effusion  in  these  cases  varied  from  the  slight 
amount  in  Case  I.,  which  would  probably  have 
disappeared  in  time  without  medication,  to  the 
large  exudation  in  Case  III.  filling  the  side  of  the 
chest.  In  treating  pleuritic  effusion  we  have  to 
choose  between  medicinal  and  operative  measures, 
and  these  cases  illustrate  the  rules  which  I  have 
already  laid  down  for  your  guidance.  In  the  first 
two  cases  the  sym])toms  were  not  urgent,  the  con- 
dition of  the  patients  good  and  the  duration  of  the 
disease  not  prolonged.  In  Case  II.  we  were  in 
doubt  whether  or  not  to  aspirate,  as  the  line  of 
dulness  reached  to  the  second  rib  ;  but  I  am  glad 
we  decided  to  try  first  the  effect  of  medicines. 

Now  the  usual  routine  in  treating  pleural  effu- 
sion is  to  give  purgatives,  diuretics,  and  diaphore- 
tics, but  the  [ilan  to  which  I  wish  specially  to  call 
your  attention  this  morning  is  the  use  of  concen- 
trated solution  of  saline  cathartics  introduced  by 
Professor  Mathew  Hay,  of  Aberdeen.  We  have 
employed  his  method  extensively  in  dropsies  from 
various  causes  and  with  very  .satisfactory  results. 

Dr.  Hay  found,  when  investigating  the  physio- 
logical action  of  saline  cathartics,  that  if  the  salt 
was  given  in  a  very  concentrated  form,  when  the 
intestines  of  the  animal  contained  very  little  fluid, 
it  produced  a  very  rapid  concentration  of  the 
blood  owing  to  the  abstraction  of  water  to  form 


256 


THfi   CANADA   MEDICAL   RECOilfi. 


the  intestinal  secretion  excited  by  the  salt.  If  the 
sahne  was  not  given  in  concentrated  form  or  was 
administere<l  at  a  time  when  the  l)owel  contained 
much  hqiiid,  the  action  upon  the  blood  was  very 
shght.  'I'he  effect  is  very  rapidly  produced  ;  in 
one  instance,  in  a  man  after  giving  six  drachms  of 
sulphate  of  soda,  the  number  of  blood  corpuscles 
per  cubic  millimetre  rose  from  5,000,000  to  nearly 
7,000,000,  owing  to  the  great  loss  of  liquid  in  the 
free  purgation.  A  few  hours  later  this  increase 
was  no  longer  apparent,  as  the  blood  had  rapidly 
abstracted  the  tissue  fluids  and  so  leplaced  the 
amount  lost.  Vou  know  that  the  |>inched,  shrivel- 
led aspect  of  a  ])erson  who  has  had  a  severe 
choleraic  attack  is  due  in  large  ]jart  to  the  absorp 
tion  of  the  tissue  lymph  to  suj.ply  the  rapid  waste 
caused  by  the  liquid  stools. 

It  is  on  this  principle  that  the  use  of  cathartics 
in  dropsical  effusions  is  based,  and  Hay's  method 
is  new  only  in  the  application.  In  the  administra- 
tion of  the  salt,  the  solution  must  be  concentrated, 
and  taken  at  a  time  when  there  is  very  little  fluid 
in  the  intestines.  Our  usual  plan  is  to  order  the 
patient  to  take  nothing  after  the  evening  meal,  and 
then,  an  hour  or  so  before  breakfast,  the  salt  is 
given  dissolved  in  as  little  water  as  possible.  The 
sul[>hate  of  magnesia  is  preferable  to  the  sulphate 
of  soda,  as  it  is  more  soluble.  Four  or  six  drachms 
in  an  ounce  of  water  is  the  usual  dose,  but  two 
ounces,  or  even  more,  may  be  given.  The  patient 
must  not  drink  after  it.  I'his  usually  jiioduces 
from  four  to  eight  watery  stools,  without  pain  or  | 
discomfort  of  any  sort.  It  very  raiely  disagrees, 
though  you  remember  in  the  case  of  Mrs.  C,  the 
patient  with  extensive  anasarca  from  Bright's 
disease,  we  had  to  give  up  this  plan  on  account 
of  the  vomiting  it  induced.  Dr.  Hay  calls  atten- 
tion also  to  another  point  which  we  have  repeated- 
iy  verified,  namely,  that  the  salt  acts  also  as  a 
diuretic.  He  found  experimentally  that  the  blood 
underwent  a  second  concentration,  not  so  marked, 
but  lasting  tor  the  greater  part  of  the  day,  and 
this  he  rightly  attributed  to  the  diuretic  action  of 
the  absorbed  salt. 

Case  II.  is  a  striking  instance  of  the  value  of 
this  |)lan  of  treatment.  Two  weeks  ago  I  demon- 
strated to  )Oii  that  the  fluid  reached  as  high  as 
the  third  rib,  and  was  rapidly  subsiding.  He  has 
been  given  every  second  morning,  since  his  admis- 
sion on  the  1 2th,  half  an  ounce  of  sulphate  of 
magnesia  in  an  ounce  of  water,  and,  as  you  can 
see  by  the  chart,  this  has  produced  from  three  to 
nine  watery  stools.  His  diet  has  been  restricted 
somewhat  in  liquids,  but  ho  has  had  no  other 
medicine.  We  find  now,  on  examination,  good 
expansion  on  the  left  side  ;  the  heart  has  returned 
to  its  normal  situation  ;  on  palpation  a  distinct 
friction  can  be  felt  in  the  axillary  region  ;  tactile 
fremitus  is  ]jresent  ;  on  percussion  the  note  is  clear 
in  the  antero-latetral  regions,  and  posteriorly  it  is 
resonant  almost  to  the  base  ;  the  breath  sounds 
are  heard  well  over  the  whole  side,  with  the  excep- 
tion  of  the    extreme  base,  where  they    are   still 


feeble.  The  patient  was  discharged  the  day  be- 
fore yesterday  to  go  on  duty  as  night  watchman  on 
the  surgical  side.  We  may  regard  this  as  an  ex- 
ceptionally good  result.  It  is  the  third  instance  in 
which  I  have  seen  a  large  effusion  disappear  rapid- 
ly treated  by  Hay's  method. 

Exudations  of  less  extent  will  sometimes  disap- 
pear in  a  few  days.  Case  I.  we  saw  early  in  the  acute 
stage,  and,  to  relieve  the  distress,  he  was  wet-cup- 
ped with  marked  benefit.  This  is  a  measure  which 
I  do  not  often  employ,  as  I  find  that  morphia  sub- 
cutaneously  fulfils  the  indication  ;  but  here  the  pain 
was  rapidly  relieved  and  the  breathing  became 
much  quieter.  The  effusion  in  this  case  reached 
only  to  the  fifth  rib.  He  had  foui-  or  five  doses  of 
the  concentrated  saline  solution,  and  was  freely 
]iurged.  To-day  there  is  scarcely  a  trace  of  fluid, 
and  you  notice  that,  on  percussion,  the  lung  is  clear 
almost  to  the  extreme  base. 

In  Case  III.  saline  cathartics  were  also  employed, 
but  other  and  more  prompt  measures  were  indicat- 
ed. The  left  chest  was  full,  the  percussion  note 
on  the  clavical  was  absolutely  flat,  and  the  fluid 
had  been  accumulating  for  at  least  seven  weeks. 
Under  such  circumstances  the  withdrawal  of  some 
of  the  fluid  was  imperative.  It  is  a  good  rule  to 
aspirate  when  the  fluid  reaches  the  second  or  third 
rib.  The  removal  of  from  twenty  to  thirty  ounces 
will  often  suffice,  and  jou  can  trust  to  medicines 
to  remove  the  balance.  \\'hen  you  find  the  fluid 
at  the  level  of  the  clavicle,  as]iirate  at  once,  as  con- 
nected with  this  condition  there  are  certain  dan- 
gers which  we  cannot  ignore.  Such  patients  are 
liable  to  sudden  and  alarming  attacks  of  dyspnoea 
This  occurred  in  Case  III.,  and  my  house  physi- 
cian, Dr.  Donohue,  wisely  withdrew  at  once  be- 
tween two  and  three  yjints  of  fluid.  There  are  in- 
stances, also,  of  sudden  and  fatal  collapse  under 
these  circumstances.  Such  a  case  occurred  last 
spring  in  the  Philadelphia  Hospital,  when  I  was  on 
duty  for  my  colleague.  Dr.  Tyson.  A  woman  was 
admitted,  stated  to  be  suffering  with  pneumonia. 
I  saw  her  for  a  few  minutes  at  the  conclusion  of 
my  visit,  and  made  a  rather  hasty  examination,  and 
determined  the  existence  of  dulness  on  the  left 
side.  She  died  suddenly  and  unexpectedly  the 
next  day,  and,  to  our  mortification,  we  ffumd  the 
left  chest  full  of  fluid,  the  lung  greatly  compressed, 
and  the  heart  pushed  far  over.  We  could  not  de- 
termine the  cause  of  the  sudden  collapse,  but  I 
feel  certain  it  might  have  been  averted  by  timely 
aspiration. 

In  Case  III.  we  would  not  trust  to  the  saline 
cathartic  alone  as  the  patient's  general  condition 
was  not  good.  He  was  aspirated  twice  subse(]uent- 
ly,  and  had  an  occasional  morning  purge.  At  pre- 
sent he  is  convalescent,  has  gained  in  weight  and 
strength,  and  although  there  is  still  dulness  at  the 
left  base,  I  believe  it  is  due  chiefly  to  thickened 
pleura  and  not  to  fluid. 

My  experience  with  this  method  is  sufficient  to 
justify  a  strong  recommendation  of  its  merits.  In 
the  general  dropsies — renal  or  cardiac — the  results 


THE  CANADA    MEDICAL   KECORIJ. 


257 


have  been  equally  good.  There  have  been 
failures,  to  one  of  which  I  have  already  referred, 
and  I  have  on  several  occasions  heard  com- 
plaints of  nausea  following  the  strong  and  hitler 
solution.  In  another  case  last  sununor,  the  i)aticnt, 
a  young  man,  thought  the  daily  imrgation  ami  a 
rather  dry  diet  terrible  hardsiiips,  and  he  escapetl 
from  the  hospital. 

'I'he  essence  of  the  method  lies  in  getting  the 
strong  salt  into  the  intestine  at  a  time  when  the 
fluid  contents  are  scanty.  The  concentrated  hitter 
st)lution  excites  a  copious  secretion  from  the  intes- 
tinal glands,  which  distends  the  intestine  and  in- 
duces rapid  peristalsis.  Saline,  as  well  as  other 
purgatives,  have  long  been  employed  in  the  treat- 
ment of  dropsies,  but  this  plan  of  Hay's  is  so  sim- 
ple, produces  so  little  irritation,  and  at  the  same 
time  acts  powerfully,  and  as  you  have  seen,  effec- 
tually, that  with  us  it  has  superseded  other  methods 
in  cases  in  which  we  wish  the  action  of  a  powerful 
and  prompt  cathartic. — Medical  News. 


THE  DIURETIC  ACTION  OF  MERCURIAL 
PREPARATIONS. 

The  diuretic  action  of  calomel,  know  to  the  older 
physicians,  has  been,  as  the  readers  of  the  G.'^zette 
are  familiar,  again  brought  to  the  attention  of  prac- 
titioners, and  we  have  published  testimony  from  a 
number  of  different  observers  which  indicates  that 
under  certain  circumstances  calomel  is  one  of  the 
most  active  diuretics  that  we  possess. 

That  this  diuretic  action  is  not  peculiar  to  calo- 
mel, as  has  been  claimed  by  a  number  of  writers, 
but  is  also,  though  perhaps  to  a  less  degree,  pos- 
sessed by  other  mercurial  preparations,  has  been 
brought  into  prominence  by  Dr.  Rosenheim  in  a 
paper  read  before  a  recent  meeting  of  the  Verein 
fiir  Innere  Medicin  of  Berlin  ( Therapeutische 
Monatshefte,  April,  1887). 

The  author  employed  corrosive  sublimate,  yel- 
low iodide  of  mercury,  and  the  amidato  bichloride 
in  amounts  of  from  i  )4  to  2  grains  given  daily. 
These  preparations  of  mercury  also  proved  them- 
selves active  diuretics  in  these  large  doses,  but  they 
produced  more  irritation  in  the  intestinal  canal 
than  calomel,  and  also  fell  behind  calomel  in  the 
degree  of  diuresis.  On  the  other  hand,  the  stoma- 
titis produced  by  these  mercurial  preparations  was 
but  slight.  Diuresis  only  follows  when  large  doses 
of  some  mercurial  preparation  are  rapidly  absorb- 
ed, seemingly  indicating  that  the  production  of 
diuresis  is  due  to  the  acute  mercurialiaation  of  the 
organism.  The  correctness  of  this  view  is  render- 
ed more  probable  by  the  large  amounts  of  mer- 
cury which    are  excreted  through  the  urine. 

Dr.  Rosenheim's  experiments  with  calomel  still 
further  strengthen  its  position  as  a  diuretic.  He 
employed  it  in  sixteen  cases  of  heart-disease  com- 
plicated by  dropsies,  in  several  of  which  kidney 
complications  were  also  present.  In  nine  of  these 
cases  a  prompt  diuresis  and  disappearance  of  the 
cedema  followed  the  use  of  calomel.     In   four  its 


action  was  hut  moderately  successful,  and  in  three 
it  entirely  failed.  It  is  worthy  of  notice  that  in  all 
these  cases  before  calomel  was  administered  digi- 
talis had  been  tried  and  proved  inefficacious. 
Since  it  has  been  found  that  calomel  has  no  direct 
a<:lii)n  either  on  the  heart  or  kidneys,  kidney-disease 
offers  no  contraindication  to  the  use  of  calomel 
for  the  purpose  of  jiroducing  diuresis.  In  fact, 
Dr.  Rosenheim  has  employed  calomel  fortius  pur- 
pose in  purely  nephritic  dropsy.  It  is  true  that 
the  results,  however,  were  unfavorable.  In  the 
greater  nunihei  of  jiatients  to  whom  calomel  was 
administered  a  more  or  less  severe  stomatitis  was 
produced,  and    in  nearly    all  cases  diarrhcea. 

In  tl)e  discussion  which  followed  the  reading 
of  Dr.  Rosenheim's  paper,  Dt.  Leyden  reported 
that  he  had  treated  three  cases  of  cirrhosis  of  the 
liver  with  calomel.  In  one  failure  had  resulted,  in 
one  marked  but  temporary  relief,  and  in  one  a  per- 
manent amelioration. 

In  the  treatment  of  dropsy  from  heart  disease, 
he  regarded  calomel  as  a  valuable  contribution  to 
our  therapeutic  measures. 

Fiihinger,  on  the  other  hand,  claimed  that  the 
diuresis  produced  by  calomel,  although  perhaps 
occurring  in  a  high  degree,  was  invariably  ephe- 
meral, and  he  regarded  its  mode  of  production  to 
dependent  upon  a  direct  action  on  the  glandular 
epithelium  of  the  kidney,  since  calomel  never  acted 
as  a  diuretic  in  cedema  dependent  upon  previous 
parenchymatous  nephritis. 

Dr.  E.  Biro,  of  Budapesth,  has  also  confirmed 
the  general  experience  of  others  as  to  the  marked 
diuresis  which  follows  use  the  of  calomel,  and  al- 
though in  his  practice  stomatitis,  colic,  and  diarr- 
hu;a  were  frequently  produced,  he  regards  these 
complications  of  but  little  moment  in  view  of  the 
powerful  action  of  the  remedy.  He  has  found 
that  the  degree  of  diuresis  depends  upon  the  inten- 
sity of  the  ffidema,  and  he  relates  one  case  of  mi- 
tral in  suffisiency  in  which  t  le  amount  of  urine  was 
increased  on  the  fifth  day  from  eight  hundred  to 
six  thousand  eight  hundred  cubic  centimetres. 
For  the  stomatitis,  which  is  at  the  worst  merely 
transient,  he  recommends  a  mouth-wash  of  potassi- 
um chlorate,  and  small  doses  of  opium  powder  for 
the  diarrhcea  and  colic. 

Terray  {Pest  med.  chir.  Press.,  18S6)  and 
Weinstein  (ITiefi.  nn-d  Blatt.,  1887,  No.  7,  p. 
206),  whilst  affirming  the  diuretic  effects  of  calo- 
mel, as  reported  in  the  Medical  Chronicle,  May, 
1887,  draw  attention  to  the  evils  which  may  follow 
its  administration.  Terrhy  states  stomatitis  occur- 
red in  all  his  cases,  and  its  intensity  seemed  direct- 
ly proportional  to  the  diuresis. 

Weinstein  records  a  marked  increase  in  the 
excretion  of  urine  in  four  cases  of  pleural  effusion, 
two  cases  of  cirrhosis  of  the  liver,  and  one  case  of 
Bright's  disease.  But  he  found  great  evils  arise 
from  the  administration  of  calomel  as  a  diuretic, 
profuse  diarrhcea,  stomatitis,  and  salivation  some- 
times occurring  after  even  small  doses.  The  diu- 
retic influence  of  the  drug,  he  says,  is   not  of  long 


25S 


THE  CANADA  MEDICAL   JlECORO. 


duration  and  he  recommends  it  chiefly  in  aihnents 
wliicii  liave  run  their  acute  course,  leaving  (jedema 
beliind  them,  and  in  those  where  the  mercurial 
itself  is  likely  to  exercise  a  beneficial  effect,  e.  g.,  in 
pleural  exudations. 

NUTRII'.NT  ENEMA  TA 

EwAi.D,  of  Berlin,  writes  to  the  Therapcutischc 
Mjnatshefte  for  April,  1887,  his  usual  methods 
ofprepaimg  such  eneniata  as  folllows  : 

In  hospital  practice  an  enema  may  be  made 
most  simply  by  beating  up  three  or  five  eggs  with 
fjur  or  five  ounces  of  a  fifteen  or  twenty  per  cent, 
solution  of  grape-sugar,  and  this  mixture  may  be 
carefully  injected,  as  most  convenient.  If  needed, 
starch  solution,  or  a  mucilage-water,  may  be 
added,  or,  if  there  exists  much  irritation,  a  few  drops 
of  tmcture  of  opium.  An  injection  of  about  eight 
ounces  of  tepid  water,  or  solution  of  common  salt, 
should  precede  the  nutrient  enema,  and  the  latter 
should  not  be  given  until  the  bowel  is  thoroughly 
eaiptied;  otherwise  the  nutrient  matter  may  beat 
once  rejected.  Enemata  should  not  be  larger  than 
eight  or  nine  ounces,  and  it  is  better  when  this 
amount  is  given  in  two  or  three  doses  during  the 
day. 

\Vhen  more  elaborate  methods  can  be  followed, 
two  or  three  eggs  should  be  beaten  with  a  sjioonful 
of  cold  water.  As  much  jjowdered  starch  as  the 
point  of  an  ordinary  kitchen-knife  will  take  should 
tnen  be  added,  and  a  small  cup,  or  half  a  large 
glass,  of  twenty  percent,  solution  of  grape-sugar, 
which  may  be  purchased  at  any  chemist's.  The 
whole  should  be  gently  heated,  and  a  wineglassful 
ot  common  red  wine  added. 

The  mixture  should  then  be  gently  stirred  or 
beaten,  and  the  caution  should  be  observed  not  to 
heat  it  so  hot  as  to  coagulate  the  egg  albinnen. 
When  ready  for  injectionthe  quantity  of  fluid  should 
not  exceed  a  half-pint. 

If  peptones  can  be  easily  procured,  a  teaspoon- 
ful  of  the  peptone  may  be  added  to  the  solution 
of  sugar  ;  while  advantageous,  it  is  not  absolutely 
needed,  for  eggs  prepared  without  peptones  are 
easily  absorbed. 

The  enema  should  be  given  with  a  syrinsre  wl.ose 
terminal  tube  is  long  and  flexible,  or  an  irriga- 
tor, whose  rectal  is  large  and  flexible,  may  be  used. 
After  taking  enemata  the  patient  should  be  kept 
quietly  upon  the  back,  or  on  the  side,  for  some 
time. 


HYDROCYANATE  OF  IRON  IN  THE 
TREATMENT  OF  EPILEPSY  AND 
NEURALGIAS. 

By  G.  W.  Baylor,  M.  D. 

Like  many  other  preparations  of  the  ferruginous 
type,  hydrocyanate  of  iron  apjiears  capable  to 
subserve  quite  a  number  of  indications,  though  its 
predominant  value  is  exhibited  in  the  treatment  of 


eiplepsy.  My  attention  was  first  called  to  this  re- 
medy in  the  treatment  of  epilepsy  by  Prof.  D.  S. 
McGugin,  of  the  Iowa  Medical  College,  in  the 
su|iplement  of  \\\tjimrnal  0/  Afati-ria  Medial,  in 
the  year  uS;!,  in  which  he  sjieaks  of  it  as  the  re- 
medy/<?/•  exLi/ieiu'C,  and  oites  a  number  of  cases 
that  were  permanently  cured  by  this  drug  alone. 
Having  at  that  time  under  my  care  and  treatment 
a  young  man  aged  eighteen  years,  who  had  been  a 
sufferer  from  that  terrible  disease,''  epilepsy,"  since 
early  childhood,  and  which  had  resisted  the  action 
of  all  remedies  then  known  to  the  medical  profes- 
sion, I  determined  upon  a  trial  of  the  hydrocyanate 
of  iron,  as  it  was  a  case  which  seemed  to  demand 
such  a  combination  or  such  a  remedy — as  his  gen- 
eral system  was  in  a  bad  condition,  which  is  usu- 
ally tile  case  after  a  protracted  course  of  treatment 
with  the  bromides. 

I    wrote  to  Messrs.   Tilden  &  Co.,   New   York, 
who  kindly  sent  me  a  sample  of  the  iron.     I  then 
put  my  patient  upon  the  following : 
y  Iron  hydrocyanate 
Pul.  valerian  a  a  gr.  cxx 

M.— Ft.— Pil.     No.    120.     S.— One   pill  three 
times  daily  after  meals. 

Each  pill  contains  a  grain  of  iron  and  one  grain 
of  valerian.  The  dose  was  gradually  and  cau- 
tiously increased,  so  that  at  the  end  of  three 
months  my  patient  was  taking  eight  grains  of  the 
drug  daily.  At  the  expiration  of  this  time  (three 
months  from  date  of  first  treatment)  I  had  the 
pleasuie  to  see  my  paiient  greatly  improved  ; 
his  appetite  and  digestion  which  had  been  bad, 
now  good :  general  health  improved ;  he  was 
no  longer  irritable  and  gloomy,  but  was  spright- 
ly and  hopeful,  and  looked  forward  with  con- 
fidence to  an  ultimate  and  permanent  cure.  The 
paroxysms,  which  had  been  frequent  and  severe, 
had  entirely  ceased.  Treatment  continued. 
Patient  died  about  six  months  afterward,  or  nine 
months  from  date  of  treatment,  from  an  intercur- 
rent disease.  I  believe  if  patient  had  lived  or 
been  put  upon  the  hydrocyanate  of  iron  treatment 
sooner,  that  a  permanent  cure  would  have  been 
effective.  There  is  one  thing  sure  in  this  case, 
that  it  controlled  the  paroxysms  better  and  more 
effectually  than  any  remedy  that  had  been  admin- 
istered before.  It  possesses  this  advantage  over  the 
bromides,  that  it  not  only  controls  the  paroxysms 
better  but  it  does  not  impair  the  general  health  of 
patient  like  the  latter.  Since  that  time  I  have 
administered  this  remedy  to  some  eight  or  ten 
cases  with  decided  success — about  half  of  this 
number  being  cured,  others  being  old  and  chronic 
cases — were  more  or  less  benefited.  Now  I  do 
not  claim  that  hydrocyanate  of  iron  is  a  specific 
for  epilepsy,  but  I  do  claim,  that,  if  judiciously 
administered  and  continued  for  a  sufficient  length 
of  time,  "  say  one  year,"  that  it  will  cure  more 
cases  than  any  remedy  or  remedies  known  to  the 
medical  profession.  It  is  an  excellent  remedy  in 
the  treatment  of  the  various  forms  of  neuralgias. 
It  can  be  combined  with  sulph.  of  quinine,  sulph. 


^HE   CANADA  MEDICAL   RECORD. 


250 


of  morphia,  or  the  extract  of  henbane,  as  each  in- 
dividual case  may  require.  It  exerts  a  powerful 
inllucnce  over  the  functions  of  the  uterus,  and 
when  coml)ined  with  the  extract  of  belladonna  1 
know  of  no  remedy  belter  to  relieve  congestive 
dysmenorrluea  or  irritation  of  the  ovaries  when  of 
a  neuralgic  eh:ira(  ter. — S.  IV.  Afed.  Gazitte. 
Mii.i.'iowN,  Ind. 


RINGWORM. 

(Dr.  Henry  Brown,  Manchester. — British 
Medical  Joitrnal.^  The  subjoined  formula  for 
the  local  treatment  of  ringworm  is  suggested  by 
Dr.  Payne's  lecture  on  the  treatment  of  that  epithy- 
tic  disease.  In  sending  it  I  am  simply  handing 
down  a  form  received  from  others,  and  used  in  the 
out-patient  practice  of  the  Manchester  infirmary, 
many  years  before  the  publication  of  the  Hritish 
Pharmacopeia.  When  the  acidum  sulphurosum 
was  made  official,  it  was  used  for  a  time  instead, 
but  we  had  to  revert  to  the  old  form  made  up  of 
materials  fully  recognized  and  explained  in  Stpiire's 
Companion.  The  form  is  :  If .  Soda;  hyposulphitis 
dr.  j  ;  solve  in  aquaj  fl.  oz.  viij  ;  et  adde  acidi 
hydrochlorici  fl.  dr.  j  ;  for  outward  use  only.  I'he 
use  of  this  lotion,  as  water-dressing  covered  with 
oiled  silk,  and  accompanied  by  daily  washing  in 
soft  soap  and  water,  has  proved  as  perfectly  satis- 
factory, as  Dr.  Payne  says  the  principle  of  the 
treatment  of  ringworm  is  perfectly  simple.  It 
fulfills  Dr.  Payne's  conditions,  and  kills  fungus. 
I  presume  the  sulphurous  acid  gas  acts  beyond 
the  limits  of  the  aqueous  solution. 


NEW  REMEDY  FOR  CY.STITLS. 

Having  seen  nothing  concerning  the  new  remedy 
for  cystitis  and  hyperesthesia  of  the  genito-urinary 
tract,  Pichi  (Fabiana  imbricata),  and  being  very 
much  pleased  with  it,  I  will  report,  briefly,  its  action 
in  a  few  cases.  The  first  case  was  one  of  cancer 
of  the  uterus,  where  the  whole  anterior  part  of  the 
vagina  was  indurated  aud  contracted — the  patient 
having  to  urinate  every  half  hour  all  night,  and 
the  pain  would  start  the  tears  every  time.  I  gave 
the  following  prescription  :  B  extract  pichi  3  vj., 
liquor  potass.,  3  ss.  elixir  aromat.  q.  s.  3  iij. ;  a 
teaspoonful  once  every  three  hours.  In  less  than 
two  days — in  fact,  the  first  night — she  had  to  get 
up  but  once.  She  took  the  medicine  irregularly, 
as  required,  until  she  returned  home,  which  was 
three  weeks  after,  and  it  controlled  the  painful 
urination  completely.  Neither  did  she  have  the 
backache,  which  had  been  a  constant  accompani- 
ment heretofore. 

Case  2. — A  lady,  with  frequent  and  painful 
urination,  having  to  get  up  four  times  at  night. 
She  had  been  overtreated  by  one  of  the  two  numer- 
ous class  who  see  a  cause  for  every  ill  that  woman 
is  heir  to  through  a  vaginal  speculum.  In  this 
case  the  medicine  acted  equally  kind  and  prompt- 
ly, remedying  the  backache  as  well. 


Case  3. — Man  with  a  ;////</ gonorrhrea.  Stopped 
all  scalding  of  the  urine  at  once. 

Case  4. — An  old  lady,  .iged  eighty-three,  who 
said  it  appeared  very  strange  none  of  the  doctors 
could  do  her  any  good.  She  had  to  get  up  several 
limes  at  night  to  urinate,  but  she  had  an  idea  that 
there  were  no  doctors  exce|)l  old  men.  I  promised 
the  medicine  should  relieve  her  in  fijrty-eighl  hours, 
liecause  a  neighbor  had  got  along  so  well  with  the 
fever,  she  became  reckless  enough  lo  trust  a  young 
doctor's  word,  and  was  all  right  in  twenty-four 
hours,  and  has  continued  so  since. 

I  have  tried  local  applications  in  two  cases  of 
vaginitis,  and  they  were  greatly  benefited,  and 
ceased  using  it.  Am  now  anxiously  watching  for 
an  old  man,  with  prostatitis  and  cystitis,  to  come 
along.  I  owe  so  much  to  ecclecticism,  in  the  short 
time  I  have  been  investigating  it,  that  I  wish  to 
inform  the  brethren  of  that  school,  concerning  a 
new  weapon  of  "specific"  tendencies,  and  in- 
creased consumption  will  lessen  the  cost.  I  be- 
lieve P.,  D  &  Co.  alone  handle  it  now. 

P.  S. — Have  considerably  lessened  the  first- 
named  dose ;  now  give  ten  drops  once  in  three 
hours. — Calif orjiia  Aled.  Journal. 


TREATMENT  OF  PROLAPSUS  ANI  IN 
INFANTS. 

Dr.  Betz,  of  Heilbronn,  relates  in  the  Meniora- 
bilicH,  1886,  Heft  4,  the  case  of  an  infant  five 
months  old  which  had  been  afflicted  with  prolapsus 
ani  for  five  weeks.  Cold  water  enemata,  ice  sup- 
positories, dusting  with  pulverized  alum,  tannin 
locally  and  internally  opium,  bromide  potassium, 
and  even  injections  of  ergotine  had  been  employed 
without  benefit.  The  little  patient  was  in  a  deplor- 
able condition,  greatly  emaciated,  covered  with 
large  and  small  boils,  and  intertrigo ;  it  was 
incessantly  straining  and  crying.  The  prolapsed 
bowel  was  a  livid,  conical  plug,  ^%  cm.  in  length; 
it  was  readily  reduced,  but  pressure  being  removed 
it  was  shot  out  again  by  the  straining  of  the  child. 
Profiting  by  a  knowledge  of  the  treatment  pre- 
viously used,  he  at  once  determined  to  resort  to 
nitrate  of  silver  applications,  but  as  the  application 
of  stick  caustic  always  acts  unequally  on  the  mucous 
membrane,  and  may  result  in  ulceration,  he  made 
a  solution  of  argent,  nitr.  i.  o,  sulphuric  ether  5  o, 
alcohol  25.0.  This  solution,  though  it  gives  rise 
to  some  smarting,  can  be  evenly  and  equally  applied 
and  enters  the  tissues  to  a  considerable  depth.  The 
prolapsus  was  thoroughly  painted  with  the  above 
solution,  and  even  after  a  few  minutes  it  became 
paler,  began  to  shrink,  and  could  be  reduced  more 
readily.  To  act  on  the  upper  portion  of  the  mucous 
membrane  a  small  piece  of  alum  was  introduced 
high  up  into  the  rectum.  To  prevent  the  bowel 
from  slipping  down,  and  to  exert  continued  pres- 
sure on  the  anus,  the  nates  were  firmly  pressed 
together  and  held  in  this  condition  by  three  broad 
strips  of  adhesive  plaster,  which  were  applied  on 
either  side,  running  from  the  anterior  surface  of  3, 


260 


THfe  CANADA  MfcDICAL  feECORD. 


thigh  across  the  seat  to  the  opposite  anterior  sur- 
face of  the  abdomen.  The  next  object  was  to  stop 
the  tenesmus  and  to  prevent  defecation,  which  was 
accomphshed  by  keeping  the  cliild  slightly  under 
the  narcotic  influence  of  opium,  and  restricting 
Its  diet  to  small  quantities  of  milk  and  water.  The 
tenesmus  st()p|)eil  at  once,  and  llatus  was  freely 
passed  in  twenty-four  hours.  The  dressing  was. 
reapplied  after  two  days.  No  prolapse  occurred. 
The  anus  was  cleansed  with  a  wad  of  cotton 
steejjed  mcarbolized  oil,  hve  per  cent.,  and  a  piece 
of  alimi  was  again  inserted.  The  aims  was  found 
drawn  into  folds  and  contracted.  After  three  days, 
a  new  dressing  was  necessary.  The  gut  being 
slightly  prolapsed  was  treated  with  the  stick  caustic. 
'J'wo  days  later  the  dressing  was  permanently 
removed.  Stools  came  on  without  tenesmus.  In 
order  to  insure  contraction  of  the  anus,  he  ordered 
it  touched  with  alcohol  for  a  few  days.  The  cure 
was  completed  in  eight  days.  Betz,  though  he  is 
inclined  to  attribute  much  of  the  rapid  success  to 
the  application  of  niir.ite  of  silver,  claims  that  the 
combined  treatment  carried  out  by  him  is  entitled 
to  the  credit  for  the  same,  and  would  in  a  similar 
severe  case  not  do  without  the  .ndhesive  dressing, 
the  opium,  the  restricted  dia  and  the  alum  sup- 
pository, in  addition  to  the  nitrate  of  silver  applica- 
tion, while  in  the  milder  case  nitrate  of  silver,  opuim 
and  restricted  diet  would  be  sufficient  for  a  cure. 
No  relapse  occurred. 


ABSORPTION  FROM  THE  MUCOUS  MEM- 
BRANE OF  THE  URINARY  BLADDER. 

The  question  as  to  the  occurrence  of  absorption 
through  the  mucous  membrane  of  the  urinary 
bladder  has  often  been  considered  both  at  the  bed- 
side and  in  the  laboratory,  but  the  results  have 
hitherto  been  sufhcicntly  discrepant  to  leave  room 
for  more  exact  work  on  the  subject.  The  latest 
contribution  towards  a  solution  of  the  problem 
bears  the  mark  of  exact  scientific  observation,  and 
seems  to  us  largely  to  settle  the  matter.  In  the 
current  number  of  the  Journal  of  Anatomy  and 
Physiology,  there  is  a  paper  on  "  Absorption  from 
the  Mucous  Membrane  of  the  Urinary  Bladder," 
by  Dr.  Herbert  H.  Ashdown,  late  senior  demon- 
strator of  physiology  in  the  University  of  Edin- 
burgh, in  which  a  critical  summary  of  the  work 
already  done  is  given,  and  a  series  of  carefully- 
conducted  experiments  is  reported.  The  observa- 
tions were  made  on  rabbits  and  dogs,  and  consisted 
essentially  in  the  analysis  of  results  obtained  by 
the  intravesical  injection  through  the  urethra  of 
substances  possessed  of  known  physiological  pro- 
perties or  readily  estimated  chemical  reactions. 
The  author  divides  his  experiments  into  three 
groups  :  (i)  Those  in  which  the  drugs  administered 
have  a  sufficiently  distinct  physio. ogical  action  of 
their  own  to  indicate  their  presence  when  absorbed 
into  the  system.  (2)  Those  in  which  the  renal 
elimination  of  the  drugs  given  can  be  readily  de- 
monstrated.    (3)  Those  in  whicli  the  quantitative 


analysis  of  a  solution  of  known  chemical  composi- 
tion can  be  conducted  after  it  has  remained  for 
several  hours  in  the  bladder.  The  results  of  the 
triple  series  are  strikingly  similar,  and  appear  to 
justify  Dr.  Ashdown's  conclusions.  These  are: 
(  1  )  That  absorption  of  a  ve;y  large  series  of  chemi- 
cal substances  does  take  place  from  the  mucous 
membrane  of  the  urinary  bladder  when  in  a  perfect- 
ly healthy  condition.  (2)  That  the  urinary  con- 
stituents themselves — those  substances  eliminated 
by  the  kidney  as  efilete  products  of  the  system  — 
are  absorbed  from  the  bladder  in  varying  pro])or- 
tions,  this  applying  more  especially  to  the  water 
and  urea,  but  also,  though  to  a  less  extent,  to  the 
inorganic  solids.  (3)  That  the  decree  of 
distention  of  the  bladder  plays  a  most  impor- 
tant part  in  increasing  or  diminishing  the  rapidity 
of  such  absorption.  (4)  That  regular  rhythmical 
contractions  take  place  in  the  muscular  wall  of 
the  bladder ;  that  these  contractions  are  largely 
influenced  by  the  degree  of  distention  of  the  blad- 
der, being  most  marked  with  a  moderate  amount 
of  distention  of  the  viscus,  and  but  feebly  marked 
in  slightly  distended  or  in  over-distended  condi- 
tions ;  and  that  the  character  of  these  contractions 
is  largely  affected  by  the  nature  of  the  fluid  con- 
tained in  the  bladder. —  The  British  Medical 
Journal,  February  12,  1887. 


TREATMENT  OF  NOCTURNAL  ENURE- 
SIS. 

Dr.  Alexander  Harkin  in  a  paper  on  this  sub- 
ject says  : 

I  have  long  since  discarded  belladonna  and 
bromide  potash  as  insufficient  remedies,  and  have 
adopted  the  use  of  the  derivatives,  and  revulsives, 
such  as  dry  and  wet  cupping,  or  blisters  to  the 
nape  of  the  neck,  applied  as  high  as  possible  and 
as  close  as  circumstances  will  permit  to  the  neigh- 
borhood of  the  foramen  magnum  occipitale  and 
the  region  of  the  medulla  olilongata. 

I  have  had  but  seldom  to  ap])ly  to  the  cupping ; 
one  full  vesication  being  generally  sufficient  ;  a  blis- 
ter three  inches  in  length  by  two  in  breadth,  either 
by  emplastrum  lyttas,  or  the  linimentumcantharidis 
of  the  Pharmacopeia,  applied  vertically,  suffices.  It 
is  very  seldom  that  a  second  application  is  required ; 
occasionally,  especially  in  females,  after  some 
months  of  respite,  there  may  be  a  call  for  the  renewal 
of  the  remedy  ;  in  obstinate  cases  and  in  grown  up 
patients,  dry  or  wet  cupping  may  be  requisite  to 
complete  the  cure. — Provincial  Med.  Journal. 


VENESECTION  IN  PUERPERAL  ECLAMP- 
SIA. 

Of  the  twenty-five  cases  which  have  come  under 
uiy  observation  during  the  past  thirty-five  years,  in 
all  there  existed  more  or  less  arterial  tension  and 
increased  blood  pressure,  which  constituted  a  factor 
of  importance  in  the  progress  and  termination  of 
the  disease.     With  a   view  of   averting  the    evil 


TBE   CANADA    MEDICAL   RECOBD. 


2G1 


consequences  of  this  influeiicii  on  the  circulation 
of  tlic  brain,  I  am  convinced  that  venesection  is  a 
remedy  which  cannot  l)e  dispensed  with  in  the 
treatment  of  eclampsia.  I  can  say  with  truth 
that  all  m\'  cases  in  which  it  was  resorted  to  early, 
freely,  and  judiciously,  have  recovered  with  a  sin- 
gle excejition.  In  this  case,  after  modern  de|)letion, 
anaesthetics  were  used  too  freely,  to  the  exclusion 
of  other  remedies.  One  of  the  earliest  and  most 
manifest  effects  of  venesection  is  that  of  unloading 
the  engorged  venous  system,  the  lungs,  the  right 
cavities  of  the  heart,  and  the  cerebral  circulation. 
If  the  comliined  inHueuce  of  inordinate  action  of 
the  heart  and  excessive  engorgement  of  the  venous 
sinuses  of  the  b'ain,  be  peiinitted  to  continue,  the 
delicate  structures  of  that  organ  must  suffer  irrepar- 
able injury  from  pressure,  and  jjrofound  coma 
result.  In  these  cases  of  protbiind  coina  with 
stertorous  breathing,  frequent  and  bounding  pulse, 
increased  temper.iture,  when  the  scene  is  varied 
by  rejieated  paroxysms  of  sjiasms,  let  us  not  be 
misled  in  our  treatment  by  any  false  theories  in 
the  pursuit  of  a  vacillating  policy.  There  is  abso- 
lute safety  in  the  lancet  judiciously  and  timely 
applied  under  these  circumstances.  The  state  of 
pregnancy,  above  all  other  conditions,  is  the  most 
tolerant  of  depletion.  The  enormous  quantity  of 
blood  often  lost  during  labor  without  serious  results 
sustains  this  opinion.  The  measure  must  not  only 
be  resorted  to  early  to  avert  impending  danger  to 
the  cerebral  structures,  but  copiously,  to  break 
down  permanently  arterial  pressure.  From  sixteen 
to  twenty  tour  ounces  will  probably  suffice  to  cause 
a  decided  amelioration  of  the  symptoms.  As  a 
usual  result,  the  action  of  the  heart  will  be  slowed, 
the  pulse  will  become  soft.  The  impulse  of  the 
organ  will  be  diminished,  temperature  will  decline, 
coma  will  be  partially  relieved,  consciousness  will 
return  temporarily,  and  cyanosis  will  diminish. 
But  depletion  cannot  accomplish  everything. 
There  may  be  a  return  of  trouble.  But  when  these 
desirable  objects  have  been  obtained  even  tempo- 
rarily, we  have  a  favorable  basis  for  the  application 
of  our  eliminative,  anaesthetic,  and  sedative  reme- 
dies.— Bedford  Brown,  M.  I).,  Jouinal  of 
American  Me,/ica1  Association. 


PERMANGANATE  OF  POTASSIUM   IN 
THE  TREATMENT  OF  ECZEMA. 

The  first  case  was  that  of  a  child,  two  years  of 
age,  who  was  covered  with  eczema  and  imiJctigo. 
Various  treatments  had  been  tried  in  vain,  and  he 
was  ordered  a  daily  bath  of  permanganate  of 
potassniin,  of  the  strength  of  15  grams  to  the  bath 
of  water,  the  child  to  remain  ui  it  till  the  water 
turned  brown.  Since  then  Dr.  Ilullmau  has  used 
the  remedy  both  in  adults  and  children,  and  mostly 
with  good  effe<t.  When  the  skin  is  nun  h  covered 
with  scales  or  scabs  it  should  first  be  well  brushed 
with  soap  and  water.  In  another  case  of  very 
chronic  eczema  of  the  back  of  the  hand,  where  the 
usual  remedies  had  been  tried  without  success,  a 
solution  of  10  grains  of  the  salt  to  an  ounce  of  water 
was  a])plied  freely  with  a  brush.  The  disease 
disappeared  in  about  ten  days.  A  third  case  of 
eczema  of  the  face  in  a  young  lady  also  yielded  to 
the  treatment  in  fifteen. — Loudon  Medical  Record. 


Phosphate  of  lime  is  strongly  recommended  by 
Dr.  Reljory  for  the  night-sweats  of  phthisis.  M. 
Potain,  and  after  him  Dr.  Rebory,  employ  the 
tricalcic  phosphate  in  doses  of  four  grammes,  often 
necessarily  increased  to  eight  and  fifteen  grammes. 
The  excellent  results  obtained  are  attributed  by 
Dr.  Rebory  to  some  special  action  of  the  medicine 
upon  the  perspiratory  apparatus.  It  would  seem 
more  likely  that  the  general  improvement  in  the 
condition  of  the  patient  brought  about  by  the 
phosphate  should  be  the  reason  for  the  diminution 
of  the  night-sweats,  one  of  the  symptoms  most  in- 
dicative of  the  great  debility  of  persons  subject  to 
phthisis. — FhiL  Med.  Times. 


ON  NOTCHES  IN  THE  UPPER  CENTRAL 

INCISOR  TEETH  WHICH  RESEMBLE 

THOSE  OF  SYPHILIS. 

There  is  a  state  of  notching  of  the  upper  incisor 
teeth  which  affects  the  two  central  ones  of  the 
permanent  set,  and  produces  a  condition  very 
deceptively  like  that  of  syphilis.  The  notches  are 
central,  and  very  conspicious.  A  chief  point  of 
difference  from  the  syphilitic  tooth  is  that  the  tooth 
is  usually  wide  instead  of  narrow  at  its  free  edge. 
Syphilitic  teeth  almost  always  show  narrowing,  like 
a  screw-driver,  as  well  as  notching.  Another  point 
of  difference  is  that  the  teeth,  when  looked  at  care- 
fully, are  seen  to  be  craggy  and  very  hard,  not 
worn  as  the  syphilitic  tooth.  In  a  very  marked 
example  of  the  pseudo-syphilitic  notching,  the 
father  of  the  patient  told  me  that  the  condition 
was  hereditary,  and  the  youth's  mother  had  teeth 
of  the  same  kind.  In  this  instance,  there  was  no 
history  of  fits  in  infancy  or  of  the  use  of  mercury 
or  teething  powders.  Nor,  indeed,  were  the  con- 
ditions those  of  stomatitis,  or  mercurial  teeth.  The 
defects  occurred  in  pairs  of  teeth,  and  did  not 
damage  the  whole  row.  Nor  were  the  first  perma- 
nent molars — the  test  teeth  of  the  mercurial  set — 
involved.  I  have  in  several  other  examples  of 
craggy  teeth  been  assured  that  the  peculiarity  was 
in  the  family.  I  feel  certain,  therefore,  that  we 
must  admit  inheritance  as  an  occasional  explanation 
of  peculiarities  in  the  form  of  the  teeth.  I  was 
once  shown,  in  one  of  the  Paris  hospitals,  a  pair  of 
teeth  such  as  those  which  i  have  above  discribed, 
and  great  surprise  was  expressed  that  I  could  not 
admit  that  the  were  characteristically  syphilitic. — 
Jonathan  Hutchinson^  in  the  British  Medical 
Jo  urn  0,1. 


262 


THE   CANADA   MEDICAL   RECORD. 


TREATMENT  OF   NIGHT-SWEETS  WITH 
PHOSPHATE  OF  LIME. 

Doctor  Rebory  has  added  his  observations  to 
those  made  some  time  ago  by  Prof.  Potain  and 
Guyot,  and  comes  to  the  conckision  that  the 
phosphate  of  lime  is  the  most  afficacious  remedy 
against  tlie  night-sweats  of  tuberculous  patients, 
not  only  because  it  allows  of  an  almost  indefinite 
continuance  of  administration  without  bad  results, 
but  because  in  the  largest  number  of  cases  it  has 
given  the  most  favorable  results.  Prof.  Potain  finds 
that  when  doses  of  from  four  to  si.\  grams  remain 
without  effect,  increased  doses  up  to  15  grams 
attain  the  desired  results.  Sometimes  also  the 
absorption  of  the  medicament  does  not  take  place 
and  hence  its  inacti\  ity.  One  must  always  adminis- 
ter it  in  a  soluble  form,  either  as  acid  phosphate  or 
lacto-phosphate  ol  lime  or  even  adding  to  its 
administration  it  in  form  of  powder,  some  acid 
mixture. —  Wtek/y  Medical  Review 


A  CASE    OF    EXTRAORDINARY    FECUN- 
DITY. 

On  Sunday  last  a  woman,  aged  about  35  years, 
was  delivered  at  the  Toulouse  Mateniite  of  three 
children  at  full  term  (two  boys  and  agirlj,  all  three, 
being  perfectly  formed  and  full  of  life. 

The  same  woman,  within  four  years,  has  had 
two  other  twin  pregnancies,  with  the  above,  she 
has  given  birth  to  seven  children  in  three  confine- 
ments and  within  an  interval  of  four  years. 

The  seven  children  are  alive. — 'I'ranslated  for 
the  Record  from  Le  Journal  dc  Geneve — Seusse. 

The  Canada  Medical  Record. 

A  Monthly  Journal  of  Medicine  and  Surgery- 

EDITORS  : 

FRANCIS  <V.  CAMPBELL.   M.A.,  M.D.,  L.K.CP.  tOMD. 

K'litor  and  Pttpprietor. 
R.  A.  KENNEDY,  M.A.,  M.D.,  Managing  K.Iitor. 
ASSISTANT  EDITORS: 
CASEY  A.  WOOD,  CM.,  M  D. 
G£O.^GE  E,  ARMSTRONG,  C-M.,  M.D. 

SUBSrillPTIIlN    TWO   DOLLARS    PEIl    ANNUM. 

AU  communicntion!>  aud  Kichantif^  vnist  be  addressed  to 
the  -Editors, /Jiiiwer356,  Post   Office,  Montreal. 

iMONTREAL,  AUGUST,  18S7. 


CHRONIC  LARYNGITIS  AND  ITS 

SEQUEL.'E. 

The  jV.  F.  Medical  Record  of  August  20th  says  : 
That  Dr.  Hunter  Mackenzie  publishes  a  lecture  on 
chronic  laryngitis  and  its  sequl.-e.  Simple  chronic 
laryngitis  and  thickening  of  the  laryngeal  stjucturcs 


may  occur  as  a  consequence  of  acute  laryngitis,  or 
from  repeated  attacks  of  the  subacute  variety  ;, 
occasionally  its  mode  of  development  is  protracted, 
and  insidious.  It  may  be  partial — that  is,  only 
one-half  of  the  larynx  may  be  thickened  perman- 
ently— it  may  be  general,  affecting  more  or  less  all 
the  intrinsic  structures.  The  question  of  degree 
or  locality  of  the  inflammation  bears  an  important 
relation  to  prognosis.  Chronic  laryngitis  may  be 
primary  or  consecutive.  Primary  chronic  laryn- 
gitis indicates  that  the  laryngeal  affection  has  not 
been  preceded  by  any  local  or  general  affection  ; 
the  term  consecutive  may  be  applied  to  that  variety 
which  ]jrecedes  or  supervenes  during  or  after  the 
course  of  the  zymotic  diseases,  malignant  disease, 
or  ]iulmonary  phthisis,  or  which  is  the  result  of 
extension  from  the  nares  or  pharynx.  In  simple 
chronic  laryngitis  there  is  very  seldom  any  true 
ulceration  or  loss  of  substance,  unless  there  is 
evidence  of  struma,  tuberculosis,  or  syphilis.  The 
character  of  the  voice  alinost  entirely  depends 
upon  the  vocal  cords.  Complete  aphonia  (whis- 
pering voice)  is,  in  the  absence  of  nervous  or 
mental  causes,  indicative  of  severe  laryngeal 
changes,  and  shows  destruction  of  the  vocal  cords, 
or  of  the  cords  and  ventricular  bands  ;  it  is  a  point 
to  be  remembered  that  a  fairly  effective  voice  can 
be  produced  by  the  ventricular  bands,  should  the 
vocal  cords  be  destroyed.  Chronic  laryngitis,  in 
addition  to  the  symptoms  produced  on  the  voice, 
respiration,  cough,  etc.,  may  sometimes  be  the 
cause  of  gastric  disorders  ;  when  pharyngitis  is 
present,  and  the  saliva  is  in  e.xcess,  or  when  fre- 
quent movements  of  swallowing  are  made,  owing 
to  the  sense  of  tickling  at  the  back  of  the  throat, 
an  excessive  amount  of  air  is  swallowed,  giving 
rise  to  gastric  flatulence.  The  following  are  some 
of  the  sequela;  of  chronic  laryngitis.  In  the  in- 
siduous  form,  the  possibility  of  tubercular  degener- 
ation is  always  present ;  in  those  cases  it  is  only 
by  the  examination  of  the  sputum  or  laryngeal 
secretion,  and  the  presence  of  the  bacilli  of  tubercle 
being  detected,  that  one  can  be  certain  the  case 
is  one  of  tubercular  disease.  Another  sequela  of 
chronic  laryngitis  is  the  formation  of  new-growths  ; 
these  may  be  papillomatous,  mucous,  fibious,  or 
cartilaginous,  according  to  their  seat  of  origin. 
The  more  chronic  a  case  is,  the  more  likely  is  the 
supervention  of  the  most  serious  of  all  sequete, 
the  tubercular  degeneration.  In  the  case  of  malig- 
nant disease  of  the  larynx  no  definite  conclusion 
should  be  arrived  at  without  examining  ujicroscopi- 


THE   CANADA    MEDICAL    RECORD. 


263 


call)'  the  sputum  or  pieces  of  the  growth,  as  in  its 
early  stages,  and  even  in  its  later  stages,  malignant 
disease  ])ossesses  no  distiuf^iiisliing  characters  to 
the  naked  eye.  With  regard  to  the  treatment,  it 
must  be  essentially  of  a  local  character  to  be  of 
any  use,  by  means  of  inhalations,  s]irays,  powders 
or  pigments.  In  well-rnarked  cases  recourse  should 
be  had  at  once  to  jiigments,  and  of  these  nitrate 
of  silver  is  the  best.  Commencing  with  a  solution 
ot  thirty  grains  to  the  ounce,  the  strength  should 
be  gradually  increased  every  ten  to  fourteen  inin- 
utes,  until  one  hundred  and  twenty  grains  to  the 
ounce  or  even  more  are  used.  These  i^igmenls 
ought  to  be  applied  locally  by  means  of  a  laryngeal 
brush,  under  the  guidance  of  the  laryngoscope,  at 
first  three  times  and  after  twice  a  week,  over 
a  period  of  several  months  ;  this  energetic  treat- 
ment is  necessary  only  in  well  marked  cases  of 
thickened  vocal  cords,  or  of  the  intra-laryngeal 
mucous  membrane.  In  chronic  laryngitis  depen- 
dent upon  chronic  nasal  catarrh,  attention  should 
be  directed  to  the  nose ;  the  nasal  jiassages  ought 
to  be  frequently  cleansed  by  means  of  a  solvent 
spray  (one  drachm  of  bicarbonate  of  soda  to  a 
pint  of  water),  and  immediately  after  an  astringent 
solution  ought  to  be  applied,  such  as  sulphate  of 
zinc  or  acetate  of  lead,  one  or  two  grains  to  the 
otince  of  water.  At  the  same  time  the  pharynx 
should  be  occasionally  stimulated  by  the  applica- 
tion of  a  solution  of  chloride  of  zinc,  twenty  or 
thirty  grains  to  the  ounce.  In  granular  pharyngitis 
the  application  of  London  paste,  or  of  the  galvano- 
cautery,  to  the  prominent  follicles  is  usually 
necessary.  When  chronic  laryngitis  has  ended  in 
the  formation  of  distinct  growths,  they  must  be 
removed  by  intra-  or  e.xtra-laryngeal  surgical 
measures.  Certain  of  the  sequels  of  chronic 
laryngitis  may  necessitate  the  opening  of  the  wind- 
pipe, and  the  operation  of  tracheotomy  is  to  be  pre- 
ferred to  thyrotomy,  if  the  same  objects  can  be 
obtained  by  it.  I'he  rest  and  freedom  from  irrita- 
tion that  is  obtained  after  tracheotomy  often  cure 
a  chronic  laryngitis  which  may  have  become  serious, 
and  in  cases  of  tubercular  disease  much  comfort 
can  often  be  given  to  the  patient  by  the  early  per- 
formance of  this  operation.  The  author  concludes 
his  lecture  by  urging  on  all  medical  men  the  im- 
portance of  treating  cases  ofchro.iic  laryngitis  with 
promptness  in  the  early  stages,  so  many  cases 
being  neglected  at  first,  when  some  active  measures 
plight  be  t^ken,  \yhich  become  useless  if  deferred. 


STOOPING  FORWARD. 

Under  this  caption,  the  Lancet  says: 
Every  one  knows  that  stooping  forward,  particu- 
larly after  rising  quickly  from  bed  in  the  morning, 
when  the  stomach  is  empty  and  the  heart  has  less 
than  ordinary  sujiport  from  the  viscera  below  the 
(li.iphragm,  is  very  apt  to  occasion  a  form  <jf  faint- 
ncss  with  vertigo,  not  unlike  that  which  occurs  in 
sea  sickness.  We  do  not  at  the  moment  speak  of 
the  faintness  and  giddiness  from  cerebral  anaemia, 
which  are  directly  consequent  upon  suddenly 
assuming  the  erect,  after  long  continuing  in  the 
recumbent,  posture,  but  of  the  more  alarming  sen- 
sation of  being  in  the  centre  of  objects  which  are 
rapidly  passing  away,  usually  fiom  left  to  right, 
with  loss  of  power  to  stand  or  even  sit,  and  an 
almost  "  nightmare  "  feeling  of  inability  to  call  for 
help  or  do  anything  to  avert  catastrophe,  while 
throughout  the  experience  the  sufferer  retains  pain- 
fully acute  consciousness.  This,  we  say,  is  familiar 
as  one  at  least  of  the  effects  not  uncommonly  pro- 
duced by  stooping  forward  under  the  special  con- 
ditions indicated.  With  many  other  varieties  of 
the  vertigo  consequent  ui)on  heart  weakness  or 
cerebral  anaemia,  observation  or  experience  has 
made  us  all  acquainted.  We  can  not,  however, 
help  thinking  that  the  consequences  of  even  par- 
tial compression  of  the  veins  of  the  neck,  offering 
an  obstacle  to  the  return  of  blood  from  the  head, 
with  its  important  organs,  are  not  so  well  recog- 
nized. The  peculiar  form — or,  more  accurately 
the  several  forms — of  headache  distinctly  caused 
in  this  way  when  the  head  is  long  bowed  for- 
ward on  the  chest,  bending  the  neck  on  itself,  can 
not  fail  to  occur  to  every  one  ;  nor  will  the  high 
tension  of  the  eyeball,  the  turgid  and  heavy  eyelids, 
the  snuffling  note,  the  deafness,  with  buzzing  or 
throbbing  in  the  ears,  the  heavy  breathing,  and  the 
puffed  and  perhaps  flushed  or  darkened  color  of 
the  face,  resulting  from  the  obstructed  venous  cir- 
culation through  the  bended  neck,  be  forgotten. 
There  are  other  and  more  perilous,  though  second- 
ary, effects  of  leaning  forward  when  the  heart  is 
weak,  or  the  blood-vessels  are  not  so  strong  as 
they  ought  to  be,  which  should  not  be  overlooked. 
Beyond  question  the  extra  strain  thrown  upon  the 
ajjparatus  of  the  circulation  by  anything  that  im- 
pedes the  free  passage  of  blood  through  almost 
any  part  of  the  venous  .system  is  more  severe  and 
dangerous  than  a  physically  equal  strain  thrown 
on  the  arteries.  At  least,  this  is  so  in  adult  life, 
and,  without  going  further  into  details  in  conjieg' 


264 


THE   CANADA   MEDICAL   RECORD. 


tion  with  the  modus  operandi  of  the  mischief  to 
which  we  point,  it  may  be  permissible  to  urge  that 
the  subject  is  one  to  which  attention  may  be 
usefully  directed.  The  weakly,  and  those  who 
are  not  unlikely  to  have  hearts  readily  overbur- 
dened, and  blood-vessels  easily  stretched 
beyond  recovery,  or  even  ruptured,  should  be 
warned  quite  as  earnestly  against  suddenly  assum- 
ing, or  too  long  retaining,  postures  which  do — 
however  slightly  and  partially — impede  the  return 
of  blood  through  the  veins.  We  know  how  pro- 
longed sitting  may  cause  the  veins  of  the  legs  to 
become  distended,  and  either  give  way  or  permit 
the  extravasation  of  their  contents.  When  this  sort 
of  thing  happens,  even  though  in  comparatively 
trifling  degree,  in  the  case  of  vessels  directly  con- 
nected with  such  delicate  organs  as  the  eye,  the  ear, 
and  the  brain,  it  is  easy  to  see  that  the  results  may 
be  very  serious  in  their  character;  and,  probably; 
few  postures  commonly  taken  up  by  persons  who 
lead  somewhat  sedentary  lives  are  so  prone  to  do 
mischief  unnoticed  as  that  of  'leaning  forward' 
as  at  work  at  a  table  which  is  not  sufficiently  high 
to  insuie  the  head  being  so  raised  that  the  veins 
of  the  neck  may  not  be  in  any  way  compressed  or 
the  return  of  blood  from  the  head  embarrassed  or 
delayed.  We  see  reason  to  believe  that  if  this 
apparently  small  matter  were  more  generally  un- 
derstood, there  would  be  fewer  head  and  heart 
troubles,  and  we  will  go  so  far  as  to  say  that  some 
lives  now  lost  would  be  saved." 


AN  UNHAPPY  MISTAKE. 

The  Dubliti  Medical  /"rwi  of  August  i8th  says  : 
An  occurrence  is  reported  from  Paris  as 
deplorable  in  its  way  asany  of  which  we  have  heard 
of  late.  Two  children  were  sent  to  a  hospital 
suffering  from  variola,  both  of  whom  were  called 
Georges.  For  obvious  reasons  the  parents  were 
forbidden  to  see  them  pending  treatment  and  con- 
valescence. One  of  the  children  died  soon  after 
admission,  and  the  decease  having  been  duly  noti- 
fied to  the  parents,  the  interment  was  proceeded 
with.  After  the  lapse  of  some  weeks  the  ]iarents 
of  the  survivor  were  informed  that  they  could  fetch 
their  child, but  on  a  messenger  being  dispatched  for 
this  purpose,  the  identity  was  disputed,  and  after 
some  delay  it  was  discovered  that  the  bed-cards 
had,  by  some  mishap,  been  changed,  and  that  the 
child  really  belonged  to  the  other  parents  who  had 


been  informed  that  their  infant  was  dead.  It  is 
needless  to  dwell  upon  the  gravity  of  such  a  mis- 
take, which  could  not  fail  to  have  cau.sed  great  and 
needless  pain  to  both  parents.  It  is  greatly  to  the 
credit  of  the  hospital  administration  that  this  is 
really  the  first  time  that  such  a  case  has  presented 
itself,  for  the  system  lays  itself  open  to  such  errors. 
It  has  been  suggested  that  in  view  of  the  disfigure- 
ment caused  by  diseases  such  as  variola,  it  would 
be  eminently  desirable  to  provide  each  patient  with 
a  bracelet  duly  numbered  by  means  of  which  the 
identity  might  be  assured.  An  unworthy  attempt 
has  been  made  to  throw  the  discredit  of  this  regret- 
able  accident  on  the  institution  of  lay  nurses,  but 
it  is  evidently  the  fault  of  the  system  rather  than 
that  of  individuals. 


WASHING  OUT  THE  STOMACH. 

This  operation,  such  a  novelty  a  few  years  ago, 
is  coming  quite  in  vague  in  the  treatment  of  certain 
forms  of  dyspepsia.  The  following  is  the  way  in 
which  it  is  carried  out :  A  soft  red  rubber  tube  is 
passed  gently  down'into  the  stomach,  quite  to  the 
pylorus  ;  with  this  tube  is  connected  about  a  yard 
of  flexible  tubing  and  a  'glass  funnel,  which  is  held 
on  a  level  with  the  patient's  breast.  Tepid  water 
is  poured  slowly  into  the  funnel  until  a  sensation 
of  fulness  is  experienced.  The  funnel  is  then 
lowered  to  the  level  of  the  waist,  and  the  fluid  al- 
lowed to  siphon  out.  The  process  is  repeated  un- 
til the  water  returns  quite  clear. 


LITERARY  NOTE. 

An  unusuallj  important  work  is  announced  by 
Cassell  &  Company.  It  is  "  Martin  Luther;  The 
Man  and  His  Work,"  by  Peter  Bayne,  LL.  D. 
Dr.  Bayne's  sympathy  is  as  great  as  his  literary 
skill.  The  men  and  women  of  whom  he  writes 
are  alive.  The  reader  will  not  only  be  made  ac- 
(juainted  with  the  facts  of  Luther's  life,  but  he  will 
follow  the  events  of  his  career  with  the  vivid  real- 
ization of  a  spectator  of  a  powerful  drama.  One 
who  has  seen  the  early  pages,  says  of  this  remark- 
able work  that :  "  it  is  undoubtedly  one  of  the 
most  comprehensive  and  accurate  personal  histor- 
ies of  that  great  promoter  of  the  general  democratic 
movement  of  modern  times,  and  also  a  capital 
record  of  the  notable  chapter  in  spiritual  evolu- 
tion." 


THE  CANADA  MEDICAL  RECORD. 


Vol.   XV. 


MONIRF.AL,    SEPTEMBER,    1887. 


No.  12. 


COnSTTEHSTTS. 


ORIGINAL  COMMUNICATIONS. 

The  \'ieiiii;i  Mixlun.'   '_'(;r> 

Diet  ill  Skin  I)ise:is-'s    207 

Oil  the 'rrealiii.'iil  c'f  Kihiciiil   I'liinwiiis 
of  the  Uieiusby  Klfitii.-ity 271 


SOCIETY  PROCEEDINGS. 

MiMli.-i.-C'liirurKi.'ul   Socii-ly    uf    MoMt 
re:il 


EDITORIAL 

College  of  Pliysiriins  ;iri.l  .Siiigeuns  of 
the  Proviiii-L- ft  nuelieo 285 

PROGRESS  0?  SCIENCE.  I  ''"i"'""  Uludliated  News 86<i 

Local  Treatmei:t  nf  Sen  if  iilous  Glands.  232  I  I'"'""""' '^* 


Tre.itiiieul  of  Chronic Syiihilis  284    Books  niiil  Pamphlets  Rcieivril. . . 


287 


(l)ri6inal  ComiiiunindioiiL 


THE  VIEN.VA  MIXTURE. 

By  Georgil  E.  Armstrong,  M.D. 

Professor  of  Physiology,  Faculty  of  MeHicine,  University  of 
Bishop's  ColU'ge.     I'hysician  to  the  Western  Hospital. 

During  a  visit  to  the  Britisli  and  European 
Hospitals,  a  medical  man  picks  up  here  and  there 
a  great  many  puints  whicli  he  thinks  are  of  more 
or  less  value  ;  and  it  often  happens,  at  least  in  mv 
experience,  tliat  some  little  improvement  in  some 
line  of  treatment  or  method  of  procedure,  from  its 
great  superiority  over  older  ways  or  means,  and 
from  the  frequency  it  is  used,  affurds  far  greater 
satisfaction  t!i:in  other  points  of  apparently  at  any 
rate  at  first  sight  much  greater  importance. 

One  day  while  in  Vienna,  in  July,  iS86,  my 
friend,  Dr.  J.  C.  Cameron,  drew  my  attention  to  the 
advantages  of  the  anaesthetic  used  by  Prof.  Billroth 
and  others  at  the  Vienna  Krankenhousa.  It  was 
a  mixture  of  alcohol  one  part,  ether  one  part,  and 
chloroform  three  jiarts.  I  admit  having  had  a  little 
prejudice  against  these  mixtures,  of  which  we  have 
had  so  many  ;  but  from  what  I  saw  of  this  mixture, 
I  thought  it  worth  while  to  try  it.  Accordingly,  I 
provided  myself  with  one  of  Leiter's  improved 
anaesthetic  bottles  and  an  inhaler,  and  on  my 
return  home  began  to  use  it.  I  was  so  much 
pleased  with  its  action,  tliat  since  then  I  have  used 
nothing  else. 

The  mixture  is  prepared  by  adding  together  first 
the  ether  sulphuric  one  part  (Squibbs),  and  then 
three  parts  of  D.  and  F.  chloroform  made  from  pure 
alcohol.  Some  chemical  action  takes  place  as  heat 
is  produced,  then    dilute  with  one  part  of  pure 


alcohol.  The  bottle  which  I  obtained  from  Leiter 
consists  of  an  ordinary  4  oz.  bottle,  of  the  shape  of 
an  Eau-de-Cologne  bottle,  with  a  faucet  attached 
to  the  neck  and  mouth,  so  lliat  the  '^o'fi  is  started  or 
stopped  by  simply  pushing  to  the  right  or  left  a 
little  button.  This  arrangement  allows  a  little 
stream  to  escape  which  can  be  checked  instantly. 
The  inhaler  consists  of  a  light  metallic  framework, 
with  a  handle  and  a  porous  woollen  cover  which 
can  be  easily  removed  and  cleansed.  The  arches 
of  the  inhaler  close  down,  bringing  the  inhaler  into 
smaller  volume  for  carrying.  The  advantages 
which  I  find  this  anesthetic  and  mode  of  admin 
istration  to  possess  are  the  following  : 


2GG 


THE   CANADA   MEDtCAL  RECORD, 


I.  It  is,  so  far  as  I  am  aware,  perfectly  safe.  I 
was  told  that  it  was  so  considered  in  \'ienna,  and 
I  have  used  it  almost  daily  for  twelve  months, 
giving  it  in  major  and  minor  operations,  some- 
times for  long  intervals  of  time,  an  hour  or  an  hour 
and  a  half  to  old  and  young,  in  midwifery  cases, 
and  in  the  dentist's  chair,  and  so  far  have  never 
seen  any  evidence  whatever  of  any  unfavorable 
action. 

II.  It  is  easily  administered.  The  an^sthetizer 
stands  at  the  head  of  the  patient,  allows  the  inhaler 
to  lie  loosely  on  the  patient's  face,  m\A  frequently 
drops  a  small  quantity  upon  the  inhaler  without 
removing  it  from  the  patient's  f;ice. 

III.  I  cannot  say  that  the  patient  goes  under 
its  influence  more  rapidly  than  under  the  influence 
of  chloroform  or  etlier ;  but  one  very  important 
advantage  will  be  noticed,  viz.:  that  there  is  abso- 
lutely no  struggling,  and  seldom  much  talking. 
Any  one  who  has  struggled  a  it\x  times  with  a 
powerful  man,  or  woman  either,  lialf  under  the 
influence  of  ether,  will  readily  appreciate  the  ad- 
vantage of  an  anaesthetic,  which  invariably  pro- 
duces its  effect  without  any  struggling  whatever. 

IV.  Another  important  advantage  it  possesses 
is  that  there  is  seldom  any  vomiting  or  retching 
during  or  after  its  administration.  This  is  particu- 
larly appreciated  after  abdominal  sections,  although 
retching  and  vomiting  are  at  any  time  sufficiently 
objectionable,  for  more  reasons  than  one,  to  be 
avoided  whenever  possible. 


V.  The  patient  comes  rapidly  from  under  its 
influence,  as  soon  as  its  exhibition  is  stopped. 

VI.  Among  its  lesser  advantages,  may  be  men- 
tioned the  absence  of  sinell  to  such  an  extent,  that 
it  will  scarcely  be  noticeable  in  a  room  half  an  hour 
after  its  administration  has  ceased. 

VII.  The  patient  is  not  saturated  with  it,  does 
not  retain  the  odour  and  taste  of  it  as  of  ether. 

VIII.  It  does  not  produce  any  bronchial  irrita- 
tion with  frothy  mucous  collections,  always  an 
important  condition  to  avoid,  and  especially  so  in 
operations  upon  the  air  passages,  as  for  instance 
in  tracheotomy  for  croup  and  diphtheria.  I  be- 
lieve many  fatal  issues  after  this  operation  are  at 
any  rate  partly  due  to  the  irritating  properties  of 
ether,  on  the  trachial  and  bronchial  mucous  mem- 
branes, putting  them  in  a  favorable  condition  to 
receive  and  retain  the  germs  of  the  disease,  carried 
down  during  the  respiratory  efforts. 

IX.  So  far  as  I  have  been  able  to  observe,  it  is 
unirritating  to  the  kidneys. 

X.  Is  very  easily  carried,  takes  up  but  little  room 
in  pocket  or  medicine  case. 

XI.  A  very  small  quantity  is  used.  The  other 
day  in  the  Western  hospital,  a  woman  was  kept 
under  its  influence  40  minutes,  during  the  explora- 
tion and  drainage  of  an  abscess  of  the  broad  liga- 
ment, and  only  one  fluid  once  was  used. 

Now  I  have  said  nothing  in  praise  of  this  mix- 
ture, which  I  think  will  not  be  found  true  by  all 
those  who  will  use  it,  and  I  would  urge  strongly 
a  trial  of  it  by  one  and  all.  For  some  years  I 
have  been  thoroughly  dissatisfied  with  ether.  It 
is  very  disagreeable — it  permeates  and  renders  un- 
pleasant a  room  for  iiours  after  its  use,  and  it  is 
only  too  often  followed  by  nausea  and  vomiting  ; 
and  in  my  experience  these  unpleasant  symptoms 
follow  its  use  in  a  large  percentage  of  cases,  even 
when  its  administration  has  been  preceded  and 
followed  up  by  the  most  careful  and  apjiroved 
methods  of  preparation  and  after  treatment  of  the 
patient. 

Chlorofonu  pure  is  more  pleasant  ;  but  being 
more  powerful,  and  thereby  necessitating  more 
careful  and  skillful  use,  has  been  followed  too  fre- 
quently by  fatal  results.  It  differs  from  ether  also 
in  this  respect,  that  when  it  kills  it  kills  at  once; 
and  when  ether  kills,  the  fatal  result  is  delayed 
several  days  or  weeks,  death  finally  resulting  from 
lung  or  kidney  trouble. 

One  more  point  I  should  like  to  mention,  that 
is  that  whatever  anaesthetic  is  used,  do  not  under 


•THE  CANADA   MEDICAL  RECORD. 


2G7 


any  circumstances  begin  operating  until  the  patient 
is  thoroughly  ana;stheli^ed.  The  importance  of 
this  was  pointed  out  to  me  by  one  of  our  leading 
Montreal  dentists.  He  insisted  that  in  all  the 
cases  of  death  from  chloroform  in  dentists'  chairs, 
that  he  had  been  able  to  investigate,  the  chloro- 
formisl  had  only  jiartially  anxsthetized  the  patient. 
Just  given  enough  to  deaden  the  pain  u  little. 

Now  in  the  American  Journal  of  the  Medical 
Sciences.  April,  1887,  p.  444,  is  an  article  from 
Professor  H.  P.  Bowditcli  of  Harvard  University, 
entitled  The  Action  of  Sulphuric  Ether  on  the 
Peripheral  Nervous  System.  In  this  article  it  is 
experimentally  proved,  that  irritation  of  the  recur- 
rent laryngeal  nerve  in  dogs  partially  under  the 
influence  of  ether,  produces  constriction  of  the 
glottis,  but  irritation  of  the  same  nerve  when  the 
dog  is  completely  anaesthetized  causes  dilatation 
of  the  glottis. 

The  observations  of  Perkins  were  also  in  the 
main  confirmed,  i.e.  "  there  was  found  to  be  a  stage 
in  the  paralysing  action  of  the  drug  when  stimula- 
tion of  the  nerve  caused  the  leg  to  assume  a  posi- 
tion contrary  to  that  occasioned  by  the  same  de- 
gree of  stimulation  without  ether." 

Here  is  experimental  proof  of  a  fact,  and  that  a 
jfact  of  vital  importance  to  all  using  anaesthetics, 
[which  had  already  been  observed  by  a  practical 
[man,  viz.:  Never  begin  operating  until  the  patient 
Vis  completely  ancpsthetized. 


DIET  IN  SKIN  DISEASES. 
Ry  J.  Leslie  Foley,  M.D.,  L.R.C.P.,  London. 
Within  the  last  decade,  diet,  in  reference  to  the 
etiology  and  treatment  of  disease,  has  become  an 
element  of  considerable  weight.  .So  much  so, 
that  the  scale  of  medical  opinion  has  shot  far  up 
in  the  high  numbers.  And  well  it  might.  Food 
is  a  great  factor  in  health  and  disease.  It  has 
made  and  unmade  nations.  \\'itness  the  decline 
and  fall  of  the  Roman  Empire  through  gourmand- 
izing;  and  one  small  article,  tea,  which  although  it 
cannot  be  strictly  classed  as  a  food,  is  seldom  left 
out  in  a  lady's  grocery  list,  has  been  the  means  of 
founding  the  greatest  republic  of  modern  times. 
While  food  has  been  a  power  in  making  and 
breaking  civil  constitutions,  it  has  been  equally 
powerful  in  making  and  breaking  corporeal  consti- 
tutions. A  good  dinner  is  a  potential  factor  in  the 
wise  stateman's,  the  wily  politician's,  and  the 
shrewd  business  man's  repertoire.  In  fact,  it  might 
almost  be  said  that  a  country  is  ruled  "  over  the  wal- 


nuts and  wine.".\nd  why  ?  Because  from  time  im- 
memorial humanity  has  been  partial  to  its  palate. 
One  would  think  that  the  gustatory  and  glosso- 
pharyngeal nerves  W(juld  be  well  nigh  degenerated, 
so  often  are  they  stimulated  by  savory  morsels.  In 
patriarchal  days,  they  used  to  kill  the  fattcdcalf  and 
make  merry,  and  the  principle  has  been  carried 
out  through  successive  ages  to  the  ])resent  day, 
culminating  in  the  modern  "dinner  p.my,''  the 
protot)pe  of  the  fatted  calf  of  yore.  Cooking  has 
become-  a  fine  art,  and  such  perfection  has  it  reach- 
ed, so  tempting,  so  luscious  are  the  delicacies  it  pro- 
duces, that  it  is  enough  to  make  Epicurus  turn  in 
his  grave.  No  wonder  the  patient  frequently  uses 
a  big,  big  D.  at  the  doctor,  and  goes  ahead,  regard- 
less of  all  dietetic  rules.  Food  is  the  fuel  which 
replenishes  the  furnace  of  our  body,  which  sets 
the  locomotive  going  along  the  multifarious 
routes  of  Life's  Railroad;  unhappily,  it  often  sets- 
the  locomotive  off  the  track.  Tyndall  says,  "  the 
growth  of  knowledge  is  from  vagueness  to  preci- 
sion." No  doubt  ere  long  we  shall  reach  precision 
in  dietetics.  But  there  are  still  many  knotty 
points  to  be  solved,  many  wrangling  fctcts,  and  the 
scientific  mind  ever  hungering,  like  Oliver  Twist, 
asks  for  more — knowledge.  The  energy  which  food 
develops  in  forming  a  muscle,  a  healthy  brain,  etc., 
expends  itself  etiually  in  deranging  or  disorganizing 
a  stomach,  liver  or  kidney.  As  diere  is  no  portion 
of  the  body  but  what  may  feel  its  beneficial  in- 
fluence so  there  is  no  part  which  may  not  be 
visited  by  its  dire  eftects.  liut^  verily,  as  one 
enters  a  restaurant,  casts  the  eye  over  the 
inviting  bill  of  fare,  observes  the  coaxing  dishes, 
smells  the  saliva  exciting  odors,  it  is  sad  to  think, 
that,  conimiiigling  with  the  jovial  conversation  and 
good  natured  smiles  of  the  bon  vivants,  is  the 
harassing  thought,  as  we  trace  the  food  from  the 
first  digestive  proces.s  prehension,  to  the  final  act  of 
defecation,  with  all  the  intervening  tions,  what 
evil  may  it  do,  are  we  sewing  the  seeds  of  a 
dyspepsia,  or  is  there  perhaps  looming  in  the 
distance  a  Bright's  disease,  skin  disease,  etc.?  The 
waiter  breaks  tiie  reverie,  and  decides  it  "  Next 
order.  Sir." 

Food  is  potent  for  fair  or  ill  in  skin  diseases  no 
less  than  in  other  affections.  Let  us  first  look  at 
the  bright  side,  that  we  may  be  the  better  able  to 
bear  the  more  shady. 

A  well  regulated  diet  is  a  strong  item  in  the 
treatment  of  a  skin  disease.  This  most  will  allow. 
While  all  in  general  are  in  accord  as  to  the  value 


268 


THE   CANADA  MEDICAL   REC0R6. 


of  diet,  there  is  considerable  divergence  of  opinion 
as  to  the  most  suitable.  Which  shall  we  elect, a  meat 
diet,  a  vegetable  diet,  or  a  mixed  diet  ?     This  dis- 
sonance of  sentiuient  is  not  confined  solely  as  to 
the  kind  of  diet  ;  some  tank  diet  above  medicines, 
while  others  do  not  consider  it  worthy  ofa  tlioiight. 
A  moderate  meat  diet  is  good,  bin  there  is  a  ten- 
dency to  take  it  in  excess,  far  more  meat  being 
consumed  than  is  of  benefit.     This  applies  more 
especially  to  the   well-to-do  class,    meat  being  a 
luxury  with  the  poor.     In  excess,  meat  is  apt   to 
develop  the  uric  acid  or  gouty  diathesis  ;  and  as  is 
well  known,  gout  is  a  factor  in  jirodiicing  psoriasis, 
etc.     Meat  once  a  day  will  suffice  in  most  cases. 
Those    taking   little  exercise    require  btit  a  small 
amount  of  meat,  while  ilie  active  need  more.     It  is 
asserted  that  a  meat  diet  lauses  congestion  of  the 
skin,  while  a  vegetable  dimuiishes  the  congestion. 
A  priori  we   should  exclude  a  meat  diet  in  all  in- 
flammatory affections  and  substitute   a  vegetable 
diet.     The  fact  that  when  vegetables  are  withheld, 
a  change    is  produced    in  the    condition  of   the 
blood  and  scurvy  induced,  shows  that  they  supply 
a  want  to  the  system.    Perhaps  no  one  more  appre- 
ciates this  than  does  the  sailor  after  a  long  voyage. 
Although  plentifully  supplied  with  lime  juice,  he 
longs  for  the  sight  ofa  fresh  vegetable,  and  on  land- 
ing highly  relishes  them.    A  due  proportion  of  vege- 
table is  necessary  to  health.  Physiologists  have  long 
taught  that  of  all  diets  a  mixed  one  is  the  best.    To 
adopt,  therefore,  an  exclusive  line  of  diet  as  a  meat 
or  vegetable  would  be  against  all  physiological  rule. 
It  would  be  impossible  to  enjoin  a  diet  that  would 
suit  all  cases.     Nor  can  we  as  in  diabetes  lay  down 
a  hard  and  fast  diet,  and  say,  "  thus  far  shalt  thou 
go  and  no  farther."     Man  is  a  composite  being, 
inade  up  of  innumerable  ingredients  ;  his  tastes  are 
as  numerous  and  variable.  What  would  be  agreeable 
to  one,  both  as  to  health  and  taste,  would  be  dis- 
agreeable to  another.     The  dietary  of  the  world 
proves  this.     Every  nation  and  frequently  every  in- 
dividual in  a  nation  having  a  peculiar  diet.     Thus 
we  have  the  rice-eating  Hindoo  and  Chinese,   the 
fish-eating  Esquimaux,  the  beef-eating  Britons,  the 
porridge-eating  Scotchmen,  etc.,  while  each  nation 
has  some  characteristic  food  on  which  it  mainly 
subsists ;  it  would   be  interesting  to    inquire  what 
influence  it  has  upon  skin   diseases.    Take  for  in- 
stance the  character  of  the  skin  diseases  as  seen  in 
London  and  Vienna,  there  is  a  marked  difference 
in  the  two  types.     It    seems  to  me  that  diet   has 
much  to  do  with  it.     The  Blackfriars  Skin  Hospital, 


London,  have  long  had  in  use  a  diet  table  which 
has  proved  of  most  service  in  the  majority  of  cases 
in  attendance.  As  the  Blackfriars  is  the  oldest  and 
largest  skin  hospital  in  Londbn,  it  deserves  a  care- 
ful study.  It  consists  of — for  Breakfast,  bread  and 
milk  or  porridge  with  or  withotit  an  egg  ;  bread  and 
bmter.  Tea  and  coffee  prohibited.  Dinner — plain 
roast  or  boiled  fish  or  poultry,  plainly  cooked  rice, 
eggs,  or  flour  pudding,  potatoes,  anj  a  few  other  ve- 
getables. Tea  or  Supper — milk  and  water,  or  gruel, 
or  other  farinaceous  food  with  bread  and  butter. 
Drinks — Barley  water,  toast  water,  thin  gruel,  soda 
water.  To  be  avoided — Salt  meats,  soups,  sweets, 
acids, fruits,  pastry.  No  malt  liquors,  wine  or  spirits, 
unless  under  medical  sanction.  The  above 
menu  would  not  be  very  congenial  or  recherche 
to  an  alderman.  It  is  certainly  puritanical  in  its 
l)lainness. 

Tea  contains  nearly  iS  per  cent,  of  tannin,  its 
astringent  properties  produce  constipation  ;  it  like- 
wise has  an  evil  influence  over  the  nervous  system, 
and  tends  to  give  rise  to  neuroses  of  the  skin.  Coffee 
is  less  open  to  the  objections  of  Tea.  Condiments 
and  spices  as  a  rule  should  he  avoided.  Milk  is  not 
always  the  harmless  thing  imagined.  It  should  be 
boiled.  It  often  disagrees  with  people  advanced  in 
years,  causing  oppression  at  the  stomach, and  often 
lingers  in  the  bowels  as  hard  cheesy  lumps.  Some- 
times it  does  not  suit  those  in  the  prime  of  life,  or 
even  children.  It  slrould  be  of  the  very  best  qual- 
ity. Water  should  be  !aken  sparingly  during  meals, 
freely  in  the  inteivals.  Drinking  cold  water  when 
fatigued  or  over-heated  by  great  exertion  has  caused 
a  permanent  skin  eruption.  .'Mcohol  has  a  tendency 
to  keej)  up  skin  affections.  Besides  its  deleterious 
effect  upon  the  skin,  it  acts  indirectly  on  it  by  crip- 
pling the  stomach,  liver  or  kidney  ;  and  yet  alcohol 
preserves  the  skin.  The  lighter  wines,  claret,  &:c., 
can  be  used  with  impunity  ;  while  spirits  should  not 
be  used,  whiskey  and  gin  are  the  least  harmful  of 
all.  Malt  liquors  make  the  skin  muddy,  thick  and 
pimply.  Excessive  beer  drinking  often  brings  on 
an  eczema.  Food  which  has  a  tendency  to  consti- 
pate should  be  avoided  as  far  as  possible. 

To  maintain  a  healthy  skin,  the  frame  should  be 
well  nourished;  if  it  is  thus  in  health,  how  much 
more  !-o  should  it  be  in  disea.se.  It  is  a  mistake, 
as  a  rule,  lo  jiut  a  patient  on  a  low  diet  in  a  skin 
disease.  The  skin  should  be  well  fed.  Diet  should 
be  of  good  quality  and  nourishing  ;  it  is  quality 
not  quantity  that  tells.  But  then  again  it  should 
}  not  be  too  rich  or  stimulating.     A  dog  fed  on  tto 


THE    CANADA   JIKOICAL    KECOKD. 


269 


rich  a  diet  will  suffer  from  skin  disease.  This  is 
known  to  every  veternary  surgeon.  The  late  lamen- 
ted Dr.  .Austin  Flint,  in  his  usual  weighty  way,  has 
said,  "  diet  shotild  be  regulated  by  the  appetite,  the 
I'ahite  and  by  common  sen.se."  Dr.  T.  Lauder 
Jjrunton  says,  "  it  is  much  simpler  to  say  what  the 
patient  may  not  eat  than  wh.it  he  may."  Each  clim- 
ate necessitates  its  own  diet.  As  far  as  possible,  it  is 
better  to  keep  as  near  the  diet  a  patient  has  been 
accustomed  to.  These  three  axioms,  ))0tent  in 
general  dietetics,  ap|)ly  with  efjual  force  to  the 
skin. 

Kood  shoulil  be  t.Tken  simple  pl.nin, 

From  excess  in  eaiing  refr.iin, 

A  refjulai  meal  hour  olitain. 

They  convey  more  reason  than  rhyme.  A  change 
of  diet  is  frequently  of  benefit. 

Many  cutaneous  erup'.ions  are  entirely  produced 
by  a  diet  too  large  in  quantity  or  too  stimulating 
A  skin  can  be  overtaxed  just  as  a  stomach  or  brain. 
It  is  related  that  a  lady,  who  was  troubled  with  an 
irritable  eruption,  always  suffered  a  rela|ise  when 
she  took  more  than  three  ounces  of  solid  food. 
The  skin  acts  as  a  drain  to  superfluous  nutritive 
particles  taken  in  excess  by  man,  as  meat  and  drink. 
Were  it  not  for  this  compensating  power,  drunkards 
and  gastronomies  would  quickly  perish.  Vigorous 
exercise  in  the  open  air  requires  larger  quantities 
of  food  of  a  solid  character.  The  horse  when  wild 
can  subsist  easily  on  grass,  but  when  hard  worked 
requires  corn  in  proportion.  Those  of  sanguine 
temperament  do  not  need  as  rich  and  stimulating 
diet  as  do  the  feeble.  Excessive  eating  produces 
plethora.  The  vascular  system  becomes  engorged. 
That  portion  of  the  skin  we  call  the  corium  is  ex- 
ceedmgly  vascular  ;  running  throughout  it  are 
innumerable  trunk-like  and  capillary  blood-vessels. 
Towards  the  papillary  layer  is  a  delicate  and  high- 
ly organized  plexus  of  capillaries  affording  abun- 
dant blood  supply.  The  skin  acts  as  an  equalizer 
of  the  circulation  at  the  surface.  It  becomes  hyper- 
semic  pari  passu  with  the  general  system.  While 
excessive  dieting  is  injurious  in  all  skin  affections, 
it  is  more  especially  so  in  those  connected,  with 
the  vascular  system. 

A  skin  disease  may  be  produced  by  too  little 
food  as  well  as  by  an  excessive  quantity.  It  is  among 
the  denizens  of  the  poorest  parts  of  a  city,  where 
squalor  abounds,  that  the  worst  cases  of  skin  dis- 
ease are  most  rife.  Of  course,  uncleanlinessandbad 
hygienic  conditions  are  dominant  in  their  caujation j 
but  insufficient  food  i§  the  ruling  sourc?  in   '.he 


majority  of  cases.     Where   the  food   supply  is  re- 
duced to  its  minimum,  we  have  as  a  consequence 
a  poor  condition  of  the  blood  (lack  of  red  corpus- 
cles, etc.)  and  malnutrition.     These  are   the  most 
favorable  for  the  develojnnent    of  a   skin  disease. 
I  doubt  not  but  what  many  of  the  parasitical  affec- 
tions are  greatly  aided  if  not  induced  by  a  starva- 
tion diet.     It  offers  a  likely   nidus  for  thern.     We 
know  that  Bacilli  are  partial  to  certain  tissues  out- 
side of  which  they  do  not  flourish.     Healthy,  well 
nourished  tissues  they  cannot  live  in,  it  is  only  in 
the  badly  nourished  where  they  reside.  And  so  it  is, 
I  take  it, with  skin  diseases.  By  producing  a  healthy 
tissue  we  can  ameliorate  the  disease.  Parasites  love 
dirt  and  decomposing  tissues.  Where  healthy  tissue 
is  these  conditions  do  not  obtain.  Ergo  no])arasite- 
Good,  nourishing  food  is  the  best  means  by  which 
we  can  ]jrocure  a  healthy  tissue  or  nutrition.    The 
late  Sir  Erasmus   Wilson,    in  his    more  advanced 
years,  did  not  believe  that  there  were  any  parasites 
at  all  ;    and   taught  that  the  small  cells  — sporates, 
bacteria,  etc.,  were  but  altered  forms  of  cell  growth 
such  as  we  find  in  ejjithelioma,  etc.,  and  not  extran- 
eous products  from   without.      His  treatment  was 
chiefly  constitutional,  good  food  being  his  mainstay. 
Malnutrition  is  at  the  bottom  of  a  great  many 
skin  diseases.     If  we  could  but  devise  some  means 
by  which  the  poorer  classes  could  be  supplied  with 
wholesome  food,    undoubtedly  there    would   be  a 
great  falling  off  in  the  statistics  of  the  skin  depart- 
ments of  the  various  hospitals  and    dispensaries, 
and  we  would  get  far  better  results  than  from  any 
lotion  or  potion.     We  give    tonics   to  procure  an 
ajjpetite  ;  but  among  the  poor,  it  is  not  so  much  the 
appetite  that  is  wanting,  as  something  to  gratify  it. 
Although  it  may  not  be  considered  germane  to 
introduce  the  sul>ject  of  exercise,  it  has  a  bene- 
ficial influence  on  the  skin,  especially  riding,  boat- 
ing, bicycling,  etc.,  but  I  doubt  whether  t.aking  long 
walks  is  not  more  hurtful  than  otherwise.     Riding, 
boating,  bicycling,  notably  riding,  keeps   the  liver 
and  digestive  organs  in  good  condition. 

While  all  skin  affections  are  benefitted  or  modi- 
fied by  diet,  it  should  be  especially  directed  in  the 
following  :  In  the  Htemorihagio;,  Purpura,  etc., 
it  should  receive  careful  attention,  nourishing  with 
as  much  variety  as  possible.  In  Miliaria,  plain. 
Pempliif^ui — of  best  quality,  pull  animal  diet, 
eggs,  milk;  ^tnd  cream,  wine  iii  proper  quantity 
allqweci-  Lichen  J^uher—'BctA  of  food  given. 
i^;Kr4'('--^MQSl  nutritive  articles.  ^tV'^-^-Special 
%lra^  laW.  on  (iiet,  heavy  andi  indigestible  foQcj. 


270 


THE   CANADA   MEDICAL    RECORD. 


cheese,  pastry,  pickles,  spices,  stimulative  drinks 
interdicted.  Acne  Rosacea — Alcoholic  drinks 
proscribed,  and  a  plain  diet  prescribed.  Ecthyma 
— Wholesome  and  nutritive,  including  meat,  eggs, 
milk,  and  all  articles  wliicli  tone  up  the  system. 
Psoriasis — ^Modified  by  diet.  Dr.  Passavant,  of 
Frankfort,  Germany,  has  reported  a  case  cured  by 
an  e.xchisive  animal  diet.  Furnnculus — Generous 
diet.  In  broken  down  cases  malt  liquors  and  wine 
useful.  Anthrax — Nourishing  diet,  milk,  eggs, 
whiskey,  wine.  Lupus  Vulgaris — Nutritious  food, 
meat,  eggs,  milk,  etc.  Scrofula  iter  met — A  most 
generous  and  nutritious  diet,  consisting  largely  of 
animal  food.  Lepra — Nourishing  diet.  Sjphilo- 
derma — Nutritious  diet,  milk,  meat,  eggs,  wine 
allowed.  Eczema — If  full  habit  plain  diet,  if  there 
is  any  disturbance  of  the  digestive  tract,  cakes, 
sauces,  pastry,  pork,  cabbage,  pickles,  cheese,  beer, 
wine,  etc.,  interdicted.  Urticaria — Diet  simple 
without  stimulating  food  and  drinks,  food  nourish- 
ing but  plain.  Erythema  A'odosa — Diet  simjile. 
Erylhema  Multiforma — Light  diet,  all  stimulating 
articles  of  food  and  drink  avoided.  Seborrhaui — 
Food  nourishing  and  of  the  best. 

In  many  instances  a  skin  eruption  is  but  an 
outward  expression  of  some  inward  trouble  ;  one 
is  too  apt  to  forget  this,  and  in  treatment  to  in- 
variably associate  it  with  an  ointment.  Some 
highly  prized  unguentum  is  ajjplied  externally, 
perchance  culled  from  the  clinique  of  some  famous 
dermatologist.  But  oftentimes  the  casus  belli  is 
inwardly ;  it  may  be  some  irritating  article  of  food, 
etc.,  inflaming  and  deranging  the  bowels  with  their 
contiguous  helpmates,  liver,  spleen,  etc.;  here  some 
internal  emollient  or  corrective  would  be  more 
useful. 

Disorders  of  the  digestive  tract  (from  mouth  to 
anus)  are  paramount  in  producing  many  affections 
of  the  dermis.  We  have  but  to  take  up  any  text- 
book on  dermatology  to  verify  this.  Under  its 
labored  and  memory-burdening  nosology  there 
is  scarcely  a  disease  but  what  disturbances  of  the 
alimentary  canal,  caused  by  food  in  excess,  in  too 
small  quantity  or  of  bad  quality,  plays  some  part 
in  its  etiology,  and  the  role  is  by  no  means  a 
secondary  one. 

Among  other  skin  diseases  induced  by  impro- 
per diet,  may  be  enumerated,  Furunculus,  Antlirax, 
Acne,  Rosacea  (spirituous  liquors),  Psoiasis 
(modified),  Lichen  Ruber  (according  to  Sir  Eras- 
mus    Wilson).    Eczema,    Urticaria— Overloaded 


stomach,  excess  in  wines  or  highly  seasoned  food 
may  produce  it,  certain  articles  are  especially 
liable  to  give  rise  to  it,  such  as  fish,  oysters,  clams, 
crabs,  pork,  saus.iges,  oatmeal,  mushrooms,  rasp- 
berries, strawberries,  etc,  Dr,  IJrunlon  relates  a 
case  where  a  single  strawberry  produced  an  in- 
tense urticaria.  Severe  dysjicpsia  may  cause 
miliaria. 

While  disorders  of  digestion  aflcct  the  skin, 
cutaneous  eruptions  are  equally  deleterious  to  the 
alimentary  canal,  the  skin  is  in  close  relation  to 
the  digestive  tract,  tiie  vaso  motor  nerves  being 
the  connecting  link.  The  bowels  absorb  the  food 
we  eat,  and  we  know  the  skin  is  cajjable  of  ab- 
sorbing food  by  inunction.  A  healthy  skin  pro- 
motes reflexly  the  vaso  motor  circulation  of  the 
different  viscera.  Trainers  have  long  known  the 
benefit  of  keeping  the  skin  in  good  condition,  the 
rub  down  being  part  of  the  course.  Possibly  in  the 
near  future  we  may  class  as  an  etiological  factor 
in  the  skin  domain  the  rank  Ptomaine. 

The  skin  is  in  sympathy  with  every  organ  of 
the  body,  likewise  there  are  few  organs  but  what 
have  some  effect  upon  the  skin.  Its  Pacinian 
corpuscles  are  the  touchstones  of  the  internal 
organs,  connecting,  as  it  were,  the  inner  with  the 
outer  world.  Contact  with  these  small  bodies  sets 
the  whole  nervous  system  agog,  and  communicates 
the  sensation  to  that  highest  consummation  of  the 
nerve  centre,  the  brain. 

A  noted  scientist  has  said  :  "  You  cannot  study  a 
snow-flake  profoundly  without  being  led  step  by 
step  to  the  constitution  of  the  sun.  It  is  thus 
throughout  nature,  all  its  parts  are  inter-dependent, 
and  the  study  of  any  one  part  completely  would 
really  involve  the  study  of  all."  It  is  so  in  medi- 
cine, as  Pope  puts  it  "  all  are  but  parts  of  one 
stupendous  whole."  All  knowledge,  therefore, 
pertaining  to  diet  and  the  digestive  tract  has  its 
bearing  upon  the  skin.  Dyspepsia  and  dieting 
have  long  been  synonymous  ;  and  I  take  it,  in 
process  of  time,  the  same  will  be  said  of  skin 
diseases,  and  he  who  treats  cutaneous  affections, 
especially  in  regard  to  diet,  from  the  broad  view 
of  general  medicine,  will,  I  venture  to  say,  bemore 
successful  in  the  long  run,  than  he  who  confines 
himself  to  one  narrow  groove. 

2  2  Dartmouth  Street.  • 

Boston,  Sept.  ist,  1887, 


THE   CANADA    MEDICAL   RECORD. 


171 


ON    THE   TREATMENT  OE  EIRROm  Tl," 

MOrRS  OF  'IHK   UTERrS  HV    KEKC- 

TRICITV;  Wn'H    ( )1!SKK  VAI  IONS 

ANP   C-()M1'I,E'IE  SlATIsriCS 

OI'"    AI,E    THE    CASKS    SO 

'J'REAIEDFROM  lUI.Y 

18S2,  TO  JULY,  1887. 

By  Dr.  G.  Ai'OSTOli,  Paris. 

Translation  by  \Vm  Woodham  Wehb,  M.  U.,U.  R.  C  P.  L. 
(A'tiiii all/ie  Aftdic<il  Jssccialion  tiieelitigal  Dubl-.n,  188". ) 

Gen'I'lemi'n  : — You  will  [leniiit  inc  to  ask  of  you 
a  temporary  sus))ension  of  the  well  merited  celebra" 
lion  oftlie  triumph  of  gynaecological  operative  sur- 
gery,in  which  you  have  held  so  important  a  position, 
while  I  lay  before  you  my  views  on  a  point  of 
conservative  treatment. 

The  surgical  measures  proposed,  discussed  and 
]nit  in  jiractice  for  the  removal  of  uterine  tumours 
have  of  late  years  occupied  a  great  share  of  the 
attention  of  practitioners,  and  yet  many  of  the 
questions  connected  with  this  subject  still  remain 
imdecided,  obscure  and  perplexing.  After  all,  the 
dangers  of  excision  are  not  much  less  formidable. 
Eor  this  reason  I  have  endeavored  to  find  out  a 
way,  neither  strictly  surgical  nor  strictly  medi- 
cal, of  dealing  with  these  cases,  by  which  I  might 
avoid  equally  the  reproach  of  surgical  insecurity 
and  the  defect  of  therapeutical  inefficiency.  By 
this  I  mean  my  electrical  treatment  of  uterine 
fibroids.  It  is  now  five  years  since  I  adopted  a 
proceeding  which  I  may  define  as  a  galvano-chem- 
ical  cauterization  of  the  utcrii!',  vaginal,  intra- 
uterine or  parenchymatons  and  always  monopolar. 

For  those  who  have  not  much  experience  in  elec- 
trical manipulations, these  few  simple  words  require 
to  be  made  clear  and  explained.  This  I  will  endea- 
vor to  do  plainly  and  shortly. 

I  may  first  of  all  point  out  what  my  predecessors 
had  done  in  the  electrical  cure  of  fibromes.  Assu- 
redly they  had  used  a  current  of  electricity,  but  all 
the  attempts  made  were  defective  in  ways  that  I 
may  thus  recapitulate  : 

The  current  of  electricity  was  employed  : 

I  St.  In  a  vague  and  variable  manner.  Some- 
times there  was  faradisation,  sometimes  there  were 
continuous,  sometimes  interrupted  galvanic  cur- 
rents, but  always  without  a  definite  object.  The 
current  was  set  in  motion  in  ignorance  of  its  inten- 
sity, and  wdth  imperfect  knowledge  of  the  best 
means  of  employing  it.  The  proceeding  was  purely 
empirical,  discrediting  a  curative  agent,  capable  of 
doing  much  good,  or  none  at  all,  according  to  the 
skill  and  intelligence  with  which  it  was  directed. 


zndly.  AVithout  dosas^e,  that  is  to  say,  without 
.inv  instrument,  in  the  form  of  a  galvanometer, 
whit  h  admittcfl  of  measuring  the  force  of  the  cur- 
rent employed,  or  of  repeating  it  under  the  same 
conditions. 

3rdly.  In  a  do»e  insignificant,  generally  so  smal' 
as  to  be  useless. 

4thly.  By  a  method  always  e.xtra-utcrine,  in  no 
way  directly  acting  upon  the  uterine  cavity,  and 
but  slightly  upon  the  neighboring  parts  of  the  vagina. 

Sthly.  By  a  method  often  dangerous,  from  the 
galvano-puncture  being  made  above  the  pubes,  and 
through  the  abdominal  integuments. 

AVith  these  imperfections  and  dangers  in  view,  it 
was  in  18S2  that  I  originated  a  new  and  rational 
way  of  using  electricity  for  this  purpose.  I  have 
since  gone  on  modifying  and  improving  my  mode 
of  operating  and  I  now  propose  to  give  you  an 
account  of  my  method  as  I  practice  it  at  the  pres- 
ent time. 

1  have  su|iplanted  the  old  way  of  operating  by  a 
method  which  is  : 

1st.  Precise— ^-y  the  introduction  n^  new  galva- 
nometers of  intensity — exact  counters  and  measur- 
ers of  the  electric  current.  It  is  in  this  way  only 
that  we  can  estimate  the  value  of  the  fluid  passed 
and  utilized  through  the  uterine  tissues. 

2nd.  Energetic,  by  an  absolutely  novel  service 
of  high  intensities  of  cunent,  which  I  have 
progressively  carried,  according  to  the  necessities 
of  my  cases,  from  50  to  150  and  250  milliamp(^res. 

3rdly.  Tolerable,  in  spite  of  the  enormity  of 
these  doses,  in  consequence  of  the  introduction  of 
a  new  form  of  electrode,  the  wetted  clay,  which 
renders  the  cutaneous  pole  innocuous  and  permits 
us  to  transmit  through  it  easily  and  without  injury 
!  a  current  of  signal  medical  intensity. 

4thly.  Better  localised,  by  a  direct  application 
of  the  active  pole,  by  way  of  the  vagina,  to  the 
uterus,  either  in  its  cavity,  or  in  the  substance  of 
the  fibroid  deposit. 

5thly.  Thoroughly  under  control,  by  the  exclu- 
sive choice  of  the  unipolar  method.  In  fact,  I 
apply  to  the  diseased  uterus  a  continuous  galvanic 
current  of  an  intensity  and  duration  sufficient  to 
produce  the  therapeutic  effect  required.  Now 
this  application,  which  is  generally  inaccurately 
described  as  electrolytic,  ought  to  be  defined  as  a 
galvano-chemical  cauterization,  that  is  to  say,  a 
cauterization  purely  chemical.  In  the  course  of 
this  current  through  the  tissues  there  are  t\yo  suc- 
cessive and  distinct  effects  developed: 


272 


THE   CANADA    MEDICAL   RECORD. 


a.  The  fangihh  efTcct,  at  the  points  of  entry 
and  exit  of  the  current,  which,  according  to  the  dose 
and  duration,  will  boa  chemical  cauterization  more 
or  less  severe  (but  not  thermic),  variable  in  confor- 
niitv  with  the  pole,  and  different  in  its  character 
at  \.ht  positive  pole  and  at  the  negative  pole.  This 
polaraction,  at  the  will  of  the  operator,  may  be 
either  monopolar  or  bqwlar. 

b.  The  effect  resulting  from  the  circulation  of 
the  current  from  one  pole  to  the  other,  which  is 
therefore  called  interpolar  action.  This  action 
follows  every  electrical  application  and  sets  up 
a  subsequent  process  of  disintegration,  proportion- 
ally wide  and  lasting,  of  the  morbid  products 
through  which  it  is  made  to  jmss. 

In  serving  myself  to  the  utmost  of  the  polar  and 
interpolar  effects  of  the  electric  current  for  the 
treatment  of  fibronies,  I  adopt  always  a  galvanc- 
caustic,  inira-uterinc  and  mo  lOpo'ar.  \  thus  onlv 
use  directly  one  active  pole,  closing  the  circuit 
outside  the  abdomen  by  a  second  pole,  made 
as  nearly  as  possible  uiert.  At  the  same  time,  I 
reckon  upon  the  interpolar  effects  of  the  current, 
as  it  necessarily  finds  its  way  through  the  entire 
uterine  substance,  from  ihe  internal  pole  to  the 
external  or  cutaneous  pole.  This,  as  I  have 
explained  elsewhere,  is  the  i)riiicipal  reason  why  1 
do  not  place  the  two  po'cs  in  the  vagina,  and  why 
I  advocate  the  method  known  as  uterine  monopolar. 

6thl.\'.  More  scientifically  exact,  from  the  due 
appreciation  of  the  topical  effects  of  the  two  poles, 
and  the  precise  chemical  and  anatomical  indications 
peculiar  to  each  of  them. 

I  have  been  able  to  demonstrate,  in  the  clearesl 
manner,  that  we  have  in  our  hands  a  double  edged 
agent,  that  we  can  make  use  of  at  di-^crction,  tc 
afford  us  local  effects  quite  different.  On  the  out 
side,  is  an  lucmostatic  more  or  less  rapid  m  il- 
action,  and  either  direct  and  immediate,  or  second- 
ary and  remote.  I  allude  to  the  postt.v-  pole,  with 
which  we  can  arrest  ha;morrhage,  either  instanily. 
if  the  cavity  of  the  uterus  be  of  normal  dimension  , 
if  the  action  be  relatively  intense,  and  if  the  1  aemorr- 
hage  be  not  excessive  ;  or  more  deliberately  and 
gradually,  after  several  successive  operations,  b_\ 
the  formation  of  contractile  cicatrices.  Tin 
various  gradations  of  the  narrowing  of  the  utcniu 
canal  are  the  plain  evidence  of  this  secondary  am 
prolonged  effect  of  positive  cauterization  . 

The  positive  pole  will  therefore  be  the  "  in  I'icn- 
mcnt  par  excellence  "  in  cases  of  bleeding  c  r  liatnor- 
ra^ic  fibrornes. 


On  the  other  hand,  with  the  tiei^ative  pole  we 
obtain  a  state  of  tcmporari/  coiis^cstio'i,  without 
direct  haemostatic  elfecl.  The  interstitial  circula- 
tion of  the  uterus,  lluis  momentarily  stimulated, 
will  be  hurried  on,  and  a  regression  of  the  non- 
hsmorrhagic  fibromes  is  the  consequence,  eiiher 
of  this  state  of  congestion,  or  of  the  supplemen- 
tary artificial  and  salutary  lijemorrahages  which 
take  place.  The  negative  pole  will  therefore  be 
found  to  render  invahKible  benelil  (though  with 
the  positive  pole  it  is  possible  to  arrive  at  the 
same  point  by  a  way  mine  indirect  and  tedious), 
in  those  cases  of  fibroids  accompanied  with 
anieiiorrhma  and  ilysatncnoi  rhcca,  which  are  only 
too  ol'ten  the  des|)air  both  of  patients  and  doctors 
without  such  means  at  command. 

Looking  iherefore  at  the  difficulties  and  dangers 
of  abdominal  surgery,  and  at  the  avowed  impo- 
tency  of  the  greater  ['art  of  medication  in  cases  of 
fibromes  I  do  not  hesitate  to  assert  for  m.y 
method  of  treating  them  a  precedence  on  the  fol- 
lowing grounds  : 

1st.  It  is  easy  of  application  ;  since  it  only  re- 
quires an  elementary  acquaintance  with  the  prin- 
ciples and  practice  of  electro-therapeutics;  it 
being,  however,  unconditionally  understood  that  a 
profound  knowledge  of  gyiijEcological  science 
must  be  the  indispensable  prelude  to  any  attempts. 

2ndly.  It  is  simple ;  for  it  is  ordinarily  nothing 
more  than  a  skill'ul,  uterine,  therapeutical  soun- 
dage.  This  is  only  what  may  be  expected  of 
ever  surgeon  pro\  ided  with  a  good  galvanometer 
of  intensity,  some  sort  of  battery  cajjable  of 
yielding  an  adequate  current  of  electiicitv,  an 
inoffensive  <  utaneous  electrode  in  wet  poller's 
earth,  an  inallackable  intra  utrine  electiode  in 
platinum,  and  a  steel  trocar  for  the  galvano- 
punctures. 

3rdly.  The  current  its  mathematically  ilosable  ;• 
so  that  every  o[)erator  can  carry  on  the  treatment 
under  the  same  conditions  and  adjust  the  force  of 
his  remedy  to  tla  nature  of  the  effects  he  has  to 
obt  li  '. 

4thly.  The  scat  of  operation  is  optional ;  for 
the  surgeon  has  the  power  of  limiting  and  defining 
the  point  of  tntiance  of  the  current,  making  it 
either  the  mucous  membrane  or  the  ti.ssue  of  tlie 
organ. 

5thly.  It  is  of  a  y  conlrol :  and  only  utilizes  an 
amount  of  force,  which  should  cause  neither  shock 
nor  suffering,  and  ought  never  to  be  put  to  use 
but  in  progressive  and  adjusted  doses. 


tHJE   CANAbA   MEDICAL   RECOUn. 


273 


6thly.  It  is  antiseptic  in  itself,  by  virtue  of  tiie 
higli  cauteriziUioii  of  tlie  active  pok:. 

7thly.  It  is  for  the  most  part  easily  supported : 
aniustlietics  being  only  required  for  certain  cases 
of  gaivano-punctLn-e. 

Stilly.  It  does  not  impose  upon  the  patients  any 
forced  seclusion:  and  mostly  admits  of  tlieir  con- 
tinuing the  usual  habiis  of  life,  and  even  of  doing 
liard  work,  in  the  iMter\,ils  between  the  ii]iera- 
tions. 

ylhly.  Hut  over  and  al)o\e  all  these  considera- 
tions, there  is  one  dominant  point  to  be  advanced, 
which  alone  is  of  weight  enough  to  turn  the  scale 
in  favor  of  the  electrical  treatment.  The  simple 
chemical  cauterization,  for  which  you  may  find 
the  equivalent  in  the  laborator\  of  the  chemist,  or 
in  the  actuti  caiiteiy,  is  not  the  only  matter  we 
have  to  take  account  of  This  chemical  cauteri- 
zation— so  called  jiolar— is  only  the  first  jiart  of 
the  therapeutical  scene  whiili  gradualh  unfolds 
itself 

The  electrical  current — the  power  we  wield,  and 
the  accompaniment  of  every  vital  manifestation, 
in  its  course  through  the  tissues  acts  prolongedly 
and  profoundly  on  every  molecule,  and  thus  causes 
ulterior  changes  in  the  tumour  structure,  which 
may  well  astonish  both  by  their  extent,  safety  and 
certainty. 

I  regret  that  I  cannot  do  more  on  this  occasion 
than  roughly  outline  these  questions  of  prime 
interest,  and  I  turn  at  once  to  the  clinical  and 
purely  practical  results  of  my  treatment. 

With  this  jjowerful  agent,  the  constant  galvanic 
current  of  high  intensity,  of  which  I  have  pointed 
out  the  tractableness  as  well  as  its  many  advan- 
tages, in  our  hands,  let  us  ask  what  can  it  do,  and 
what  ought  we  to  be  able  to  do  with  it,  for  the 
relief  of  the  uterine  fibroid? 

Symptomatically,  the  fibroids  may  be  divided 
into  two  great  classes,  those  which  are  htemor- 
rhagic  and  those  which  are  not  so. 

The  positive  pole  is  the  express  remedy  for  the 
cases  attended  with  haniorrhage,  the  negative 
pole  when  they  are*  >iot  /neinorrhagic.  Each  of 
the  two  poles,  conveying  the  current,  acts  in  the 
first  instance  locally  on  that  part  of  the  mucous 
membrane  with  'which  it  is  in  contact — the  nega- 
tive pole'^  as^  producing  congestion,  the  positive 
pole  as2  hemostatic.  Moreover,  if  they  both  in 
their  secondary  interstitial  action  induce  a  regres- 
sion of  the  tumour,  I  ^believe  that  in  this  respect 
the  greater  potency  belongs  to  the  negative  pole. 


Hut  beyond  this  the  negative  pole  has  a  further 
faculty.  It  we  make  it  enter  by  puncture  into  the 
substance  of  the  fibroid  deposit,  it  will  more  rajiidly 
insure  the  diminution  of  the  tumour,  and  what  is 
truly  remarkable  is,  that  this  negative  pole, 
uatur.dlv  congestioning,  and  little  if  at  all  hemos- 
tatic, becomes  by  a  sort  of  rout  re-coup  markedly 
hxMiiosialic,  .and  will  at  the  end  of  a  certain  tune, 
arrest  e\en  troublesome  luemorrh.iges.  I  ins 
staunching  effect  is  due  to  the  cutting  off  of  the 
supplementary  circulation,  by  the  rai)id  atrophy 
broughi  ilioiit  by  t'le  action  of  ilie  negative  cur- 
lent. 

As  a  supplement  to  the  rule  which  I  have' just 
formulated, — pole  positive  intra-uterine  for  the 
restraining  of  hemorrhage,  pole  negative  inlra- 
ulerinc  for  tumours  without  h;emorrhage— comes 
the  second  indication  {ox  i:;alvano-punctures.  'J'hese 
punctures,  as  my  experience  incieases,  assume 
daily  a  more  and  more  prei'onderating  importance 
in  my  estimation. 

The  indications  for  galvano-puncture  are  two- 
fold;  first,  as  a  matter  of  necesuty  in  conse- 
quence of  uterine  atresia,  or  where  there  is  such 
displacement  of  the  organ  as  to  prevent  any 
introduction  of  a  sound  ;  second,  by  preference 
I  when  we  see  that  we  can  advantageously  combine 
punctures  with  intra-uterine  cauterization,  so  as 
to  expedite  and  make  sure  of  the  effects  that, 
with  the  cauterizations  only,  we  should  tardily  or 
perhaps  imperfectly  realize.  We  must  therefore 
undertake  the  galvano-punctures  atone  whenever 
the  case  will  fairly  admit  of  them,  or  use  them  in 
other  cases  as  adjuncts  to  the  intra-uterine  caute- 
rizations previously  tried. 

The  manipulations  in  the  oiieration  of  galvano- 
puncture  will  always  be  more  difticult  and  even 
dangerous  in  incautious  hands.  I  cannot  therefore 
too  much  insist  upon  a  rigid  observance  of  the 
directions  and  precautions  I  have  elsewhere  given 
at  length.  I  can  now  only  offer  a  very  short 
summary  of  them. 

I  St.  Absolute  and  regular  antiseptic  irrigation 
of  the  vagina,  before  and  after  each  operation. 

2nd.  Use  as  the  puncturing  instrument  a  small 
steel  trocar  or  needle,  and  let  the  punctures  be 
shallow,  that  is,  not  deeper  than  from  i  to  2  cen- 
metres. 

3rd.  Make  the  punctures  on  the  most  promi- 
nent part  of  the  fibroid;  whenever  possible,  in 
the  posterior  culde-sac. 

4th.  Make  the    punctures    without    speculum. 


m 


TSE   CANADA  MEDICAL   RECofefi. 


Sl'.de  the  trocar  through  the  celluloid  sheath  which 
protects  the  vagina,  after  having  examined  and 
chosen  by  touch  the  point  where  the  puncture  is 
to  be  made. 

Sth.  Take  the  precaution  of  ascertniniiix:  flu 
seat  of  any  pulsation^  so  as  to  avoid  wounding  an 
important  vessel. 

6th.  In  case  of  any  unusual  lismorrhage,  im- 
mediately dilate  the.  vagina  with  an  expanding 
speculum,  and  if  necessary  put  on  pressure 
forceps  to  the  bleeding  point. 

Such  is  a  rapid  sketch  of  the  directions  for 
opeiation;  what  now  are  the  anatomical  and 
clinical  results  to  be  expected  ? 

A.  As  regards  the  material  changes  we  may 
affirm,  that  every  fibroid  tumour,  submitted  to  this 
treatment,  sometimes  after  so  short  a  time  as  one 
month,  but  certainly  when  the  treatment  is  fully 
carried  out,  will  undergo  a  manifest  reduction 
appreciable  by  the  touch,  and  demonstrable  by 
internal  measurement.  The  fiuther  diminution  o' 
the  tumour  which  continues  for  some  months, 
varying  in  amount  from  a  fifth  to  one  half  of  the 
original  volume,  is  generally  associated  with  a 
coincident  and  equal  accumulation  of  subcuta" 
neous  adipose  tissue  on  the  abdominal  walls. 

The  regression  of  the  tumour  is  not  only  appa- 
rent during  the  time  of  active  treatment,  but  goes 
on  continuously  after  it  has  been  suspended,  and 
is  the  persistent  proof  of  the  enduring  influence  o- 
the  electrical  operations. 

The  liberation  of  the  tumour  from  its  local  attach 
ments  takes  place  simultaneously  with  its  decrease 
of  bulk.  The  tumour  which  at  the  commence, 
ment  of  the  treatment  was  immovable  can  progres- 
sively be  made  more  and  more  to  change  its  posi- 
tion, as  the  absorption  of  the  enveloping  tissues, 
deposited  round  it,  advances. 

Another  phenomenon  is  observed  in  connection 
with  the  regression  of  the  tumour.  It  not  only  con- 
tracts on  itself,  but  it  shows  a  tendency  to  separate 
it  self  from  the  uterus,  to  become  more  distinctly 
subperitoneal,  to  detach  its  mass,  as  were,  from  its 
setting  in  the  uterine  wall,  and  to  remodel  itself 
into  a  pedunculated  form. 

B.  Clinically. — The  results  are  not  less  striking 
Perhaps  they  are  even  more  so,  as  they  are  not 
only  matter  of  proof  by  the  examination  of  the 
furgeon,  but  the  patient  herself  is  the  living  exhi- 
bition of  them.  We  may  generalise  the  extent 
and  importance  of  these  results  by  saying,  that 
ninety-five  times  out  of  one  hundred,  they  comprise 


the  suppression  of  all  the  miseries  constituting  the 
fibroidal  symptomatology,  which  may  be  thus 
categorically  enumerated  : — Hiemnrrhages,  the 
troubles  of  mcnstniation,'  di/smenorrlioea,  amenorr- 
hfca,  iierroiis  distiii-hances,  the  direct  pains  in  the 
growth  itself,  and  from  mechanical  pressure,  and 
the   harassing  series  of  reflex  actions. 

In  a  word,  the  assertion  may  be  safely  advanced 
that,  though  our  therapeutical  resources  only  carry 
us  so  far  as  the  sensible  reduction  of  fibroid 
tumours,  and  not  to  their  total  absorption,  we  may, 
with  regard  to  the  symptoms,  certainly  anticipate 
their  complete  removal,  and  the  establishment  of 
a  state  of  health  equivalent  to  a  true  resurrection. 
I  am  justified  in  saying,  that  the  greater  part  of 
women  who  have  persisted  in  the  necessary  treat- 
ment, not  only  were  cured  but  remain  well. 

I  use  the  expression,  theg/eater  fart,  because 
there  is  no  such  thing  as  human  infallibility,  espe- 
cially in  medicine.  I  acknowledge  having  been 
sometimes  unsuccessful,  and  so  instructive  are  my 
failures,  that  I  shall  recount  them  at  length  in  a 
work  now  preparing.  It  will  be  seen  that  they 
were  cases  in  which  there  was  no  possibility  of 
satisfactory  treatment,  owing  to  an  apparently 
absolute  intolerance  of  high  intensites  of  current.  I 
see  now  that  I  was  wrong  in  retreating  before  this 
supposed  intolerance.  Among  them,  were  three 
cases  of  fibrome  with  ascites,  and  I  regret  now  that, 
with  the  aid  of  anaesthetics,  I  did  not  persist  in  going 
to  the  limit  of  my  power.  I  have  also  met  with 
the  same  intolerance  in  some  hysterical  subjects, 
in  cases  of  very  irritable  uterus,  and  in  others  of 
peri- uterine  and  intestinal  phlegmasia.  Now,  with 
my  present  experience,  I  should  not  hesitate  to 
operate  to  the  fullest  extent  with  the  patient  under 
chloroform.  There  remains  yet  the  obscure  ques- 
tion as  to  the  class  of  cystic  fibromes,  and  tumours 
with  a  tendency  to  malignant  degeneration,  where 
there  is  often  an  accompanying  fearful  and  irre- 
pressible hydrorrhcea.  I  have  recorded  three  such 
instances, and  in  them  intra-uterine  galvano-cautiza- 
tion  generally  proves  useless.  Something  more  is 
demanded,  and  we  must  seek  in  galvano-punctures 
means  of  denutritive  action  more  powerful  and 
more  efficacious. 

Finally,  I  may  lay  down  the  following  proposi- 
tion. No  operator  should  admit  the  failure  of  intra- 
uterine galvano-cauterization,  before  having  had 
recourse  to  the  galvano  punctures,  which  he  must 
enforce  either  with  or  without  ancesthetics. 

We  will  now  turn  aside  from  all  theoretical  con- 


THE   CANADA    MEDICAL   RECORD. 


275 


siderations,  and  look  at  the  facts.  I  may  rely  upon 
tliem,  with  confidence,  as  my  great  suijport.  I 
desire,  however,  in  the  first  instance,  to  prove  the 
comparative  safety  of  intrauterine  medication  when 
my  method  is  adopted. 

Botli  in  my  din  '//itc,  and  in  my  private  consul- 
tations as  far  as  regards  gyn.xcological  practice, 
the  ajiplication  of  electricity  therapeutically  assumes 
two  forms.  In  the  one,  it  is  exclusively  faradic, 
in  the  other  galvanic.  For  the  present  I  pass 
over  faradism,  to  occupy  myself  solely  with  what 
reiates  to  the  patients  who  have  been  subject  to 
the  treatment  by  continuous  currents. 

In  the  five}  ears,  from  July,  1882,  to  July,  1887^ 
I  have  made,  either  privately  or  at  the  cliniqiie,  as 
many  as  5201  applications  of  continuous  galvanic 
currents,  for  most  of  the  maladies  included  in  the 
gynecological  nosology;  and  I  may  enumerate 
them  in  the  following  order : 

1  Fibroids  of  uterus — polypi; 

2  Entire  or  partial  hypertrophies  of  the    uterus  . 

3  Subinvolutions ; 

4  Acute  and  chonic  metritis  and    endometritis  ; 

5  Ulcerations  of  the  neck,  of  the  uterus  ; 

6  Peri-uterine  inflammations  (perimetritis,  para- 
metritis, cellulitis,  phlegmons)  ; 

7  Ovarialgia  ; 

8  Ovaritis  and  periovaritis  ; 

9  Salpingitis  ; 

10  Ovarian  and  tubular  cysts  at  an    early  stage; 

11  Atresia; 

12  Hematocele. 

These  5,201  operations  were  thus  jjartitioned  : 

I.  AtMV  CLINTQUE,  2,837. 

a.  1,524     galvano    cauterizations,    chemical, 
positives  intra-uterine. 

b.  745  galvano  cautizations  chemical,  negative, 
intra-urine. 

c.  368  galvano  punctures,  chemical,  negative, 

vaginal. 

Id.     200    cauterizations,    galvano,    chemical,  of 
neck  of  uterus. 
II.  In  mv  private  practice,  2,364. 

a.  1,245     galvano     cauterzations,     chemical, 

positive,  intra  uterine. 

b.  1,027  galvano  cauterizations,  chemical,  nega- 

tive, intrauterine. 

c.  72  galvano  punctures,  chemical,  negative, 

vaginal. 

d.  20  galvano   cauterizations,  chemical,  of 
peck  of  uteriis, 


I 


These  5,201  operations,  which  range  over  a  space 
of  five  years,  were  made  upon  403  patients,  who 
went  through  the  treatment  more  or  less  systemati- 
cally. And  I  must  not  omit  to  mention  that  I 
intentionally  say  nothing  about  the  number,  far  in 
excess  of  the  above,,  who  were  merely  the  subjects 
of  faradism,  as  I  have  the  intention  of  publisliing 
a  separate  memoir  on  that  .subject. 

Now  in  referring  to  the  history  of  these  403 
patients  (276  at  the  clinique,  127  private),  the 
number  of  whom,  for  the  time  occupied,  may  really 
be  considered  as  great,  I  have  only  to  deplore  the 
loss  of  two.  Of  these  two  deaths  I  take  upon 
myself  the  entire  responsibility.  My  method  was 
not  in  fault.  I  only  was  to  blame,  as  may  be  seen 
by  the  full  and  detailed  report. 

In  one  case,  I  admit  candidly  that  there  was  a 
fatal  error  in  my  diagnosis.  1  did  not  recognise 
the  presence  of  a  suppurating  ovarian  cyst,  which 
ended  in  death  from  peritonitis.  Death  was  due, 
in  the  second  case,  to  a  puncture  made  too  deeply. 
The  consequence  was  intra-peritoneal  gangrene, 
for  which  the  abdomen  was  not  opened. 

In  addition,  I  have  to  confess  to  having  either 
excited  or  aggravated,  in  the  course  of  the  five 
years,  ten  peri-uterine  phlegmonous  inflammations. 
These  must  be  attributed  to  blunders  in  carrying 
out  the  treatment,  as  will  be  shown  when  the  ac- 
count is  published  at  length. 

But  these  errors  of  practice  happened  during 
the  early  days  of  my  work,  and  were  either  : 

a.  Negligence  of  antiseptic  measures,  which  were 
either  omitted  altogether  or  done  imperfectly; 
or, 

b.  The  too  violent,  or  too  intense,  use  of  the 
negative  pole,  in  cases  of  subacute  peri-uterine 
inflammations. 

The  fact  is,  that  the  negative  pole,  having  a 
strong  power  of  producing  congestion,  is  a  dan- 
gerous weapon,  which  at  the  beginning  of  any 
treatment  must  be  brought  to  bear  with  great  pru- 
dence and  reserve,  if  one  would  avoid  overshooting 
to  mark  for  which  it  is  intended. 

To  lay  before  you  the  facts  of  these  accidents 
will  serve  the  double  purpose  of  warning  you  of 
what  may  befall  you,  and  of  preventing  you  from 
falling  into  similar  errors.  My  caution  is,  that 
whenever  the  negative  pole  is  put  in  use,  and  there 
is  any  trace  of  peri-uterine  inflammation  present, 
you  miist  t\qX  only  rec^ouble  your  antiseptic  heed- 
fulness,  but  your  operative  proceedings  must  be  car- 
rie(J  Q\\   ^ith   deliberate   carefulness.     Y^v^  xi\\^X 


276 


THE   CANADA   MEDICAL   RECORD. 


feel  your  way,  testing  the  susceiitibility  you  have 
to  work  upon  by  two  or  three  preliminary  opera- 
tions, in  which  you  give  doses  so  feeble  that  they 
only  serve  to  enlighten  you,  and  to  habituate  the 
patient,  so  as  lead  on  safely  to  the  use  of  higher 
intensities. 

But  when  I  tell  you  that  this  operative  gynfc- 
colgy,   as  1  have  to  practise  is  carried  on  in  such 
exceptional  circumstances  that    no  one  else  has 
ventured  to  encounter   them,    and    upon    a  class 
of  women  who  are  obliged  to  walk  home   shortly 
after  they  get  up  from  tiie  couch,  who  seldon  take 
tiie  necessary  rest  in  bed,  who  are  in  no  way  under 
my  surveillance,  and  whose  poverty  forces  them  in 
some  fashion  to  get  through  all  the  ordinary  duties 
of  life,  you  will  be  curious  to  know,  and  you  will 
ask  of  me,  what  is  tiie  explanation  of  this  illusive 
mystery.     All  that  that  I  can  say  is,— it  appears 
to     me    that    the    intra-uterine    current,    at    the 
high  propertions    I    trust  to,    seems    to    have  ni 
itself  some  special  antiseptic  and  atrophic  property. 
I  must  close  these  remarks  on  the  failures,  which 
I  have  no  wish  to  concealbut  which  I  now  expose  to 
you  in  all  their  nakedness,  tliough  they  so  stand  as 
the  evidence  of  only   the  usual  difficulties  which 
accompany  the  laborious  and  misty  development 
of  any  new  method  of  treatment,  without  speaking 
of  other    dangers   which   lie  in     the   way,    such 
as   the  possibility  of  concealed    pregnancy,  and 
accidental  abortion,  and  also  the  risk  of  opening 
up  a  vesico-vaginal  fistula.   I  have  already  enlarged 
on  this  matter  elsewhere,  and  in  my  ne\t  work,  on 
gynecological  electrical  therapeutics,  1  shall  devote 
a  chapter  to  the  consideration  of  the  needful  [ire- 
cautions. 

I  am  anxious  to-day,  as  the  completion  of  my 
))ai)er,  to  put  forward  a  simple  statistical  statement 
of  what  has  been  my  trv-aiment  of  uterine  fibroids. 
From  ]uly,  1882  to  July,  1887.  I  have  had  under 
my  care  278  patients  with  hbromes  or  ]iyi)etrophy 
of  the  uterus  in  some  manifest  degree,  ui)on  wliom 
I  have  used  4,246  applications  of  the  continued 
current  of  electricity.  The  iiatients  and  the  opera- 
tions may  be  thus  classified: 

1.   ClINIQUE  1S6  PATIENTS,  .■VNO  2.347  OPERATIONS. 

,j  1433  galvano  caulcrizatioiiB,  positive,  intra- 
uterine. 

J,.  593  galvano  cauterizations,  negative,  intra- 
uterine. 

(,     321  galvano  punctures,  negative,  yaginal, 


II.  Private,  92  patients,  and  1,899  operations. 

a.   1,085  galvano  cauterizations,  positive,  intra- 
uterine. 

d.  746  galvano  cauterizations,  negative,  intra- 

uterine. 

e.  68  galvano  punctures,  negative  vaginal. 

As  I  said  before,  I  do  not  wish  to  convey  the 
impression  that  all  these  patients  have  been  cured. 
It  is  not  so,  for  the  very  good  reason,  that  some 
of  them,  especially  those  of  the  dinique,  have  not 
persevered  to  the  end,  attendance  having  been 
discontinued  as  soon  as  the  first  feelings  of  amend- 
ment have  been  experienced.  But  I  can  atfinii  that 
when  there  has  been  no  ne;.:ligence,  and  my  advice 
has  been  fully  acted  upon,  95  times  out  of  100,  per- 
manent benefit  has  been  acknowledged.  I  may 
also  predict  that  if  adopted  in  its  integrity,  and 
worked  as  it  ought  to  be,  the  mortality  from  my 
treatment  will  henceforward  be  nothing.  I  cannot, 
however,  omit  to  report  a  fact  which  gives  o'ca- 
sion  for  melancholy  comparison. 

Among  the  patients  who  had  not  the  will  to  let 
me  finish  what  I  had  begun,  and  whose  impatience 
led  them  voluntarily  to  seek  the  removal  of  their 
tumours  by  excision,  sevenput  themselves  into  the 
hands  of  six  of  our  most  eminent  surgeons,  and 
not  one  of  the  seven  recovered  from  the  operation. 
Commentary  on  this  would  be  superfluous. 

One  word  in  parting.    Men  and  their  labors  can, 
in  general,  only  find  their  proper  level  and  value 
through  the  esteem  of  their  associates,  and  the  way 
in  which  what  they  have  done  is  publicly  accepted. 
Now,  I  feel  it    pressing    upon    me  as  a  duty  to 
acknowledge,  that  if  the  method  about  which  1  have 
j  been  addressing  you   e\er  meets  with  the  confi- 
(Icinc  of  the  profession  (to  speak  only  of  England) 
'   11  will  be  nuunly  due  to  your  illustrious  countryman 
I   Sir  Spencer  Wells,  who  was  one  of  the  first  to  extend 
'   tome  the  benefit  of  his  experience  and  authority, 
and  to    his   learned   friend    Dr.  ^Voodham  Webb, 
whose  name  will  ever  decoupled  with  its  introduc- 
tion and  diffusion.  It  would  be  injustice  were  I  not 
also  to  refer  to  the  honor  such  distinguished  gyn»- 
cologists,  as  Keith,  father  and  son,  Playfair,  Savage, 
Elder  and  others  have  done  me  by  their  visits,  and 
to  the  encouragement  tlicv  have  given  me  by  their 
apin'obation, 

T  coidiallv  thank  all  who  are  i)resent.  and  I  assure 
you  that  the  best  recompense  of  the  work  of  my  life 
will  t>e  ^o  find  many  of  you  becoming  my  followers. 


THE   CANADA    MEDICAL   RECCED. 


277 


Soclefff  3^/'ocecdinoS. 


MEDICO  CHI RURGICAL  SOCIETY  OF 
MON'i'REAI,. 

SlaUd  Met-tiiig,  xMay  13///,  1887. 
J.  C.  Cameron,  M.D.,  Presidf.nt,  in  the  Chair. 

ratholiigical  Specimens. — Dr.  Johnston  exhi- 
bited specimens  from  a  case  of  perityphlitis  in  a 
i;irl  aged  12.  Tliere  was  110  lesion  found  in  the 
brain. 

Dr.  ]{i, NCKADKK  said  tliat  lie  had  been  called  in 
consultation  in  the  case.  The  girl  complained  of 
pain  in  the  back,  right  iliac  region,  and  down  the 
right  leg.  A  week  before,  the  attack  had  set  in 
with  vomiting  and  abdominal  pain  when  the  mo- 
ther had  given  a  purgative.  There  was  no  marked 
rise  of  temperature  (101-102),  and  the  pulse  never 
was  high.  Abdomen  was  tender  and  tympanitic. 
The  child  had  been  brought  to  him  formerly  for 
convulsions,  which  set  in  first  on  right  sidCj  then 
becoming  general,  lasting  about  twenty  minutes. 
He  liad  been  able,  also,  to  elicit  clonic  movements 
of  that  side,  first  of  the  arm,  then  of  the  right  leg) 
but  they  did  not  become  general.  These  nervous 
symptoms  yielded  to  arsenic,  and  her  general 
health  was  good.  The  convulsions,  however,'con- 
tinued  up  to  three  o'clock  of  the  day  previous  to 
death. 

1  )r.  JoHN.STON  exhibited  specimens  of  tubercle 
of  the  traihea  from  a  case  of  general  tuberculosis, 
ui  which  several  of  the  rings  were  exposed  from 
ulceration  of  the  posterior  surface.  He  also  exhi- 
bited the  stcrniiiii  and  ribs  from  a  case  of  rickets 
in  which  the  Rachitic  Rosanj  was  well  shown 
from  the  inside,  but  not  externally. 

A  Rare  Form  of  Epilepsy. —  Dr.  AVoon  then 
read  the  fiillowingiia|)er  cjn  a  rare  lorni  of  epilepsy, 
and  exhibited  the  patient: 

.Some  years  ago,  Dr.  William  Osier  read  a  pajier 
in  this  room,  in  which  he  spoke  of  a  case  C'f  Jack- 
sonian  e|)ilepsy.  He  was  fortunate  enough  to  be 
able  to  show  the  brain  of  the  subject  and  the  cor- 
tical growth  (a  small  glioma)  which  gave  rise  to 
the  epileptiform  seizures.  I  am  unable  to  demons- 
trate the  actual  existence  of  any  disease  within  or 
about  the  motor  zone  of  the  patient  about  which 
I  am  going  to  speak,  because  he  is  still  alive  ;  but 
I  thought  it  might  be  interesting  to  introduce  for 
discussion  hereby  detailing  such  a  case,  the  whole 
subject  of  false    (non-hysterical_j  epilepsy.     The 


subject  of  epileptic  aurae  and  the  modes  of  onset 
in  epilepsy  has  always  been  an  attractive  one  to 
me,  and  I  would  like  to  hear  from  members  of 
this  .Society  in  this  connection. 

Until  eighteen  months  ago,  the  patient,  E.  PJ., 
aged  70,  was  in  fair  health.  Had  never  had 
syphilis,  but  now  suffers  and  has  suffered  at  times 
for  many  years  from  rheumatic  gout,  the  great  toe 
of  right  foot  being  the  chief  seat  of  the  trouble. 
Has  occasionally  had  pains  (which  were  set  down 
as  rheumatism)  in  several  other  joints  of  his  body, 
but  has  never  been  laid  up  with  them.  Has  never 
suffered  from  persistent  headache  ;  never  had  any 
injury  to  his  head,  and  his  intellectual  faculties  are 
well  preserved.  There  is  no  history  of  family 
netnoses.  His  digestion  is  fair,  and  his  heart  and 
kidneys  are  m  normal  condition.  He  had  his  first 
attack  eighteen  months  ago,  and  the  half  dozen 
attacks  which  he  has  had  since  then  are  similar  to 
that  one,  only  they  seem  to  getting  worse.  He  fir.st 
noticed  twitchings  of  the  muscles  of  the  left  forearm 
and  face  ;  these  twitchings  increased  in  violence, 
and  although  he  made  efforts  to  control  them,  they 
went  on  getting  worse.  He  then  began  to  experi- 
ence feelings  of  fear  as  of  impending  danger,  and 
in  about  a  quarter  of  an  hour  after  the  first  muscu- 
lar contraction,  he  thinks  he  became  unconscious 
for  a  few  moments,  but  is  not  certain  of  it.  In 
half  an  hour  the  whole  attack  was  over,  and  with 
the  exception  of  a  feeling  of  weakness  in  the  arm, 
he  was  all  right  again.  He  has  had  since  then, 
but  at  no  regular  interval,  some  half-dozen  attacks, 
varying  little  in  character  from  the  fii'st  one. 
Nearly  every  attack  has  been  witnessed  by  his 
fellow  workmen  or  his  wife,  and  I  have  been 
able  to  get  a  pretty  fair  account  of  them.  The 
loss  of  consciousness  lasts  but  a  ^liw  moments. 
Sometimes  he  has  had  what  he  calls  double  attacks  ; 
that  is.  he  will  have  a  second  attack  a  few  minutes 
after  the  first,  which  is  not  as  severe  at  the  first, 
and  is  not  accompanied  by  unconsciousness.  He 
knows  when  he  is  going  to  have  an  attack,  and 
will  grasp  his  left  wrist  in  his  right  hand,  and  do 
his  best  to  prevent  the  spasm  from  gvnting  worse 
or  from  attacking  his  face.  I  saw  the  latter  half 
of  one  of  these  attacks,  which  he  declares  he  can 
bring  on  at  will,  or  rather  (becau'-ethe  man  suffers 
much  from  the  dread  of  approaching  danger  which 
accompanies  the  attack)  he  thinks  that  when  he 
has  a  second  attack  it  is  due  to  putting  the  arm  or 
his  body  in  some  uncomfortable  position.  I  was 
talking  to  hjm  one  day  (having  reached  the  house 


278 


THE   CANADA   MEDICAL   RECORD. 


shortly  after  a  seizure)  when  he  said, '"  There,  I 
am  going  to  have  another  attack."  He  grasped 
his  left  wrist  firmly,  but  jerking  began  in  the  arm. 
the  muscles  of  the  upper  arm  being  most  affected. 
This  was  shortly  followed  by  twitching  in  the 
other  muscles  of  the  arm,  all  growing  worse,  until 
the  forearm  became,  flexed  upon  the  upper  arm; 
then  the  muscles  of  the  face  began  to  twitch,  and 
both  sides  seemed  affected  just  as  in  true  epilejjsy. 
The  man  meantime  made  violent  efforts  to  control 
the  spasms,  and  called  to  his  wife  to  jirevent  the 
flexion  of  the  tbrearm.  She  succeeded  in  straight- 
ening it  with  some  difTicuity.  In  five  luinutes  the 
attack  was  over,  and  I  am  unable  to  .say  whether 
lie  was  unconscious  or  not.  For  several  days 
afterwards  he  complained  of  weakness  in  the 
affected  arm.  The  spasm  in  this  instance  and  in 
every  other  attack  was  distinctly  confined  to  the 
left  arm  and  face,  beginning  first  in  the  arm  and 
extending  to  the  facial  muscles.  Without  the 
dynamometer  test,  the  grasp  of  the  left  hand, 
several  days  after  an  attack,  appears  to  be  as  firm 
as  that  of  the  right.  I  do  not  know  why  it  should 
be  so,  hut  the  patellar  tendon  reflex  is  wanting  in 
the  left  leg,  and  is  faint  on  the  right  side.  The 
only  doubt,  it  appears  to  me,  in  the  diagnosis  of 
this  case  as  one  of  Jacksonian  epilepsy,  or,  in 
other  words,  of  disease  affecting  the  fiice  and  arm 
centres  about  the  fissure  of  Rolando,  is  that  matter 
of  loss  of  consciousness.  It  seems  to  me,  however, 
that  the  clonic  muscular  contractions,  confined  to 
such  related  groups  of  muscles  as  those  of  the  arm 
and  face — the  gradual  onset — the  loss  of  consci- 
ousness, if  at  all,  but  very  slight,  and  coming  on 
near  the  end  of  the  attack,  after  the  patient  has 
been  able  to  make  vain,  but  inlelligent,  efforts  to 
prevent  the  involvement  of  the  other  arm  and  facial 
muscles — the  absence  of  any  history  of  his  falling 
down. — all  these  point  to  a  local  brain  lesion  and 
not  to  true  epilepsy.  There  was  no  paralysis  in 
this  case,  nor  any  tonic  contractions  of  the  muscles, 
although  the  patient  complains  of  weakness  in  the 
arm  for  a  day  or  two  after  an  attack.  One  must 
conclude  that  there  is  no  actual  destruction  of  the 
cortex  within  the  motor  area,  but  that  some  growth 
or  induration  in  a  situat-on  outside  of  it  irritates, 
upon  occasions,  the  centres  that  preside  over  the 
face  and  arm  muscles.  In  Dr.  Osier's  case,  there 
was  a  long-standing  contraction  of  the  right  foot. 

Regarding  the  treatment  of  this  case,  he  has 
been  taking,  for  several  months,  5  grs.  of  potassic 
iodide,  (ogrs,  of  potassic  bromide,  and  15  grs.  pf 


potassic  bicarbonate,  three  times  a  day,  on  alternate 
days,  and  so  far  he  has  been  free  from  attacks. 
I  am  watching  the  case  and  awaiting  develop- 
ments. Thinking,  foi  obvigus  reasons,  that  it  was 
advisable  to  have  his  eyes  examined,  I  sent  him 
to  Dr.  I'roudfoot,  and  I  conclude  with  his  re- 
port : 

"  I  send  you  the  following  notes  of  E.  B.'s  case. 
I  am  sorry  he  could  not  come  to  see  me  again,  as 
I  wished  to  examine  his  colour  perception  and 
visual  powers,  which  I  could  not  do  before.  At 
the  time  I  examined  him,  I  found  the  humors  of 
the  eye  perfectly  transparent  and  nothing  abnor- 
mal, with  the  exception  of  the  '  disc,  '  which  was 
somewhat  grayish  in  colour,  and  there  were  two 
or  three  small  collections  of  pigment  at  the  upper 
and  outer  margin,  and  a  narrow  atrophic  ring  ex- 
tending round  the  lower  and  inner  third,  with  a 
slight  depression  of  the  vessels  in  that  region. 
There  was  no  hyperjemia  or  other  evidence  of  any 
very  recent  trouble,  and  the  patient  informed  me 
that  his  sight  was  as  good  then  as  it  had  been  for 
some  time  back. '' 

Disaission. — Dr.  Bui.ler  said  that  there  were 
many  well-established  cases  where  epileptic  attacks, 
were  caused  by  the  irritation  produced  by  a  shrun- 
ken eye-ball.  This  is  especially  the  case  where 
the  choroid  coat  is  undergoing  inflammatory  chan- 
ges resulting  in  the  formation  of  bone.  He  then 
called  the  attention  of  the  Society  to  the  condition 
of  the  patient's  eye,  in  which  the  osseous  deposit 
was  perceptible,  and  said  that  the  irritation  produ- 
ced by  the  pressure  of  this  hard  ring  on  the  ciliary 
nerves  was  sufficient  to  set  up  sympathetic  chan- 
ges, and  perhaps  to  account  for  the  epilepsy. 

Dr.  Stewart  said  the  case  was  evidently  one 
of  cortical  epilepsy.  General  epilepsy  might  be 
traced  to  such  a  source  as  irritation  of  the  ciliary 
nerves,  but  he  did  not  understand  how  it  could 
jnoducc  one-sided  epilepsy. 

Dr.  Trf.nholme  thought  Dr.  Buller's  views  were 
very  important ;  slight  but  continuous  irritation  of 
sensitive  nerves  is  apt  to  set  up  epileptic  attacks. 
He  throught  enucleation  of  the  eye  might  be 
performed  with  benefit. 

Dr.  Duller,  in  answer  to  a  question  from  the 
President,  said  that  if  the  attacks  recurred  he 
would  recommend  removal  of  the  eye. 


Ts^-yi 


ftife  CANADA   MEDICAL   llECORD. 


270 


Stated  Meeting,  May  27M,  1887. 
J.  C.  Cameron,  M.D.,  Presidknt,  in  thk  Chair. 

PATHOLOGICAL  SPECIMEKS. 

Ulcerative  Endocarditis. — Dr.  Rowkll  c.\lii- 
bilcd  spcciuK'Hs  from  a  case  of  iilccraliNe  (jiido- 
carditis. 

Bright' s  Disease. — Dr.  R.  I>.  Mai  Donm:i.i. 
exhibited  the  heart  and  kidneys  from  a  case  of 
Blight's  Disease. 

Albuminuric  Retinitis. — Dr.  Buli.ek  sliewed 
one  of  the  retime  from  the  above  case.  The  pa- 
tient had  first  api)lied  to  the  oplithahnic  cHnic  on 
accomit  of  loss  of  sight,  about  two  weeks  before  her 
death  ;  could  then  count  fingers  at  a  distance  of  a 
few  feet.  Pupils  were  dilated  ;  ophthalmoscope 
shewed  extensive  outbreak  of  patches  of  infiltra- 
tion near  macula.  Recommended  patient  to  enter 
hospital  for  her  renal  disease.  At  the  autopsy, 
besides  the  infiltration  of  retina,  several  small  hem- 
orrhages and  some  accumulations  of  pigment 
were  detected.  It  was  a  good  example  of  albunii- 
auric  retinitis  in  a  late  stage. 

Cancerous  Angioma. — Dr.  Fenwick  shewed  a 
small  tumor  removed  from  the  neck  of  a  girl  aged 
21.  When  first  noticed  two  years  before  was  about 
the  size  of  a  pea.  Local  applications  had  no  effect. 
On  removal,  was  the  size  of  an  egg,  encapsulated, 
situated  just  behind  angle  of  jaw,  and  apparently 
very  vascular.  Patient  had  an  attack  of  cynan- 
che  four  months  before  the  tissue  growth  was  first 
noticed. 

Dr.  Johnston  stated  that  the  growth  was  a  can- 
cerous angioma,  and  exhibited  a  micro.scopic  sec- 
tion. He  thought  this  was  of  interest,  because  in 
this  region  remnants  of  the  brochte  would  exist. 

Dr.  Kingston  considered  the  attack  of  tonsilli- 
tis as  merely  a  coincidence. 

Depressed  Fracture  of  the  Skull. — Dr.  Fewvick 
shewed  a  specimen  of  depressed  fracture  of  skull- 
Patient,  aged  25,  was  admitted  into  hospital  April 
3rd,  18S7,  in  an  unconscious  state,  supposed  to 
have  been  injured  by  puttuig  his  head  through  a 
window  of  railway  car  and  striking  abutment  of 
bridge.  Scalp  wound  over  three  inches  in  left 
parietal  region  ;  beneath  this  a  depressed  commi- 
nuted fracture  was  noticed.  Ecchyniosis  of  left 
eyelid  and  conjunctiva.  A  little  bloody  serum 
oozing  from  left  ear.  Wound  dressed  with  iodo- 
form, and  patient  given  bromide  of  potash. 

April  i^th. — Some  small  pieces  of  loose  Lone 
removed  from  wound,  leaving  an  opening  in  skull 


2)4  by  1  inch.  Dura  mater  slit  up  for  about  an 
inch,  evacuating  a  quantity  of  fa;tid  jius  from  an 
abscess  in  cerebral  cortex.  Discharge  from  ear 
has  become  ]nirulent.  Drainage-tube  inserted  and 
wound  closed. 

April  x'f^ih. — 'remperaliwe.  rising  for  several 
days:  to-day  iOcS.5  ^  .     Died  at  8  jliu. 

Head  examined  l>y  Dr.  Johnston  75  hours 
after  death. — 'I'he  wound  above  described  was 
found  bathed  in  i)us.  On  removing  stitches  where 
the  depressed  internal  table  of  jjarietal  bone  is 
exposed  diploe  has  a  granulating  surface.  The 
incision  in  dura  mater  had  not  united.  Line  of 
fracture  extends  downwards  through  petrous  bone 
which  is  splintered  into  many  little  pieces,  thence 
across  the  lesser  splienoid  wing  and  in  front  of  the 
anterior  clinoid  jirocess  to  the  right  orbital  plate. 
In  the  left  temporal  fossa  were  two  drachms  of 
pus  between  dura  and  bone  ;  a  good  deal  of  blood 
extravasated  in  this  neighborhood.  Pia  mater 
ill  this  region  and  at  the  base,  normal.  In  the 
cerebral  cortex  an  abscess  the  size  of  a  hazel-nut 
was  found  just  beneath  the  su|jra-marginal  convo- 
lution, which  presented  a  small  superficial  slough. 
Tlie  abscess  did  not  extend  quite  as  deep  as  the 
roof  of  the  left  lateral  ventricle.  On  sawing  open 
tympanum,  the  cavity  was  found  full  of  jnis.  The 
mastoid  cells  contained  a  little  pus. 

Dr.  Fenwick  stated  that  he  had  put  a  stitch  in 
the  incised  dura  ;  would  not  do  so  again  in  a  simi. 
lar  case. 

Dr.  BuLi.ER  1  ai  seen  a  case  some  years  ago; 
patient  had  been  run  over  by  a  cartwheel,  by  which 
petrous  bone  was  fractured  and  several  ounces  of 
brain  matter  escaped  through  the  ear.  The  pati- 
ent recovered.  Drum  membrana  was  defective 
in  upper  and  anterior  part,  and  there  was  a  marked 
deformity  in  meatus. 

Dr.  Fenwick,  in  reply  to  a  question  by  Dr. 
Buller,  did  not  consider  ecchymosis  of  conjunctiva 
pathognomonic  of  fracture  of  ethmoid  bone. 
Thought  tearing  of  small  vessel  in  sphenoidal  fissure 
might  cause  it  in  absence  of  any  fracture  of 
ethmoid,  and  cited  cases  where  the  ethmoid  was 
fractured  this  sign  was  absent. 

Dr.  Roddick  asked  (i)  if  he  would  have  open- 
ed the  skull  below  the  temporal  fossa  if  he  had 
known  the  state  of  damage?  (No.)  (2)  If  he  would 
have  operated  in  the  same  manner  again  ? 

Dr.  Fenwick  said  that  he  would,  citing  Bank's 
case  where  skull  was  drained  and  sinus  had  dried 
up. 


280 


*rHE   CANADA  MEDICAL   RECORD. 


Extirpation  of  thcUtenis. — Dr.  \Vm.  Gakdner 
exhibited  a  uterus  removed  by  the  vaginal  method 
for  cancer,  and  related  the  case.  A  lady  of  57 
had  consulted  him  a  few  months  ago  for  continuous, 
shghtly  reddish,  watery  vagnial  discharges,  pain  in 
the  sacral  region,  and  general  debihty.  On  exam- 
ination, the  uterus  was  considerably  enlarged, 
measuring  4  inciies  in  the  depth  of  its  cavity,  retro- 
verted,  and  quite  moveal)le.  Tlie  cervi\,  which 
was  rpiite  healthy,  was  dilated  with  a  tent,  and  a 
(piantity  of  friable  outgrowth  in  the  cavity  detec- 
ted and  removed.  No  improvement  in  the  symp- 
toms resulted.  A  {kw  weeks  later  total  extirpation 
was  advised,  and  perfoiincd  a  few  days  ago.  The 
operation  presented  nothing  unusual,  except  that 
after  it  was  completed  an  embryonic  dermoid  cyst 
of  the  size  ofa  small  orange  presented  in  the  wound 
and  was  removed.  The  patient  made  an  excellent 
and  speedy  recovery.  'I'he  specimen  showed 
that  the  disease  was  slrictl}-  confined  to  the  inte- 
rior of  the  uterus.  The  case  was  therefore  a 
typical  one  for  the  operation  of  total  extirpation. 
Dr.  Johnston,  Lecturer  on  Pathology  in  McGill 
University,  had  made  a  microscopical  examination, 
and  pronounced  the  disease  to  be  carcinoma,  less 
favorable  for  non-recurrence  than  sarcoma,  which 
it  was  hoped  it  might  be. 

Dr.  Johnston  thought,  from  its  api)earance, 
the  cyst  must  have  arisen  from  inclusion  of  a  por- 
tion of  the  amnion  in  early  f(„etal  life. 

Dr.  Kingston  thought  it  was  properly  a  piece  of 
included  fcetal  membrane. 

Ovariotomy  during  Prey  11  a  a  cy. —  Dr.  Wm. 
G.\RDNER  made  a  brief  communication  about  a  case 
related  to  the  .Society,  with  exhibition  of  the  speci- 
men, some  three  months  ago.  The  case  in  r^uestion 
was  one  of  ovariotomy  pertbnned  on  a  patient 
suffering  from  symptoms  of  peritonitis.  The  tumor 
was  a  dermoid  cyst,  universally  adherent,  with 
twisted  pedicle  ;  washing  out  and  drainage  were 
resorted  to,  the  drainage-tube  remaining  in  the 
Douglas  p.nich  and  resting  against  the  posterior  wall 
of  the  uterus  t'or  five  days.  The  patient  made  an  easy 
and  raijid  recovery.  At  the  operation  the  uterus 
was  suspiciously  bulky,  softened,  and  vascular. 
The  possibility  of  pregnancy  certainly  occurred  to 
the  operator,  but  was  not  seriously  entertained. 
However,  a  few  days  ago  he  had  an  opportunity 
of  examining  the  woman,  and  found  her  certainly 
pregnant  about  five  months.  In  some  particulars 
he  thought  the  case  unique,  and  well  worthy  to  be 
placed  on  record.     Ovariotomy  during  pregnancy 


without  interruption  of  gestation  has  been  performed 
a  good  many  times  ;but  iminterrupted  gestation  in 
spite  of  ovarian  tumor  with  twisted  pedicle  and 
consequent  severe  peritonitis,  and  a  complicated 
ovariotomy  with  seperation  of  adhesions,  copious 
washing  out  drainage-tube  for  five  days,  if  not  un- 
paralleled must  be  exceedingly  rare.* 

Dr.  HiNosTON  thought  it  should  not  be  an  invaria- 
ble rule. 

Dr.  (Iardnkk  thought  that  those  operating 
largely  were  agreed  that  tiie  danger  of  such  opera- 
tion was  less  than  the  danger  from  the  tumor  if  left 
till  full  term.  His  comse  would  depend  from  the 
date  of  pregnancy. 

Fibro-dysic  Tumor  of  the  Testicle.— ^'ix.  Rod- 
dick reported  a  case  of  fibro-cystic  tumor  of  the 
testicle,  and  made  some  general  remarks  ui)on 
the  subject  of  tumors  of  the  tesicle.  He  said  : 
The  specimen  I  show  you  is  a  diseased  testicle  re- 
moved n  few  weeks  since.  The  patient,  a  health)'- 
looking  young  man  of  24  \ears,  was  brought  to 
me  from  one  of  the  neighbouring  States,  having  a 
history  of  slow  enlargeinent  of  the  testicle,  the 
duration  extending  over  at  least  ten  years.  Tlui^ 
the  patient  being  only  24,  there  is  no  likelihood  of 
its  being  syphilitic.  So  far  as  he  remembered,  ihe 
testicle  was  never  injured.  He  had  gonorrhoja 
some  four  years  ago,  and  is  now  suffering  from 
stricture.  No  history  inflammation  of  the  epididy- 
mis or  testicle  during  the  presence  of  the  gonorrhoea. 
On  examination,  the  left  testicle  was  found  to  be 
the  size  of  the  closed  fist,  very  heavy,  and  gene- 
rally firm  to  the  feel.  In  one  place  in  the  front 
was  a  distinct  spot  of  fluctuation,  which  led  one 
surgeon  to  susjDect  hydrocele  and  to  tap,  removing 
about  a  drachm  of  bloodstained  serum.  The 
bulk  of  the  mass,  however,  was  very  firm  and 
fibrous  in  the  feel.  The  cord  is  quite  free  and  nor- 
mal to  the  feel.  The  diagnosis  was  fibro-cystic  dis- 
ease. I  advised  removal.  In  the  operation,  at 
the  first  incision,  the  hydrocele  fluid  escaped.  The 
usual  mode  of  operating  was  modified  ;  instead  of 
ligaturing  the  whole  cord,  the  vessels  were  tied 
separately.  Thorough  drainage  was  provided,  and 
dry  dressing  of  borated  cotton  and  naphthol  used. 
The  patient  was  sent  home  in  ten  days.  Dr.  Johnston 
has  given  me  the  following  pathological  report: 

"The    specimens    were    somewhat    gelatinous, 
looking,  and  not  vascular.  On  microscopicexamin- 


*The  patient  is  now  (.Sep.  (3)  daily  expecting  her  confine, 
ment,  and  except  for  complaint  of  pain  iu  the  loins,  is  in 
perfect  health. 


TLIE   CANADA    MEDICAT,    RKCOIID. 


281 


aliiin,  thr  iii.iin  ji;irl  o'  iho  tiiiuoi-  i  (iiisi>K  of 
cpillu'li;)!  (.•IcuK'iils,  wliiili  do  nut  a]i|ic.u  lo  lie 
grciu  iiiL;,  dw  golaliiiims-ioi.)kinj,'.  :uiil  air  ()ti\  iou>ly 
sciiiin.il  tiilns,  \vluisi'c|iillu'lial  (c-lls  arc  (K'gclH-rak'il 
oil  aK.iHinl  (.r(i^)  the  ^rowlli  of  a  large  ainoiiiU  of 
fibrous  idiinciiivc  lissui.-,  uliich  has  in  places 
undotg  jne  a  similai-  degeneration  to  thai  of  the 
epithelium,  and  the  amounl  of  uhich  vari'js  in 
different  places.  Withoiu  knuwuiL;  the  history  of 
the  case,  I  Ihoiight  from  the  sijccinien  that  it  ua-.  a 
tumor  growing  out  of  an  old  orchitis.  Should  call 
it  quite  benign,  with  liie  single  reservation  that 
tumors  arising  out  of  inrlanuiKU(jr\-  product  have  a 
tendency  to  recur.  At  all  events,  it  has  none  of 
the  distinctive  microscopical  api)earances  of  a 
indignant  growth.  (()f  c  )urse  this  statenunt  only 
refers  to  the  bits  given  nij  to  examine,  but  1  suppos- 
ed the  rest  was  of  the  same  uatuie.)" 

The  name  which  1  gave  to  this  tumor,  libro-cystic 
disease,  is,  in  my  opinion,  a  good  one  for  clinical 
Ijurposes, although  I  am  aware  it  is  seldom  emiiloyed 
n<)w-a-da\s  bv  |iatho  logists.  AVe  have  the  pure 
fibroma  diften  an  atrophied  condition)  and  the 
cystoma  described,  but  in  my  experience  uegcl  the 
fibrous  element  iiredominating  to  such  an  extent  in 
some  cases  that  we  are  justified  in  retaining  the  old 
name.  1  think  that  the  greater  the  cystic  forma 
tion,  the  more  likely  is  the  tumor  to  have  malig- 
nant tendencies,  and  fibro-cystic  tumors  doubtless 
often  degenerate  in  this  wav.  Will  this  tumor? 
Dr.  Johnston  thinks  it  may.  I'lifortuuately,  the 
condition  of  the  cord,  while  cif  some  service  in 
making  a  prognosis,  is  not  always  reliable 

Dr.  Roddick  then  exhibited  photographs  of  the 
patient  before  and  after  the  operation. 

Dr.  Ff.xwick  spoke  of  the  difficulty  in  prognosis 
after  removal  of  such  tumors.  Even  with  the 
microscope  it  was  not  aKvavs  possible  to  say  whether 
it  would  return  in  the  stump.  He  agreed  with 
Dr.  Roddick,  except  that  he  thought  the  two  classes 
of  tumors  he  described  could  look  ns  like  as  two 
peas,  and  cited  cases  to  prove  it. 

Dr.  HiNGSTON  urged  the  propriety  of  always 
giving  a  favorable  prognosis  in  all  cases  of  tumor  of 
testicle  where  cord  was  not  involved.  As  to  detail 
in  the  operation,  he  thought  Dr.  Roddick's  special 
l)rocedure  was  the  general  rule.  It  was  not  neces- 
sary to  attach  the  cord  to  the  skin. 

Dr'.  Roddick,  in  reply,  stated  that  he  had  formed 
his  opinion  after  rcfening  to  at  least  five  leading 
authors,  including  Bryant.'  Had  himself  seen  Bryant 
ligature  en  f/iassv. 


S<7\'ri's  llaininock. — Dr.  Roddick  also  gave  a 
d'.-inonstration  of  modilication  ofSayre's  hammock, 
to  avoid  the  danger  of  the  jacket  in  ajiplying 
plasler-of'paris  jacket. 


Stated  Mcdin;,  June  IWi,  1887. 
J.  C.  C AMKRo.M,  M.D.,  President,  in  the  Ch.^ir. 

Dr.  K.  L.  M  AcDoNNEi.L  read  the  history  of  two 

interesting  cases  wliic  h  hail  recently  come  under 
liis  notice : 

I .  Malignant  Disease  of  the  Lung. — A  boy, 
aged  3  years,  had  ap]jeare(l  for  some  weeks  to  be 
suffering  from  shortness  of  breath,  without  any 
other  symiUom.  At  the  first  visit,  the  whole  right 
chest  was  found  to  be  flat  on  percussion,  and  to 
jiresent  the  physical  signs  of  pleurisy  with  effusion. 
.\spiration  yielded  a  negative  result,  nothing  but 
a  kw  drops  of  blood  entering  the  instrument. 
These  being  examined  by  Dr.  Wyatt  Johnston 
were  found  to  contain  no  pus,  but  an  unusual  num- 
ber of  leucocytes.  Several  further  attempts  at  aspi- 
latioii  \  iclded  scarcely  better  leuilts.  At  one  time 
about  two  ounces  of  [Hire  blood  were  withdrawn. 
Dyspmea  became  very  urgent,  and  pressure  signs, 
distension  of  thoracic  veins,  and  (edema  of  the 
right  side  of  the  face  set  in.  'J'he  child  died  after 
an  illness  of  six  weeks.  An  autopsy  showed 
that  the  right  lung  was  the  seat  of  an  extensive 
growth  of  a  lympho-sarcomatous  nature.  No 
other  organs  were  found  involved. 

Discussion. — Dr.  Johnston  stated  that  the 
tumor  was  a  lympho-sarcoma.  It  wa^  like  a  small, 
round-celled  sarcoma,  but  with  a  number  of 
lymph  elements.  The  specimens  showed  the 
anomaly  that,  though  sarcomatous,  the  cells  were 
arranged  in  alveoli. 

Dr.  HiNGSTON  said  the  symiJtoms  seemed  lo 
point  to  emjiyema,  cancer  is  so  rare  in  children. 
He  also  quoted  a  case  of  empyema  that  occurred 
about  the  same  time,  in  which  the  first  aspiration 
produced  fluid,  but  the  second  gave  none,  the  pus 
having  become  consolidated. 

2  Cerebral  Syphilis. — The  second  case  was 
that  of  a  married  woman,  aged  20,  who  entered 
hospital  on  account  of  "  fits,"  which  had  occurred 
off  and  on  during  the  last  nine  months.  These 
attacks,  one  of  which  occurred  in  the  hospital, 
consisted  of  clonic  spasms  affecting  the  left  side 
of  the  face  and  left  arm,  and  were  preceded  by  a 
distinct  aura.  There  was  subsequent  hemiplegia 
of  these  parts,  with  dragging  of  the  left  leg  "on 


282 


THE   CANADA   MEDICAL   RECORD. 


attempting  to  walk.  On  the  left  side  the  reflexes 
were  exaggerated  and  ankle  clonus  present. 
General  intelligence  was  but  fair,  and  speech  thick. 
Optic  neuritis  was  present  in  botii  eyes,  with 
intense,  but  not  localized,  headache.  Though  no 
history  of  syphilis  was  to  be  obtained,  a  course  of 
inunction  with  mercury  was  carried  on  to  saliva- 
tion, Dr.  MacDonnell  recognizing  that  the  sym]!- 
toms  were  the  result  of  some  lesion  of  the  motor 
area  of  the  right  side  of  the  brain,  and  that  the 
most  probable  origin  of  such  a  condition  was 
syphilitic  tumor.  Tiie  result  was  most  sati.sfactory. 
Complete  recovery  of  the  paretic  parts  rapidly 
ensued,  the  headache  disappeared,  and  after  a 
month's  stay  in  hospital  the  patient  relumed 
home  in  an  excellent  state  of  health. 

Discussion. — Dr.  Stewart  stated  that  he  was 
called  to  see  the  case.  He  thought  there  were  two 
points  of  great  interest  in  this  case.  The  first  was 
that  the  onset  of  the  symptoms  seemed  to  point  to 
a  cortical  lesion  which  was  probably  of  syphilitic 
origin  ;  the  lesion  might  be  a  tumor  or  merely  a 
thickening  of  the  membrane.  The  second  point 
to  be  observed  is  the  greater  value  of  mercury 
compared  to  potassium  iodide  in  the  treatment  of 
cerebral  syphilis.  If  the  woman  could  have  stood 
the  effects  of  more  mercury  she  would  probably 
have  got  better  sooner.  He  also  called  attention 
to  the  value  of  using  an  antisejitic  mouth-wash. 
In  Vienna  mercury  was  rubbed  in  thirty  times  a 
month  without  saturation,  because  the  patient's 
mouth  was  well  washed. 

Dr.  Cameron  asked  at  what  jwint  could  one 
determine  when  the  mercury  had  reached  its  full 
effect,  and  when  would  it  be  advisable  to  resort 
to  operation  ? 

Dr.  Stewart  rej-ilied  that  if  the  disease  was 
syphilis,  a  complete  cure  might  be  expected  ;  but 
if  no  effect  was  produced  in  six  months,  operative 
procedure  might  be  considered. 

Dr.  HiNGSTON  referred  to  the  efficacy  of  potas- 
sium iodide  over  mercury  in  his  experience. 
There  is  very  little  douljt  of  the  su]ierior  efficiency 
of  potassium  iodide  over  mercury  in  syphilis 
generally,  why  not  in  cerebral  syiihilis?  He  then 
referred  to  the  difficulty  of  diagnosing  syphilis 
even  in  cases  where  the  lesion  was  visible,  and 
quoted  cases  where  it  had  been  mistaken  for 
malignant  disease.  He  believed  potassium  iodide 
was  a  scavenger  for  the  disease,  and  if  it  had  no 
effect  on  any  disease,  that  disease  was  not  syphi- 
litic. 


Foreign  body  in  the  Bladder. — Dr.  Hingston 
related  an  interesting  case  of  this  nature.  An  old 
man  came  into  hospital  complaining  of  frequent 
micturition  at  night,  with  pain  and  other  symptoms 
of  calculus.  The  lithotrite  was  inttoduced  without 
preliminary  sounding,  opened,  and  closed  on 
something  soft,  not  attached  to  the  vesical  wall. 
On  withdrawing  it,  found  a  piece  of  sheet  rubber; 
again  introduced  the  instrument,  and  withdrew 
another  piece,  and  afterwards  crushed  and  re- 
moved a  calculus  that  was  there.  Patient  stated 
that  he  had  been  examined  with  an  instrument  in 
Chicago,  where  he  was  treated  for  irritation  of  he 
neck  of  the  bladder.  Probably  part  of  the  rubber 
catheter  was  left. 

In  reply  to  Dr.  Gurd,  Dr.  Hingston  stated 
that  the  rubber  was  very  much  incrusted. 

Case  of  supposed  Aneurism. — Dr.  MacDonnell 
related  a  case  of  supposed  thoracic  aneurism. 
There  was  great  intrathoracic  pain,  and  neuralgic 
pains  in  the  course  of  the  fifth  and  sixth  nerves, 
requiring  hypodermics  to  produce  sleep.  Patient 
had  history  and  symptoms  of  syphilis.  Complete 
relief  was  afforded  by  potassium  iodide.  There  is 
now  no  pain  nor  any  pressure  symptoms;  and 
ixitient  is  up  and  about  the  wards. 

In  answer  to  Dr.  Gurd,  Dr.  MacDonnell  said 
that  potassium  iodide  gives  wonderful  relief  in 
cases  of  aneurism.  Would  not  say  whether  this 
was  due  to  its  antisyphilitic  action  or  to  its  power 
of  producing  a  clot  in  the  sac. 

LOCAL    TREATMENT  OF    SCROFULOUS. 
GLANDS,  ft, 

WITH  A  NOTICE  OF  COMPOUND  SYRUP  OF  TRIFOLIUM  ' 
AS  A  THERAPEUTIC  AGENT. 

BY  H.  C.  ROGERS,  M.  D.,    BROOKLYN. 

.^11  surgeons  are  familiar  with  the  class  of  cases 
to  which  I  would  draw  attention,  and  probably 
there  are  few  of  them  who  have  not  wished  such 
cases  removed  from  their  care.  I  allude  to  the 
large  number  of  strumous  children  with  slowly 
suppurating  cervical  and  other  lymphatic  glands, 
tedious  and  insidious  in  their  course,  and  generally, 
after  months  and,  it  may  be,  years  of  suffering, 
ending  at  the  best  in  elevated  or  depressed  cicatrices 
and  unsightly  scars.  Under  the  most  careful  and 
judicious  treatment,  the  surgeon  is  liable  to  bring 
disgust  to  his  patient  and  friends  and  discredit  on 
himself  The  old  practice  by  free  incisions,  blis- 
ters,  valvular  openings,  and  other  means  which 


THE   CANADA    MEDICAL    RECORD. 


283 


were  in  use  ten  years  ago,  or  have  been  introduced 
within  that  jicriod,  I  liavc  liad  recourse  to  with 
varying  results,  a  few  cases  heahng  kindly,  wliilc 
otiiers  (the  majority),  in  every  respect  favorable, 
have  tried  my  skill  and  patience  for  weeks  and  even 
months. 

During  the  ])ast  two  years  1  ha\e  luirsued  one  of 
Iwoline.sof  ire.ilnicnt  :  i.  Teal's  nietlcod  ofdissect- 
ing  out  the  enlarged  and  inflamed  glands  and 
scrajiing  old  sinuses.  I  have  resorted  to  this 
metlujd  in  three  cases,  with  results  which  were  all 
that  could  be  desired.  The  one  objection  to  it  is 
that  it  is  quite  an  operation  and  can  not  be  adojHed 
without  an  anesthetic.  'I'o  this  the  jiareuts  and 
friends  of  the  children  frequently  object,  remarking 
that  they  would  rather  lake  a  longer  time  than  to 
have  any  operation  [lerformed  on  their  little  ones. 
2.  In  the  "Annals  of  Singery  "for  ].)ecember,  1885, 
]).  493,  will  be  foimd  an  editorial  by  Dr.  L.  .S. 
rilcher  reviewing  ,in  article  in  the  "  Revue  dc 
Chirurgie  "  for  May,  1885,  ^'•y  Professor  Verncuil, 
of  Paris,  on  the  treatment  of  cold  aliscess  by  draw- 
ing off  the  pus  and  injecting  an  ethereal  solution 
of  iodoform. 

C\SE  I. — A  short  time  (January  3,  1886I  after 
reading  the  article  referred  to,  I  was  asked  to  see 
a  yoimg  lady  who  was  suffering  t'roin  cervical 
abscess  on  the  left  side.  She  had  had  a  similar 
abscess  on  the  right  side  three  years  before,  which 
had  healed,  but  had  left  an  imsightly  scar.  Her 
general  condition  at  this  time  was  poor  ;  she  was 
anaemic,  and  her  occupation  (that  of  school-teach- 
er) kept  her  closely  confined  to  the  house.  She 
told  me  she  could  not  afford  to  lose  any  time,  and 
asked  if  there  was  not  some  way  of  treating  the 
abscess  by  which  to  avoid  leaving  such  an  ugly 
scar.  I  stated  to  her  that  I  knew  of  no  operation 
other  than  dissecting  out  and  scraping  the  cavity 
that  would  give  her  any  relief,  but  that  I  would  try 
and  devise  some  form  of  treatment  whereby  she 
would  lose  no  time.  She  reported  at  my  office  the 
following  morning,  when  I  drew  off  the  pus  in  the 
abscess  with  the  finest  needle  in  my  aspirating 
case.  After  the  fluid  had  ceased  running,  I  slowly 
injected  250  minims  of  a  five-per-cent.  solution  of 
iodoform  in  ether.  The  patient  complained  of 
some  heat  and  smarting  at  the  commencement  of 
the  injection,  but  this  all  passed  off  before  I  had 
completed  the  operation.  The  small  wound  made 
by  the  needle  was  closed  with  collodion,  and  the 
patient  was  given  a  tonic  containing  arsenic,  iron, 
and  iodide  of  potassium. 

January  ^f/i. — Patient  called  at  my  house. 
The  seat  of  yesterday's  injection  is  quite  swollen, 
but  has  lost  its  soreness  and  redness  and  causes 
her  no  annoyance. 

dth. — Swelling  much  smaller,  free  from  pain. 
On  the  opposite  side,  just  below  the  old  scar,  I  find 
a  small  enlarged  gland,  which  feels  soft  in  its  center, 
but  does  not  fluctuate.  With  the  smallest  needle 
I  injected  between  20  and  30  miniins  of  a  five-per- 
cent, ethereal  solution  of  iodoform'.  The  injection 
aroused  some  pain,  which  passed  away  in  the 
course  of  an  hour. 


lotk. — She  says  she  has  suffered  no  pain  nor 
any  inconvenience  in  or  about  her  neck.  The 
swelling  over  the  site  of  the  first  o))eration  is  nearly 
gone,  and  the  skin  has  resumed  its  natural  color. 
The  seal  of  the  last  injection  is  still  quite  hard,  but 
the  gland  is  much  smaller. 

April  ■},>■({. —  Patient's  condition  good.  All  glan- 
dular swelling  is  well  gone.  'I'here  is  no  evidence 
on  the  former  site  of  operation. 

The  ])atient  passed  through  a  moderately  severe 
attack  of  typhoid  fever  thning  the  autumn  of  1886. 
She  is  now  feeling  (|uite  well,  and  is  able  to  attend 
to  her  duties  as  sciKJol-teacher.  She  has  had  no 
further  trouble  with  the  glands  on  her  neck. 

Case  II. — Kate  R.,  .tged  twelve,  of  striunous 
a|}pearance,  applied  to  me  (March,  1886),  suffering 
from  an  abscess  of  the  cervical  glands  on  the  left 
side  of  the  neck  of  about  the  size  of  a  hen's  egg. 
There  was  only  slight  redness  of  the  skin,  but  fluc- 
tuation was  well  marked.  By  means  of  a  fine 
aspirating  needle  I  gave  exit  to  a  small  quantity  of 
thin  pus.  I  then  slowly  injected  into  the  cavity 
between  200  and  300  minims  of  a  five-per-cent. 
ethereal  solution  of  iodoform.  She  complained  of 
some  heat  and  pain  at  first,  but  both  had  entirely 
passed  away  before  she  left.  .She  was  ordered 
arsenic,  iron,  and  iodide  of  potassium. 

Six  days  later  the  patient  called  with  her  mother, 
who  stated  that  her  daughter  had  since  not 
complained  of  any  pain.  The  swelling  was  about 
half  the  size  it  was  when  I  injected  it.  Over  the 
site  of  the  injection  a  small  s]:)Ot  of  induration  could 
be  felt.  The  mother  called  my  attention  to  the 
child's  tonsils,  which  were  enlarged.  I  directed 
her  to  paint  them  with  tincture  of  iron  three  times 
daily,  and  to  keep  on  with  the  medicine.  At  the 
end  of  the  ninth  day  the  swelling  was  fully  two- 
thirds  smaller;  no  pain,  redness,  or  heat ;  appetite 
good  ;  and  the  patient  said  that  she  felt  better. 

I  did  not  see  this  patient  again  until  October. 
18S6, when  the  mother  said  that  her  daughter  had 
had  no  more  trouble  with  her  neck  since  the  opera- 
tion, a  statement  which  I  was  able  to  confirm  a  few 
days  later. 

Case  III. — July  i,  1886,  Robert  J.,  aged  ten, 
in  poor  health.  He  had  a  swelling  on  the  right 
side  of  his  neck  of  about  the  size  of  an  English 
walnut,  bluish-red,  evidently  about  to  break.  The 
case  was  an  unfavorable  one  for  injection  ;  but,  at 
the  earnest  request  of  the  father,  who  had  seen  the 
effect  in  the  first  case  cited  above,  I  consented  to 
operate.  1  drew  off  the  jhis,  which  was  thin  and 
watery,  and  contained  small  pieces  of  cheesy 
matter,  and  injected  the  cavity  with  a  five-per-cent. 
ethereal  solution  of  iodoform.  The  operation  was 
peiformed  with  great  care,  but  just  before  I  applied 
the  bandage  I  noticed  a  small  space  where  the  solu- 
tion was  oozing  out.  The  case  progressed  fairly 
well  for  the  next  two  or  three  days,  when  (July  4th) 
the  patient  went  on  an  excursion  contrary  to  my 
wishes.  On  the  way  back  a  severe  thunder-storm 
broke  over  the  grove.  My  patient  got  thoroughly 
wet,  and,  having  no  means  of  drying,  had  to  remain 


28'1 


THE   CANADA   MEDICAL    RECORD. 


in  damp  clothing  tiie  rest  of  that  day  (about  eight 
lioiirs).  That  night  I  was  sent  for  Co  see  my 
]iatient.  AMitn  I  reached  the  hotel  where  he  was 
staying,  I  learned  that  a  short  time  before  they 
sent  for  me  he  had  had  a  chill,_and  was  complaining 
of  a  severe  pain  and  burning  over  the  left  sideof 
his  neck  and  face,  which  were  ranch  inflamed.  He 
was  ordered  quinine  and  iron,  and  his  face  and 
neck  were  bathed  with  a  solution  of  biniodide  of 
mercurv.  i  lo  3.000.  The  following  morning  I 
found  him  much  l)etter,  the  pain  and  redness  nearly 
gone.  The  abscess  which  1  had  injected  was  about 
the  same  in  size,  btit  had  lost  its  red,  angry  look. 
At  the  end  ofUiree  weeks  the  swelling  was  entirely 
sjone.  leaving  a  vcrv  trifling  scar,  in  marked  contrast 
with  the  scar  on  the  opposite  side  of  his  neck, 
where  he  had  suffered  from  anotiier  abscess  some 
time  before. 

I  have  treated  by  the  method  now  mentioned 
nine  cases  in  all.  The  swelling  has  giadnally 
disappeared,  taking  bum  three  weeks  to  Iw.) 
months. 

Professor  Verncml's  plan  i.-,  first  to  evacuate  thc 
abscess  by  aspiration.  To  do  this  he  makes  use 
of  a  large-sized  trocar,  handling  the  jjarts  as  little 
a-:  possible.  As  soon  as  the  liquid  becomes  slightl)' 
blood-stained. he  injects  the  cavity  with  the  solution, 
which  is  one  of  five  j'er  cent.  The  largest  quantity 
used  is  one  hundied  grammes;  generally  fifty  or 
sixty  grammes  suffice.  'I'he  amount  of  iodoform 
remaining  in  the  abscess  cavity  to  be  absorbed 
rarely  exceeds  four  to  five  grammes.  He  has  never 
seen  any  bad  effects  from  the  absorption  of  ether. 

My  experience  has  been  that  generally  one  injec- 
tion will  be  sufficient.  In  only  three  cases  have 
I  found  it  necessary  to  repeat  the  injection  into  the 
same  swelling.  In  four  cases  I  injected  glands 
where  I  could  not  find  pus.  but  wiiere  the  centre  of 
the  swelling  was  siift  and  in  a  condition  to  break 
down.  In  such  CT-es  in\  plan  is  to  inject  from 
ten  to  twenty  minuns  of  a  two-per-cent.  to  ihree- 
pei-ccnt.  solution.  In  all  cases  the  swelling  is 
gradually  reduced,  so  that  in  from  lour  weeks  to 
three  months  it  has  entirely  disa])peared.  In  all 
my  cases  I  ha-\e  emiiloyed  internal  treatment,  as 
all  the  ]mtients  were  more  or  less  anajniic.  Up  to 
some  six  months  ago  I  had  been  using  atonic  con- 
taining arsenic,  iron,  and  iodide  of  potassium  ;  but, 
on  account  of  the  difficulty  apothecaries  have  in 
making  up  a  pleasant  mixture  that  children  would 
take,  1  lui\e  had  some  trouble  in  keejiing  up  the 
treatment  with  the  iciularity  I  would  like. 

About  six  months  ago  I  received  a  sample  bottle 
of  compound  syrup  of  trifolium,  which  is  a  mixture 
containing  iodide  of  potassium,  combined  with  the 
vegetable  alteratives  red  clover,  burdock-root, 
prickly-ash  bark,  stillingia,  poke-root,  and  Berbcris 
(jquifo/iiun,  each  ounce  containing  eight  grains  of 
the  iodide  of  ])otassiuin.  The  skill  of  the 
manuf;iclurers,  Parke,  Davis  &Co.,  has  succeeded 
in  so  combining  these  drtigsas  to  render  the  finished 
pieparation  vny  palatable — a  property  most 
essential  to  a  preparation  which  is  designed  for 
prolonged  administration, 


I  am  in  the  habit  of  using  the  iodide  of  arsenic, 
bichloride  of  mercury,  suli)liide  of  calcium,  or  iron, 
with  the  coraiiound  syrup  of  trifolium.  Children 
will  take  this  combination  for  a  long  time,  and  not 
be  troubled  wiih  nausea  or  any  derangeinent  of  the 
stomach.  I  haie  a  |)atient,  a  child  suffering  from 
congenital  syphilis,  who  has  taken  it  since  its  first 
introduction,  six  or  seven  minths  ago.  She  is 
taking  one  fiftieth  of  a  grain  of  bichloride  in  half  an 
ounce  of  the  compound  syrup  of  trifolium,  and  has 
improved  in  every  way  while   under  its  influence. 

From  my  experience  with  this  syrup  in  a  great 
variety  of  cases,  and  from  the  very  satisfactory 
results  which  I  have  obtained  from  its  use,  I  am  of 
the  opinion  that  it  is  destined  to  occupy  a  high 
position  among  our  therapeutic   resources. 

.Since  [ireparing  the  foregoing  paper,  I  have 
learned  that  Professor  Venietiil  has  substituteii 
glycerin  for  ether,  using  fifieen  to  twenty  grammes 
of  iodoform  in  sulficient  glycerin  to  make  a  thin 
paste.  I  le.irn  aNn  that  Prolessor  iiillroth,  at  his 
clinic,  uses  a  solution  of  ten  parts  of  iodoform  to 
one  hundred  parts  of  glycerin, for  the  same  purpose, 
and  speaks  very  highly  of  it. — A'  }'.  Mcil.  Journal. 


TREATMENT  OF   CHRONIC  SYPHILIS. 

In  the  treatment  of  chronic  syphilis,  but  too  often 
it  ha|jpens  that  tiie  patient  improves  up  to  a  cer- 
tain point,  and  then  ceases  to  respond  to  the  admi- 
nistration of  antisyphilitic  remedies,  even  when 
they  be  combined  with  the  most  careftil  hygienic 
treatment  and  the  exhibition  of  tonics,  etc. 

Any  remedy  which  offers  a  fair  ])robabiIity  of 
being  able  to  carry  on  the  amelioration  of  the 
disease  under  these  circumstances  is  one  worthy 
of  very  careful  consideration  by  the  profession. 

Many  years  ago  Mr.  Carmichael,  of  Dublin, 
asserted  that  he  found  the  oil  of  turpentine  often 
of  unquestionable  value  in  the  treatment  of  obsti- 
nate and  long-continued  syphilitic  iritis,  and  dur- 
ing tiie  service  of  Mr.  G.  J.  Guthrie,  of  the  Royal 
0|)hthalmic  Westminister  Hosjjital,  the  practice 
was  accomiianied  with  alleged  excellent  results. 

Mr.  Jabez  Hogg  of  the  same  hosj)ital  has  recent- 
ly (^/)Av//fi// /'/•«^  or//;/  Circular,  April  27)  luib- 
lished  the  account  of  a  case  in  which,  after  the 
fiiilure  of  mercurials  by  the  mouth,  by  inunction, 
and  fumigation  conjoined  or  alternated  with 
the  use  of  iiiydriatics,  tonics,  iodide  of 
ammonium,  iron,  etc..  turpentine  succeeded.  It 
was  given  in  Y2  drachm  doses,  suspended  in 
mucilage,  three  times  a  day  after  meals.  For  the 
first  week  an  inunction  of  a  twenty  ])er  cent,  solu- 
tion of  the  oleate  of  mercury  was  freely  employed, 
bui  this  was  then  laid  aside,  and  for  fotir  months 
the  turpentine  alone  was  steadily  persevered  in. 
Not  only  was  the  patient's  general  health  improved 
bit  the  corneal  ojiacity  of  the  iritis  gradually 
disappeared,  and  at  the  time  of  the  making  of  the 
report  the  serous  exudations  and  other  local  chan- 
ges in  the  eye  had  so  I'nr  been  absorbed  or  amelio- 
rated that  the  vision  was  almost  what  it  was  before 
th§  (lifljiinitiatory  attack,  fourteen  inontlis  prexjotts, 


THt  CANADA   MEDICAT,  RECoftt). 


285 


iiwi  Canada  Mkdtcal  Record. 

A  Montlily  Journal  of  Medicine  and  Surgery- 

EDITORS  : 

FRANCIS  ".v.  CAMFBbll.J  .    MA..  M.D  .,  I..  K.(M  .  1.0ND, 

l.ilil.ii-  Mil. I  Prii|iru'l,iir. 
K.  A.  KKNNEUY,  M.A.,  I^I.D,,Millliv-i^n^;,lil..l• 
ASSISTANT    EDITORS: 
ii\SEY  A.  WOOD,  CM.,  M  D. 
GEOUltE  E,  AllAiSlKONlJ.  CM.,  M.D. 

MlnSCIIH'TloN    TWO    DOl.L.Ml.S    l'i:U    A.NMIM. 

All  eoinniiiiiic.ilioiif  aiul  h'.iclKdii/fx  must  be  j  lilrexscd  to 
the  tiditors,  Dniivei  Xtf',  I'oal   Ollice,  Mniilieii I . 


MONTREAL,  STKPK.MBKU,   1SS7. 


COLLEGE    OF    PHYSICIANS    AND     SUR- 
GEONS OF  IHK  PROVINCE  OF  QUEBEC. 

'I'lie  semiannual  mt-cting  of  ihc  College  of 
Physicians  and  Suigeons  of  ihc  Province  of  Que- 
bec was  lielil  in  L.ival  Uni\eisily,  in  the  city  of 
Qnebec,  on  llie  j8tli  .SeiUeniber.  in  the  absence 
of  Dr.  W.  11.  Ilingston,  the  Pi-esident,  wlio  was 
unavoidably  detained,  the  Hon.  Dr.  Ro.ss,  Vice 
President,  for  Quebec,  took  the  chair.  'J'here  were 
present:  Dr.  J.  L.  I.eprohon,  Vice-President,  for 
Montreal ;  Dr.  E.  P.  I.achapelle,  'Preasuier;  Dr.  J>. 
Larue,  Registrar;  Dr.  A.  G.  Bellcau  and  Dr.  F. 
W.  Campbell, Secretaries;  Drs.  E.  -A.  de  St.  George, 
M.  P.,  C.  S.  Parke,  R.  S.  Rinfret,  M.P.P.,  A.  A. 
Waters,  C.  E.  Leniieux,  sen  ,  L.  J.  A.  Simard,  of 
Quebec;  'P.  A.  Rodger,  R.  A.  Kennedy,' Robert 
Craik,  R.  P.  Howard,  L.  B.  Du  roc  her,  of  Montreal ; 
Malcolm  Guay,M.  P.,  St.  Romuakl ;  I..  '1'.  E.  Rous- 
seau, St.  Casimir  ;  P.  E.  Grandbois,  M.  P.,  Eraser 
villa  ;  Tancrede  Fortier,  St.  Marie  de  la  Beauce  ; 
G.  E.  Turcotte,  St.  Hyacinthe ;  1  hos.  Ciirislie, 
Lachute  ;  J.  A.  Dnscheneau,  Terrebonne;  L.  D. 
Lafontaine,  St.  Edouard  de  Napierville ;  David 
Marcii,  St.  Eusta;che  ;  G.  E.  Badeaux, Three  Rivers; 
'I'hos.  Larue, -Compton  ;  F.  J.  Austin,  Sherbrooke. 
After  the  reading  of  the  minutes  of  the  jirevious 
meeting.  Dr.  Campbell,  Dean  of  the  Medical 
Facidty  of  Bishop's  College,  amiouuced  that  as  Dr. 
Kennedy  had  inij)roved  in  health  he  would  again 
take  his  seat  on  the  Board  as  one  of  the  representa- 
tives of  Bisho|)'s  College. 

Reports  from  the  assessors  of  the  Medical 
Faculties  of  Laval  University  in  Quebec  and 
Montreal,  and  of  \'ictoria  College,  were  received 
and  adopted. 

Dr.  Manseau,  of  Red  Jacket,  Michigan,  applied 
for  a  duplicate  license- — the  oiiginal  hav'ng  been 
burned.     The  request  was  granted. 

The  folio  ving  gentlemen,  having  passed  satis- 
factory examinations  before  the  Board  of  Examin- 


ers on  General  Education,  were  admitted  to  the 
study  of  Medicine,   viz. : — George  Clouticr,  John 

liusby,  Sylvia  Lebcciif,  G.  Octave  Johnson,  Jules 
(  hopin,  Albert  Aubry,  Louis  Coderre,  Arthur 
liliiinn,  George  Eugene  (juilkrnitle,  Adelard 
Bazin,  Atpiila  I'id  cite,  .Alexis  BclUn  arre,  Chas. 
Edouard,  L.  Auger,  W'illriil  Beaudoin,  Gideon 
Blanc  het,  1'.  B.  Boisseau,  l.eger  Brousseau,  Achille 
Chandonnet,  Achille  Dagenais,  Osias  Dagneault. 
James  E.  Kearney,  P.  O  Lauzoi,  Ovide  Norman, 
din,  R.  Augustc  P.iradis,  J.  N.  Perreauit,  Joseph 
l'oiij)art,  Fran^-ois  de  Sales  Prevost,  Clias.  Auguste 
Prevost  and  J.  W.  Rourke. 

'I'he  following  graduates  received  the  license  of 
the  College  ; — Joseph  Lesjjerance,  Montreal  ; 
Louis  Joseph  Octave  Sirois,  Bic  ;  Chas.  Onesime 
Honore  Desilets,  Becancour ;  Simeon  Eugene 
Grondin,  Quebec  ;  Paul  F.  Briere,  Thetford  Mines  ; 
Nazaire  Napoleon  Gingras,  St.  Nicholas  ;  George 
Tremblay  Belanger,  Sherbrooke  :  Pierre  Julien 
Bissonnette,  St.  Esprit  ;  James  H.  Brodie  .Mian, 
John  W.  Sterling,  Josejih  .Arthin-  IXagneault, 
Severin  J.  Girard,  Arthur  Delisle,  Kenneth  Camer- 
on, Montreal;  Joseph  S.  E.  Ferland,  St.  Julien, 
comte  de  Montcalm;  Vincent  Howard  Morgan, 
Riviere  Beaudet ;  Antoine  Alfred  Duhamel,  St. 
Justin  de  Maskinonge  ;  V\'m.  Christie,  Lachute  ; 
Charles  Edouard  Kasconi,  Pierreville. 

The  subject  of  the  proposed  new  Medicil  Bill 
was  then  brought  forward,  when  Dr.  R.  P.  Howard 
stated  that  the  two  English  Universities  of  McGill 
and  Bishoji's  College  had  discusse'd  it,  and  were 
united  in  opposing  certain  clauses,  principally  the 
one  relating  to  the  formation  of  a  Central  Exam- 
ining Board  and  additions  to  the  preliminary  ex- 
aminations. The  Bill  was  then  read  clause  by 
clause.  Dr.  Howard  proposed,  and  Dr.  F.  W. 
Campbell  seconded,  that  clause  7  of  the  present 
.Act  be  maintained,  and  that  it  replace  clause  24  of 
the  jiroposed  Act,  thus  doing  away  with  the  pro- 
posed Central  Board  of  Examiners. 

This  amcndnient  was  rejected  on  the  following 
division  ; — Jujr — Doctors  Howard,  Craik,  Christie, 
Rodger,  Kennedy,  Austin,  Lemieux,  Simard, 
Durocher,  Campbell. — 10.  Agaif'st — Doctors  I.a- 
chapelle, Duchesneau,  Lafontaine,  Thos.  Larue, 
Grandbois,  Pare,  Rousseau,  Marcii,  Turcotte, 
Watters,  St.  George,  L.  Larue,  Guay,  Badeau, 
Fortier,  Rinfret,  Belleau. — 17. 

Proi)Oscd  by  Dr.  Marcii,  seconded  by  Dr. 
Simard,  and  carried  on  a  division  of  16  to  12,  that 
the  date  of  holding  the  professional   examination 


286 


THE   CANADA   MEDICAL   RECOfeJJ. 


be  made  the  first  Wednesday  in  July.  This 
amendment  shows  a  change  in  the  views  of  the 
Board,  the  date  fixed  by  it  at  the  previous  meeting 
being  the  first  Wednesday  in  May. 

Dr.  Howard  proposed, seconded  by  Dr.  Christie, 
that  the  preliminary  examination  for  admission  to 
medicine  be  relegated  to  the  Roman  Catholic  and 
Protestant  Board  of  Public  Instruction.  Lost — 7 
to  19. 

The  Bill  was  then  jiassed  as  a  whole,  and  referred 
to  the  coniniittee,  which  has  already  had  it  in 
charge,  with  instiuctions  to  have  it  printed  in 
English  and  French,  and  distributed  to  the 
members  of  the  Board,  also  to  take  the  necessary 
steps  to  have  it  brought  before  the  Legislature  of 
the  Province  at  its  next  session. 

A  resolution  of  condolence  on  the  death  of  Dr. 
Baddeau,  sen.,  of  Three  Rivers,  one  of  the  oldest 
members  of  tlie  profession,  was  passed,  on  motion 
of  Dr.  Leprohon,  seconded  by  Dr.  L.  Larue.  After 
several  votes  of  thanks  the  meeting  adjourned  after 
a  session  of  seven  hours. 

LONDON  ILLUSTRATED  NEWS. 
Most,  if  not  all,  of  our  subscribers  know  by  repu- 
tation the  London  Illnstraltd  A^eics,  the  pioneer 
Illustrated  Journal  of  the  British  Metropolis.  For 
many  years,  in  s]jite  of  formidable  rivals,  it  has  held 
its  own.  The  care  with  which  its  engravings  have 
been  prepared,  and  the  literary  character  of  its 
contents,  ha\e  all  helped  to  further  its  hold  ujion 
the  British  public.  Unfortunately  its  high  subscrip- 
tion price,  nearly  $10  a  year,  prevented  it  having 
an  extended  circulation  in  the  United  States  and 
Canada.  But  all  this  hindrance  has  been  removed 
by  the  jiublication  in  New  V'ork  of  an  American 
edition,  ])rintfd,  we  believe  from  plates  forwarded 
from  London,  andforwhicli  issue  the  subscription 
is  only  $4.00  a  year.  Surely  such  an  enterprise 
deserves  success,  and  we  hope  soon  to  hear  that  the 
London  lUustratid  Nkiks  is  entering  regularly 
every  cultured  family  in  Canada.  Its  New  York 
office  is  237  Potter  Building,  New  York. 


PERSONAL. 

Dr.  H.  S.  Birkett  and  Dr.  Rollo  Campbell  have 
been  ajjpointed  assistant  attending  physicians  to 
the  Montreal  Dispensary. 

Drs.  Thos.  Roddick,  James  Bell  and  F.  J.  Shep- 
hard  have  all  returned  from  England  after  an  ab- 
sence of  several  months. 


j       Dr.  F.  M.   R.  Spendlove   (Bishop's   1881)  has 
i  been  appointed  attending  physician  to  the   Mont- 
real   Dispensary,    vice   Dr.    A.  F.   Longeway   re- 
signed. 

Dr.  Phelan  (M.D.  Bishop's  1S87)  has  commenc- 
ed practice  at  San  Bernardino,  California. 


BOOKS  AND  PAMPHLETS  RECEIVED. 

Some  Recent  Experiences  in  Clinical  Surgery. 
By  Donald  Maclean,  M.D.,  Detroit,  Mich. 

Persistent  Pain  after  abdominal  Section.  By 
James  B.  Hunter,  M.D.,  New  York. 

Brain  Exhaustion.  By  N.  H.  Beemer,  M.  B., 
first  assistant  physician  Asylum  for  Insane,  Lon- 
don, Ontario. 

Observations  on  the  Administration  of  Chloro- 
orm.  By  O.  J.  S.  Sullivan,  M.D.,  Ann  Arbor. 
Michigan. 

Operations  on  the  Drum-Head  for  Impaired 
Hearing :  with  Fourteen  cases.  By  Seth.  S. 
Bishop,  M.  D.,  Chicago. 

Mental  Epilepsy.  By  L.  W.  Baker,  M.D.,  Bald. 
winviUe;  Mass. 

The  Scientific  Rationale  of  Electrotherapy .  By 
C.  H.  Hughes,  M.D.,  St.  Louis. 

Some  Considerations  concerning  Cancer  of  the 
Uterus,  especially  its  Palliative  Treatment  in  its 
later  stages.      By  Andrew  F.  Currier.  M.D. 

A  Novel  System  of  Operating  for  the  Correc- 
tion of  the  Deflected  Septum.  By  William  Chap- 
man Jarvis,  M.D.,  New  York. 

The  Antiseptic  Treatment  of  Summer  Diarrhcea. 
By  S.  Emmett  Holt,  A.M.,  M.D.,  New  York. 

Fourteenth  Annual  Report  of  the'  Board  of 
Health  of  the  City  of  Boston,  for  the  year  1885. 

Ovarian  Tumors  and  Remarks  on  Abdominal 
Siugery,  with  the  result  of  50  cases.  By  Edward 
Barck,  A.M.,  M.D.,  Professor  of  Surgery,  etc,  St. 
Louis.  Mo.,  1S87.  Second  revised  reprint  edi- 
tion. 

The  Radical  Cure  of  Retro-Displacements  of 
the  Uterus  and  Procidentia  by  Alexander's 
operation  and  Median  Colporrhaphy.  By  J.  H. 
Kellogg,  M.D.,  Battle  Creek,  Michigan. 

Advances  in  Surgery,  Medicine  and  Pharmacy  in 
the  last  Forty  Years.  By  C.  W.  Moore,  M.D., 
San  Francisco. 

Intubation  of  the  Larynx.  By  E.  Fletcher 
1  Ingals,  M.D.,  Chicago. 


tHE  CANADA   MEDICAI-   UEOOfeft. 


28-/ 


"  Renal  Colic  "  Parasitic  and  Calculus.  Tly  J- 
B.  Marvin,  M.D.,  Louisville,  Ken. 

Elementary  Microscopical  Technology  Fart. 
I.   By  Frank  I,.  James, Ph.D., M.D.,  St.  Louis,  Mo. 


'  KKVIKWS. 

0/1  tlie  Pathology  and  Treat ituiit  of  GonorrJura 
a'lj  Spermatorr/ia'd.  I'.y  j.  L.  Mii.TO.N,  .Senior 
.Surgeon  to  St.  John's  Hospital  for  Diseases  of 
the  Skin,  London.  Octavo,  484  pages.  Illus- 
trated. Price,  bound  in  extra  nuislin,  $4.00. 
New  York  :  William  Wood  &  Company. 
Earlier  editions  of  tliis  work  have  appeared  in 
England,  and  this  edition  is  an  abridged  form  of 
these,  as  also  of  papers  on  the  same  subject,  which 
from  time  to  lime  have  appeared  in  the  Medical 
Times  and  Medical  Circular.  There  are  also 
chapters  on  gonorrhceal  affections  of  the  heart, 
peritoneum  and  pleura  and  the  dura  mater  and 
sheath  of  the  chord,  and  gonorrhceal  pyaemia, 
pyelitis,  etc.,  which  are  now  printed  for  the  first 
time.  The  work  being  intended  for  one  of  refer- 
ence, much  that  has  been  considered  as  superfluous 
has  been  omitted.  The  author  has  endeavored 
to  prove  that  gonorrhcea  can  be  cured  without  the 
use  of  drugs  which  have  well  nigh  been  held  as 
specifics.  Nothing  has  been  recommended  in 
this  work,  but  what  has  stood  the  brunt,  not  merely 
of  experience,  for  that  the  author  rates  rather  low, 
but  of  special  observation.  The  author's  aim  has 
been  as  far  as  possible  to  separate  clearly  what 
might  be  looked  on  as  established  from  what  was 
doubtful,  and  not  merely  to  prove  every  assertion, 
but  to  place  it  on  such  a  basis  that  it  could  not 
be  disproved.  After  the  history  and  pathology,  four 
chapters  are  devoted  to  the  ireatment.  Chapter 
VII  treats  of  the  pathology  and  treatment  of  gleet. 
The  treatment  of  spermatorrhoea  and  impotence 
occupy  the  closing  cha|)ters  of  a  work  which  the 
reader  will  find  to  be  carefully  and  ably  written, 
and  one  of  the  greatest  value  as  an  authority  for 
reference. 


A  Practical  Treatise  on  Penal  Diseases  and 
Urinary  Analysis.  By  William  Henry  Por- 
ter, M.D.,  Professor  of  Clinical  Medicine  and 
Pathology  in  the  New  York  PostGraduate 
Medical  School  and  Hospital;  Curator  to  the 
Presbyterian  Hospital.  One  Vol.  360  pages, 
100  illustrations.  New  York  :  William  Wood  & 
Company. 

The  author  states  that  for  the  past  ten  years  he 
has  had  ample  opportunity  for  studying  the  various 


lesions  of  the  kidneys,  as  they  are  found  in  human 
and  aniin:U  subjects.  As  the  essential  ideas  ad- 
vanced in  this  book  are  based  upon  the  statistics 
gathered  from  over  one  thousand  post-mortems, 
Dr.  Porter  would  certainly  seem  to  have  had  all 
data  necessary  for  forming  a  correct  opinion  upon 
this  subject.  Special  attention  has  been  devoted 
to  the  class  of  lesions  commonly  known  as  Bright's 
disease,  and  it  is  from  these  observations  that  the 
deductions  employed  throughout  die  work  were 
obtained.  Renal  diseases  have  been  studied 
chietly  from  a  clinical  and  pathological  point  of 
view  and  the  author  has  endeavored  to  present 
them  not  only  from  this  standard,  but  also  from  the 
physiological  sland[)oint,  deducing  the  methods 
of  treatment  not  only  from  the  jihysiological,  but 
from  the  jiathological  phenomena.  A  chapter  is 
specially  devoted  to  the  consideration  of  diabetes. 
The  second  portion  of  the  book  is  devoted  to  a 
study  of  urinary  analysis  ;  not  simply  the  chemical 
or  microscopical  examinations  of  samples  of  urine, 
but  also  the  pliysiological  indications,  with  their 
bearings  on  clinical  medicine.  The  original  draw- 
ings, some  fifty  in  number,  were  made  by  Dr. 
George  S.  \'an  Schaick,  from  sections  in  the 
authors  possession.  The  author  seems  to  have 
taken  every  advantage  of  his  opportunities,  and 
we  consider  his  work  a  most  valuable  one. 


A  Text  book  of  Pathological  Anatomy  and  Path- 
ogenesis. By  Ernst  Ziegler.  Translated  and 
edited  for  English  students  by  Donald  .Macalis- 
ter,  M.A.,  M.D.  Three  parts  complete  in  one 
volume.  Octavo,  11 18  pages,  289  illustrations. 
Price,  extra  muslin,  S5.50  ;  sheep,  $6.50.  New 
York:  William  Wood  &  Company. 

The  work  as  now  presented  consists  of  three 
parts  complete  in  one  volume ;  the  several  parts 
including  sections  which  treat  on  such  practical 
subjects  as :  Malformations,  anomalies  in  the 
distribution  of  the  blood  and  of  the  lymph^  re- 
trogressive and  progressive  disturbances  of  nutri- 
tion, intlamniation  and  inflammatory  growths, 
tumors,  parasites,  special  pathological  anatomy 
of  blood  and  lymph,  of  the  vascular  mechanism, 
of  the  spleen  and  lymphatic  glands,  skin,  and 
serous  and  mucous  membranes,  alimentary  tract, 
liver  and  pancreas,  urinary  organs,  respiratory 
organs,  and  nervous  system.  This  work  (which 
is  the  only  recent  complete  volume  on  pathological 
anatomy  in  the  German  language),  is  now  pre- 
sented to  the  profession  in  English,  having  been 


288 


fail   CANADA  MEDICAL   RECORD. 


ably  translated  by  Donald  Macalister,  M.A,  M.D. 
of  Cambridge,  England.  The  German  original  is 
held  in  high  esteem  at  home,  having  met  with  a 
hearty  reception,  as  is  proven  by  two  editions 
being  rapidly  exhausted,  a  third  being  nuw  m 
preparation.  The  treatise  is  exhaustive  in  the 
manner  in  which  its  ntnnerons  details  are  taken 
up.  It  is  abundantly  illustrated  with  excellent 
wood  cuts.  The  author  has  wisely  considered  it 
best  to  omit  theoretical  discussions  almost  alto- 
gether. It  is  a  book  to  be  used  as  a  companion 
for  the  text  books  on  Medicine  and  Surgery.  \Vm. 
Wood  &  Co.  deserve  great  credit  tor  the  manner 
in  which  they  have  brought  the  work  befoie  the 
public. 


The  Principles  of  Antiseptic  Mctlinds  applied  to 
Obstetric  Practice.  By  E)r.  Paul  B.\r,  accou- 
cheur to  the  Maternity  Hospital,  Paris;  tianslated 
by  Henry  D.  Fry,  M.O.,  Philadelphia  :  P.  Blakis- 
ton.Son  &  Co.,  1012  Walnut  Street,  1887.  Price 
«<.75- 

This  is  a  translation  of  Dr.  Bar's  work  on  "  Les 
Methodes  Antiseptiques  en  Obstelrique, "  a  work 
that  is  very  popular  throughout  Europe  as  the 
practitioners  of  obstetrics  in  Germany  and  France 
rigidly  adhere  to  the  antiseptic  principles  and  are 
very  successful  in  their  results.  While  the  ajipli- 
cation  of  antiseptic  practice  has  found  wide  favor 
in  the  two  above  mentioned  cbiintries,  it  does  not 
seem  to  have  been  adopted  with  the  same  enthu- 
siasm by  the  English-speaking  physicians.  In  the 
consideration  of  antiseptic  methods  and  agents, 
corrosive  sublimate  is  given  a  high  place.  In  this 
chapter  some  very  valuable  tables.giving  the  germi- 
cidal power  of  various  agents,  are  given  and  will 
repay  perusal.  In  the  appendix,  the  antisepsis  of 
the  umbilicus  and  of  oi)hthalmia  neonatorum  are 
considered.  The  use  of  antiseptics  is  greatly  on 
the  increase  in  Ameiica,  and  we  predict  thai  this 
work  will  meet  wiih  a  ready  sale.  The  book  is 
gotten  up  in  Blakiston's  usual  style,  having  a  good 
binding  with  clear  gold  lettering,  and  the  paper 
and  variety  of  type  are  of  the  best. 


known  to  the  Medical  public  of  this  country  for 
his  contributions  to  general  medicine  and  nervous 
pathology.  His  book  has  had  a  favorable  recep- 
tion abroad,  and  it  fully  sustains  the  reputation  of 
the  author.  There  are  several  things  which  charac- 
teiise  this  work  and  gi\e  to  it  a  piarticular  value; 
these  are  the  copiousness  of  the  thera|)eutical  dis- 
cussions and  suggestions,  and  the  extremely  com- 
plete thoroughness  with  which  the  author  goes  over 
the  field  of  medical  pathology.  The  abundance  of 
the  illustrations  adds  considerably  to  the  attrac- 
tiveness and  clearness  of  the  volume. 


Handhook  of  Practical  Medicine.  By  Dr.  Hi.RMANN 
EicHHORST,  professor  of  special  Pathology  and 
Therap-'utics  and  Director  of  the  University 
Medical  Clinic  in  Zurich.  Vol.  II.  Diseases  of  the 
Digestive,  Urinary  and  Sexual  Apparatus.  One 
hundred  and  six  wood  engravings,  New  York  : 
William  Wood  &  Co.,  iSSO. 

Professor  Eichhorst    has  long  been    favorably 


Sufgery,  its  Theory  and  Piac'icc.  By  \\illiam 
J.  Walsham,  M.D.,  F.R.C.S.,  Assistant  Surgeon 
to  St.  Bartholomew's  Hospital  ;  Surgeon  in 
charge  of  the  Orlhopcedic  Department  and 
Demonstrator  of  Practical  Surgery  at  St. 
Bartholomew's  Hos])ital  ;  Surgeon  to  the  Metro- 
politan Free  Hospital,  London,  &c.  With  236 
illustrations.  Philadelphia  :  P.  Blackiston,  Son  & 
Co.     Price,  cloth  S3. 00,  leather,  S3. 50. 

This  is  the  ninth  volume  of  the  new  series  of 
manuals  for  Medical  Students  and  Practitioners. 
This  series  of  works  has  become  extremely  popular 
owing  to  their  great  value  and  the  reasonable  price 
at  which  they  are  sold.  Not  a  few  of  the  works 
upon  surgery  which  were  designed  at  first  as  text- 
books Imve  been  so  increased  in  sive  at  the  present 
time,  and  become  so  voluminous  with  the  advance 
of  surgery,  as  really  to  be  no  longer  suitable  as 
text-books.  The  author  of  the  volume  before  us 
has  prepared  it  with  reference  to  the  wants  of  the 
student,  so  that  he  can  gain  an  insight  into  the 
theory  and  practice  of  surgery.  The  various 
subjects  of  surgery  are  treated,  of  cov.rse,  as 
briefly  as  possible,  but,  at  the  same  time,  it  has 
been  the  object  not  to  make  such  sacrifices  to 
brevity  as  to  fail  to  give  a  clear  understanding  of 
whatever  is  treated.  The  author  has  given  special 
]n-ominencc  to  those  subjects  with  which  every 
I  student  ought  to  be  acquainted  ;  while  the  rarer 
injtiries  and  diseases  have  received  but  a  brief 
mention,  or  have  been  altogether  omitted.  No 
account  has  been  given  of  the  specialties  of  the 
eye  and  ear,  as  the  pathology  and  treatment  of  the 
diseases  of  these  organs  are  best  studied  in  some 
one  of  the  very  many  monographs  which  aie 
found  devoted  to  them.  We  have  no  doubt  but 
that  students  in  attendance  upon  Colleges,  or 
engaged  in  studying  in  the  wards  of  hospitals,  will 
find  the  work  just  suited  to  their  requirements. 


THE  CANADA  MEDICAL  RECORD. 


Vol.   XVI. 


MONTREAL,    OCTOBER,    18S7. 


No;  1 , 


OOItTTEHSTTS. 


ORIGINAL  COMMUNICATIONS. 

l'))('<»nlr<illiil)lt'  \'oiiiitiii;;  of  rroj;";iiH'y 
SOCIETY  PROCEEDINGS. 

Mo.Ii.-n  Cliinir;;!.';!!     Sn.jcly    «'t     M'Mll- 

roal 

PROGRESS  OF  SCIENCE. 

Tlic  Acivriittagrs  of  Aiitift*l)rin. 

Im|ilniit:ition     of    Tueth  —  Youiiger*8 

I\I<-tlu..i 

A  Clitj.-al  Stiiiiv  of  Antipyriu  and  Au- 

tif.'In-iii,.,.'...   . 

The   Til  frapp  utical    A'alue    of    Blood- 

I«-ttii.tf 

Tlie  Proper  Kt»iplovmeiit  of  Prepared 

Foods  for  Infants 


rtio  Tii'^tnu'ut  of   Vaiicoso    VciiiM  of 

till'  Leg.  14 

The  [iiHiiencP  of  Tea,  Coffee  and  Cocoa 

nil   Dicpstion M 

Tlio  Use  of  Indigo  as  an  Knimoiiaijo^'ne  IT* 
I'leatinont  of  f'liolera  Infintvim  in  the 

Now  York  Infant  Apyluni   ..     I.'t 

The  Pni|u'r  Selertion  of  Ktlier  or  Clilo- 

roforni  an  an  Anepth«tif ]<• 

The  Coiiiparriiivo  Action  of  Aitipyrin 

and  Antifebrin 17 

Tin"  Tivatinent  of  Colds IR 

Thf  Valuta  of  Ifa^niorrhape  in  Treating 

Wounds 1« 

A  Poiiil  in  Ih.- Treatmtnit  of  rhofpa.. .  18 
Iron  and    Sodium  Salicylate   in  Hlien- 

inatiKm  and  KIieumntic  AlTpctiouR-  19 
Incubation  of  the  Infection  of  Measles    19 


Treatment  of  I>vHeiitcry l!^ 

Delivery  afior  l>'.'ath 20 

Treatment  of  Late  Cases  of  Puerperal 

Infection 20 

EDITORIAL. 

[.iiMlnny  and  ItlaeluHton's  Visitine  Llgt.  20 

The  ('anudiaTi  Medical  Afisociation  .. . .  20 

liitertiational  Medical Congrees 21 

KreBh  Air 21 

The  Kighth  Volume  of  the  Index  Cata- 
logue   22 

The  Illustrated  London  News 22 

T.lTl  ItARV  N0TK8 22 

Pkusonal 22 

Upvikw 23 

Obituary 24 


f)n6(nal  BommimicaUoni. 

UNCONTROLLABLE  VOMITING  OF 
PREGNANCY. 

DELIRIUM,    INDUCED    ABORTION,  RECOVERY. 

By  A,  Lapthorn   Smith,    M.D.,   M.R.C.S.,   England, 

F.O.S.,  I.onHon,  Professor  of  Medical  Jurisprudence, 

Faculty  of  Medicine,  University  of  Bishop's  College, 

Consulting  Physician  to  the  Montreal  Di-ipensary. 

I  was  called  to  attend  Mrs.  on  the  i6th 

Oct.,  1887.  Previous  History. — I  had  attended  her 
once  before  for  painful  dyspepsia  accompanied 
with  severe  vomiting  about  a  year  ago,  wiiich  was 
readily  cuied  with  bismuth  and  morphia.  She 
had  one  child  two  years  ago,  and  when  she  became 
pregnant  with  it,  she  vomited  nearly  everything 
she  took  during  the  first  and  second  months;  but 
she  was  able  to  be  up  a  part  of  each  day.  She 
informed  me  that  she  had  a  severe  labor,  which 
was  followed  by  puerperal  fever  and  abscess  of 
the  breast,  which  kept  her  in  bed  several  months. 
She  suffered  so  much  with  this,  her  first  jiregnancy, 
that  her  husband  generotisly  resolved  to  abstain 
from  any  further  se.xual  intercourse.  In  this  re- 
solve he  persevered  for  two  years,  although  with 
considerable  difficulty,  when  one  day  he  mentioned 
the  matter  to  a  friend,  who  told  iiim  he  could 
have  connection  without  endangering  her  life, 
provided  he  withdrew  before  emission.  He  had 
partial  connection  in  this  way  several  times  in 
August,  without  fecundating  her,  for  on  tlie  21st 
August  she  menstruated  as  usual.  His  business 
then  called  him  away  until  tiie  19th  September, 
when  he  returned  ;  but  he  unfortunately  forgot 
himself,  and  the  result  was  that  she  did  not  men- 
struate on  the   2 1st  Sept.     A  few  days  later  she 


commenced  to  vomit  so  severely  that  she  took  to 
her  bed  and  sent  for  her  family  |)hysician,  who 
during  the  next  three  weeks  tried  a  great  many 
remedies  without  avail. 

Present  condition — Very  much  emaciated. 
Pulse  very  weak — 100.  Temperature  normal.  Does 
not  sleep  more  than  an  hour  at  a  time,  and  has  a 
haggard  look.  She  moans  and  retches  almost 
constantly  niglit  and  day,  bringing  up  mucous  and 
bile,  and  sometimes  a  little  blood.  Does  not  dare 
to  take  any  food.  Has  severe  headache.  Com- 
plains of  a  loathsome  taste  in  her  nioutli.  She  is 
positive  that  she  is  not  pregnant  because  of  the 
precautions  taken  ;  but  a  bimanual  examination 
of  the  uterus  shows  that  it  is  gravid.  It  is  some- 
what enlarged  ;  the  body  has  an  elastic  feeling, 
and  the  cervi.x  is  pulpy,  and  the  os  slightly  open. 
A  specular  examination  reveals  a  granular  erosion, 
the  size  of  a  10  cent  piece,  on  the  cervix,  which 
presents  a  dark,  purple  hue  ;  the  vagina  is  almost 
slaty  in  color,  and  the  external  organs  are  very 
red  and  sensitive.  The  breasts  are  not  enlarged 
and  there  are  no  areola;. 

Diagnosis.  Although  her  tongue  was  red  and 
coated,  and  although  she  had  already  had  dyspep- 
sia with  vomiting,  and  in  spite  of  hers  and  her 
husband's  assurance  that  she  could  not  be  pregnant, 
the  feeling  and  ajjpearance  of  the  uterus  made 
me  feel  sure  that  she  was,  and  that  this  was  a  case 
of  vomiting  of  jiregnancy. 

Prognosis.  This  was  serious  enough.  Most  of 
the  usual  remedies  had  been  tried  by  her  family 
physician  during  tliree  weeks  without  avail,  and  I 
was  convinced  that  unless  I  could  put  a  slop  to 
the  incessant  vomiting  which  prevented  her  from 
keeping  down  either  nicdicme  or  food,  and  which 


THE   CANADA   MEDICAL   RECORD. 


was  just  as  constant  whether  she  took  anything 
down  or  not,  I  felt  sure  that  she  would  soon  die. 
M.  Gueniot  (Cazeaux,  p.  46S)  collected  1 18  cases 
of  which  72  recovered  and  46  died.  They  were 
all  serious  cases. 

CURED. 

Without   aborting    and   after    an   extremely 

varied  treatment 31 

After  spontaneous  aborting 20 

After  provoked  abortion  or  confinement 21 

DEATHS. 

Without  abortion 28 

After  spontaneous  abortion  or  premature  de- 
livery        7 

After  provoked  abortion 11 

As  the  prognosis  becomes  more  serious  every 
moment  we  delay,  these  last  1 1  deaths  might  have 
been  cures  if  abortion  had  been  brought  on  before 
the  woman's  case  became  desperate. 

Treatment  Medical.  I  began  with  a  mixture 
containing  morphia,  subnitrate  of  bismuth,  acacia 
and  pepsine.  As  it  increased  the  nausea,  I  left 
the  morphia  out,  and  substituted  acid  hydro- 
cyanic and  spirits  of  chloroform.  As  she  could 
not  keep  this  down,  I  tried  tablets  of  different 
kinds,  but  with  no  benefit. 

Dietetic. — For  several  days  before  I  saw  her  she 
had  been  taking  milk  and  soda  water ;  but  she  could 
not  keep  it  down  more  than  a  few  minutes.  I  tried 
milk  and  lime  water,  and  she  kept  this  in  teaspoon- 
fuls  for  two  days,  but  she  turned  against  it ; 
beef  tea  she  could  not  even  swallow,  and  at  last 
she  was  reduced  to  sucking  small  pieces  of  ice, 
which  she  vomited  as  soon  as  it  became  warmed. 
I  then  began  rectal  alimentation  with  peptonized 
milk  and  beef  tea  and  a  little  brandy.  She  rallied 
a  little  on  this,  but  the  rectum  becoming  irritable 
she  could  not  after  two  days  retaui  it  longer 
than  a  few  minutes,  and  she  was  so  low  that  I  did 
not  dare  to  introduce  morphia  with  it. 

Surgical. — I  began  by  applying  a  blister  to  the 
epigastrium.  I  then  cauterized  the  erosion  on  the 
OS  uteri  with  solid  nitrate  of  silver.  Both  of  these 
measures  proved  futile.  She  was  now  reduced 
very  low.  She  was  consumed  with  a  burning  thirst 
which  she  could  not  assuage.  Her  bowels  had  not 
been  moved  for  many  days,  and  she  was  distended 
with  flatus,  neither  of  which  conditions  were  re- 
lieved by  copious  enemata,  or  turpentine  stupes  on 
the  abdomen.  She  had  a  horrible  taste  in  her 
mouth  which   made   her  loathe   herself,  and  she 


prayed  that  she  might  die.  Her  temperature  be 
gan  to  fall  below  normal  and  delirium  set  in,  so 
that  by  the  23rd  I  felt  sure  that  surgical  gynecology 
alone  could  save  her,  and  1  determined  to  clear 
out  the  contents  of  the  utSrus.  Whether  the  vomit- 
ing be  due,  as  some  think,  to  reflex  irritation  of  the 
sympathetic  nerves  of  the  stomach  due  to  pressure 
on  its  uterine  filaments  by  the  growing  and  dis- 
tending uterus ;  whether  it  is  due  to  hardness  and 
lack  of  distensibility  of  the  uterine  walls ;  whether 
it  is  due  to  disease  of  the  lining  membrane  of 
the  uterus,  which  I  think  is  the  cause,  or  to  disease 
of  the  ovum,  I  am  convinced  that  the  surest  and 
safest  way  to  put  an  end  to  the  trouble  is  to  turn 
the  contents  of  the  uterus  out.  This  is  the  view 
held  by  Veit  of  Berlin,  whom  I  witnessed  perform- 
ing the  same  operation  for  the  same  cause.  Neither 
is  provoked  abortion  in  skilled  hands  an  at  all  dan- 
gerous proceeding,  if  the  preliminary  dilatation  of 
the  uterus  is  performed  with  thoroughly  aseptic 
tents  and  the  uterus  and  \agina  are  kept  aseptic 
both  before  and  afterwards  by  means  of  frequent 
antiseptic  irrigations.  There  is  no  danger  from 
hemorrhage  because  the  uterus  will  surely  be  made 
to  contract  by  irrigation  with  very  hot  water. 

On  the  23rd  Oct.,  therefore,  I  called  Dr.  Gardner 
in  consultation,  and  he  was  perfectly  satisfied  that 
her  condition  was  desperate,  and  that  an  abortion 
was  an  immediate  necessity.  The  patient  was 
placed  on  a  table  in  Sim's  position,  and  he  intro- 
duced a  carefully  carbolized  sponge  tent,  without 
the  aid  of  ether.  It  caused  very  little  pain ;  but 
when  he  removed  it  next  day,  the  24th  Oct.,  it  was 
constricted  at  the  internal  os  which  had  to  be 
further  dilated  with  a  Goodell  dilator,  in  order  to 
allow  a  large  sized  tupelo  tent  to  be  introduced. 
On  the  25th  the  os  was  well  dilated;  the  patient 
was  placed  on  the  table  and  the  uterus  and  vagina 
well  washed  out  with  sublimate  solution  i  to 
2000.  She  was  then  anaesthetized  with  the  A.  C.  E. 
mixture,  which  acted  most  satisfactorily,  and  Dr. 
Gardner  skilfully  removed  the  ovum  and  a 
considerable  part  of  the  uterine  mucous  membrane 
with  spoon  forceps.  An  irrigator  with  1-5000 
sublimate  solution  as  hot  as  could  scarcely  be  borne 
by  the  hand  was  in  readiness  with  a  Fritsch- 
Bozeman  return  flow  uterine  catheter  attached,  and 
the  moment  the  ovum  was  removed,  and  while  the 
blood  was  pouring  out  of  the  uterine  sinuses,  the 
catheter  was  introduced  to  the  fundus,  and  the 
water  turned  on,  when  we  had  the  pleasure  of  see- 
ing the  flow  of  blood  instantly   arrested,    and  the 


THE  CANADA.  MEDICAL  RECORD. 


uterus  firmly  contracted.  The  os  and  vagina  were 
tliorouglily  insutHated  witli  iodoform,  and  she  was 
rcjjlaa.'d  in  bed.  Tiie  vomiting  was  not  relieved  by 
llie  dilatation,  as  has  been  held  by  some.  She 
continued  to  vomil  all  that  day,  but  has  not  vomited 
once  since  then.  There  was  little  or  no  hemorr- 
hage after  the  operation,  and  the  very  ne.\t  day 
she  began  to  drink  beef  tea  and  milk  in  increasing 
quantities.  She  had  no  rise  of  temperature  ;  in 
fact,  to  use  her  own  words,  she  felt  so  much  better 
that  "it  was  like  being  in  heaven.''  On  the  12th 
Nov.  she  is  up  and  well.  The  only  regret  that  I 
had  was  that  I  had  not  decided  upon  the  opeiation 
sooner.  The  perfect  recovery  was  largely  due  to 
the  minute  antiseptic  precautions  employed. 


MEDICO-CHIRURGICAL    SOCIETY    0¥ 

MONTREAL. 

Stated  Meeting,  June  lot/i,  1887. 

J.  C.  Cameron,  M.  D.,  President,  in  the  Chair. 

Dr.  R.  L.  MacDonnell  read  the  history  of 
two  interesting  cases  which  had  recently  come 
under  his  notice : 

I  Malignant  disease  of  the  Lung- — A  boy, 
aged  3  years,  had  appeared  for  some  weeks  to  be 
suffering  from  shortness  of  breath,  without  any  other 
symptom.  At  the  first  visit  the  whole  right  chest 
was  found  to  be  flat  on  percussion,  and  to  present 
the  physical  signs  of  pleurisy  with  effusion.  Aspi- 
ration yielded  a  negative  result,  nothing  but  a  itw 
drops  of  blood  entering  the  instrument.  These 
being  examined  by  Dr.  Wyatt  Johnston  were 
found  to  contain  no  pus,  but  an  unusual  number 
of  leucocytes.  Several  further  attempts  at  aspira- 
tion yielded  scarcely  better  results.  At  one  time 
about  two  ounces  of  pure  blood  were  withdrawn. 
Dyspnoea  became  very  urgent,  and  pressure  signs, 
distention  of  thoracic  veins,  and  oedema  of  the 
right  side  of  the  face  set  in.  The  child  died  after 
an  illness  of  six  weeks.  An  autopsy  showed  that 
the  right  lung  was  the  seat  of  an  extensive  growth 
of  alympho-sarcomatous  nature.  No  other  organs 
were  found  involved. 

Discussion. —  Dr.  Johnston  stated  that  the 
tumor  was  a  lympho-sarcoma.  It  was  like  a  small, 
round-celled  sarcoma,  but  with  a  number  of  lymph 
elements.  The  specimen  showed  the  anomaly 
that,  though  sarcomatous,  the  cells  were  arranged 
in  alveoli. 


Dr.  Kingston  said  the  symptoms  seemed  to 
point  to  empyeiTia,  cancer  is  so  rare  in  children, 
lie  also  quoted  a  case  of  empyema  that  occurred 
about  the  same  lime,  in  which  the  first  aspiration 
produced  tluid,  but  the  second  gave  none,  the  pus 
having  become  consolidated. 

2  Cerebral  Syphilis. — The  second  case  was 
that  of  a  married  woinan,  aged  20,  who  entered 
hospital  on  account  of  "fits,"  which  had  occurred 
off  and  on  during  the  last  nine  months.  These 
attacks,  one  of  which  occurred  in  the  hospital, 
consisted  of  clonic  spasms  affecting  the  left  side 
of  the  face  and  left  arm,  and  were  preceded  by  a 
distinct  aura.  There  was  subsequent  hemiplegia 
of  these  parts,  with  dragging  of  the  left  leg  on 
attempting  to  walk.  On  the  left  side  the  reflexes 
were  exaggerated  and  ankle  clonus  present.  Gen- 
eral intelligence  was  but  fair,  and  speech  thick. 
Optic  neuritis  was  present  in  both  eyes,  with 
intense,  but  not  localized,  headache.  Though  no 
history  of  syphilis  was  to  be  obtained,  a  course  of  in- 
unction with  mercury  was  carried  on  to  salivation. 
Dr.  MacDonnell  recognizing  that  the  symptoms 
were  the  result  of  some  lesion  of  the  motor  area  of 
the  right  side  of  the  brain,  and  that  the  most 
probable  origin  of  such  a  condition  was  syphilitic 
tumor.  The  result  was  most  satisfactory.  Com- 
plete recovery  of  the  paretic  parts  rapidly  ensued, 
the  headache  disappeared,  and  after  a  month's 
stay  in  hospital  the  patient  returned  home  in  an 
excellent  state  of  health. 

Discussion. — Dr.  Stewart  stated  that  he  was 
called  to  see  the  patient.  He  thought  there  were 
two  points  of  great  interest  in  this  case.  The  first 
was  that  the  onset  of  the  symptoms  seemed  to 
point  to  a  cortical  lesion  which  was  probably  of 
syphilitic  origin  ;  the  lesion  might  be  a  tumor  or 
merely  a  thickening  of  the  membrane.  The 
second  point  to  be  observed  is  the  greater  value  of 
mercury  compared  to  potassium  iodide  in  the 
treatment  of  cerebral  syphilis.  If  the  woman 
could  have  stood  the  effects  of  more  mercury  she 
would  probably  have  got  better  sooner.  He  also 
called  attention  to  the  value  of  using  an  antisep- 
tic mouth-wash.  In  Vienna  mercury  was  rubbed 
in  thirty  times  a  month  without  saturation,  because 
the  patient's  mouth  was  well  washed. 

Dr.  Cameron  asked  at  what  point  could  one 
detemiine  when  the  mercury  had  reached  its  full 
effect,  and  when  would  it  be  advisable  to  resort  to 
operation  ? 

Dr.  Stewart  replied  that  if  the  disease  was 


THE   CANADA   MEDICAL   RECORD. 


syphilis,  a  complete  cure  might  be  expected  ;  but 
if  no  effect  was  produced  in  six  weeks,  operative 
procedure  might  be  considered. 

Dr.  HiNGSTON  referred  to  the  efficacy  of  potas- 
sium iodide  over  mercury,  in  his  experience.  There 
is  very  little  doubt  of  the  superior  efficiency  of 
potassium  iodide  over  mercury  in  syphilis  generally 
why  not  in  cerebral  syphilis  ?  He  then  referred  to 
the  diflficulty  of  diagnosing  syphilis  even  in  cases 
where  the  lesion  was  visible,  and  quoted  cases 
where  it  had  been  mistaken  for  malignant  disease. 
He  believed  potassium  iodide  was  a  scavenger  for 
the  disease,  and  if  it  had  no  effect  on  any  disease, 
that  disease  was  not  syphilitic. 

Foreign  body  in  the  Biadiicr. — Dr.  Hingston 
related  an  interesting  case  of  this  nature.  An  old 
man  came  into  hospital  complaining  of  frequent 
micturition  at  night,  with  pain  and  other  symiUoms 
of  calculus.  The  lithrotite  was  introduced  with- 
out preliminary  sounding,  opened  and  closed  on 
something  soft  not  attached  to  the  vesical  wall 
On  withdrawing  it,  found  a  piece  of  sheet  rubber ; 
again  introduced  the  instrument,  and  withdrew 
another  piece,  and  afterwards  crushed  and  remov- 
ed a  calculus  that  was  there.  Patient  stated  that 
he  had  been  examined  with  an  instrument  in 
Chicago,  where  he  was  treated  for  irritation  of  the 
neck  of  the  bladder.  Probably  part  of  the  rubber 
catheter  was  left. 

In  reply  to  Dr.  Gurd,  Dr.  Hingston  stated  that 
the  rubber  was  very  much  incrusted. 

Case  of  supposed  Aneurism. — Dr.  MacDonnell 
related  a  case  of  supposed  thoracic  aneurism. 
There  was  great  intrathoracic  pain,  and  neuralgic 
pains  in  the  course  of  the  fifth  and  sixth  nerves, 
requiring  hypodermics  to  produce  sleep.  Patient 
had  history  and  symptoms  of  syphilis.  Complete 
relief  was  afforded  by  potassium  iodide.  There  is 
now  no  pain  nor  any  pressure  symptoms,  and 
patient  is  up  and  about  the  wards. 

In  answer  to  Dr.  Gurd,  Dr.  MacDonnell  said 
that  potassium  iodide  gives  wonderful  relief  in 
cases  of  aneurism.  Would  not  say  whether  tliis 
was  due  to  its  antisyphilitic  action  or  to  its  power 
of  producing  a  clot  in  the  sac. 


Stated  Meeting,  Sept.  30,  1S87. 

J.  C.  Cameron,  M.  D.,President,  in  the  Chair. 

Drs.  J.  Stirling  and  K.  Ca-xneroi)  were  elected 
members  of  the  Society. 


PATHOLOGICAL     SPECIMENS. 

Dr.  Johnston  exhibited  the  following  speci- 
mens : — 

1.  Enlarged  prostrate,  with  bladder  attached, 
showing  the  beneficial  Effects  of  systematic 
catheterization.  P.ladder  mucosa  was  quite  nor- 
mal, and  neither  the  ureters  nor  the  kidneys  were 
affected,  though  the  enlargement  was  sufficient  to 
prevent  the  passage  of  urine  except  by  the  use  of 
a  catheter. 

2.  Acardia  ;  a  foetus  from  the  McGill  College 
Museum,  with  the  organs  of  circulation  entirely 
wanting. 

3.  A  fibrous  nodule,  found  lying  free  in  a  pocket 
formed  by  an  old  pleuritic  adhesion.  The  nodule 
was  quite  cartilaginous  in  consistence. 

Dr.  Major  exhibited  his  new  insliument  for  the 
removal  of  growths  from  the  vault  of  the  pharynx. 
It  works  on  the  principle  of  the  guillotine,  and  is 
A  great  improvement  on  the  older  forms  of  forceps, 
as  the  uvula  could  not  be  caught  in  the  instru- 
ment, and  most  growths  could  be  removed  at  one 
operation. 

Dr.  WiLKiNS,  First  Vice-President,  took  the 
chair,  and 

The  President  (Dr.  Cameron)  read  a  paper  on 
The  influence  of  Lcukamia  on  Pregnancy  and  La- 
bor, which  will  appear  shortly  in  the  American 
Journal  oj  the  Medical  Sciences.  He  said  that  after 
a  careful  search  through  the  literature  of  the  subject 
he  had  been  able  to  find  reports  of  only  four  cases 
where  leukaemia  was  said  to  have  occurred  in  the 
course  of  pregnancy,  but  in  none  of  these  had  a 
blood-count  been  made,  or  the  condition  of  liver 
and  spleen  carefully  examined.  No  case  has 
hitherto  been  recorded  where  a  woman  already 
leukfemia  has  been  known  to  become  pregnant. 
He  then  reported  at  considerable  length  a  case 
which  he  considers  unique.  A  woman,  aged  36, 
married,  was  treated  in  Montreal  General  Hospital 
for  leuka;mia,in  September,  1885,  and  at  the  same 
time  her  three  months  old  infant  and  six  year  old 
daughter  were  found  to  be  leukremic.  She  became 
pregnant  in  March,  1886,  her  liver  and  sjileen 
became  enlarged  and  tender,  and  as  pregnancy 
went  on,  dyspncea  and  cedema  became  extreme, 
and  her  blood  showed  profound  alterations.  She 
had  repeated  attacks  of  epistaxis  before  labor  set 
in,  and  became  so  weak  and  faint  that  her  condi- 
tion was  really  alarming.  She  was  confined  in  the 
University  Maternity  Hospital  on  29th  October, 
214  days  after  cessation  of  last  menstrual  period. 


I 


itilE  CANADA  MEDICAL   RECoRb. 


5 


Her  labor  was  perfectly  dry  and  bloodless,  and  a 
scant  slimy  disdiargc  for  a  c(iui>lc  of  days  Was  the 
sole  lochial  How.  Two  boiirs  after  the  birth  of  the 
child,  the  blood  of  both  mother  and  child  was 
examined,  with  the  following  result; — 
Alvlhcr — Reil  corps  ,  per  c  mm.,  990,000.  .W:K;=  1:4 
Child—        "        "  "         5,210,000.. W:R=i:i75 

She  made  a  rapid  convalescence,  and  was  dischar- 
ged from  hospital  on  the  twelfth  day,  when  her 
blood  was  found  to  have  improved  so  as  to 
register 

Red  corps.,  per  c.mm.,  1,900  000.  .\V:R::=I;35 
The  placenta  was  carefully  examined,  and  showed 
remarkable    and    interesting     diflerenccs    in    the 
quality  of  the  blood  at  different  [larts  ; 

/■/.   Vein — Red  corps.,  perc.mm.,  4,60,000.  .\V:R=I:I73 
PI.  Aiimy-^  "         "  "         5,410,000.  .W:R=I:270 

PI.  Sinuses— "  "  "  950,000.  .W;R=:l:36 

The  child,  which  throve  nicely  for  a  day,  was 
clandestinely  jnit  liy  the  patient  to  her  own  breast, 
and  in  a  few  hours  a  purpuric  rash  appeared  and 
spread  over  the  body,  the  child  began  to  voinit 
and  purge,  and  in  four  days  died.  Nothing 
special  was  found  post-mortem.  The  patient 
regained  her  strength  so  completely  that  she  was 
able  to  do  heavy  housework,  wash  and  scrub,  iron, 
and  drive  a  waggon  to  market.  Early  in  May, 
1887,  she  became  again  pregnant,  liver  and 
spleen  began  again  to  enlarge,  her  red  corpuscles 
to  decrease,  and  white  corpuscles  to  increase, 
and  the  course  of  pregnancy  is  running  along 
very  similar  to  the  previous  one.  She  is  being 
kept  under  careful  supervision,  and  a  number  of 
interesting  observations  are  being  made  which 
will  be  published  in  due  time.  In  conclusion, 
Dr.  Cameron  summarized  the  points  of  interest  in 
the  case  as  follows  : 

1.  T/ie  family  history. — The  grandmother, 
mother  and  brother  of  the  patient  have  suffered 
from  symptoms  probably  pointing  to  leukaemia. 
Two  of  her  own  children  have  had  well-marked 
leukcemia ;  another  is  now  in  ill-health  with 
diminished  red  cells  and  enlarged  spleen.  None  of 
her  children  reach  the  normal  standard  of  five  to 
six  millions  of  red  corpuscles  were  c.mm.  All 
of  them  have  had  Jaundice.  In  this  case  there 
seems  to  be  a  %\.xox\^hcrcditary  tendency. 

2.  The  enlargement  of  the  spleen  was  first 
noticed  by  the  patient  at  the  beginging  of  her 
sixth  pregnancy,  and  now  both  liver  and  spleen 
begin  to   enlarge   when  she    becomes    pregnant, 


while  at  the  same  time  her  red  corpuscles  ditninish 
and  white  corpuscles  increase. 

3.  During  labor  and  the  puerpeial  period,  there 
was  absence  of  hemorrhage  or  any  appearance  of 
blood. 

4.  After  l.dior,  the  oedema  and  dyspmva  rapidly 
subsided,  the  red  corpuscles  increased  and  white 
corpuscles  decreased,  till  her  usual  strength  and 
vigor  were  regained,  though  the  spleen  remains 
considcrbly    ei.iuged. 

1^.  The  remarkably  chronic  course  of  the  disease, 
and  the  recurrence  of  pregnancy  (now  the  third 
time  since  splenic  enlargement  was  first 
noticed). 

6.  The  remarkable  difl'erence  between  the 
blood  of  mother  and  child  and  of  the  blood  in  the 
placenta,  showing  that  the  fcetal  and  maternal 
circulations  were  not  only  entirely  distinct,  but  also 
that  the  child  actually  made  red-blood  in  its  body 
and  lost  it  in  the  placenta. 

7.  The  disastrous  effect  of  nursing  upon  the 
child,causing  purpura,vomiting,  purging  and  death. 

Discussion Dr.    Geo.    Ross    said    that  this 

unusually  interesting  case  had  been  for  some  time 
under  his  care  at  the  General  Hospital.  Her 
health  at  the  time  of  her  confinement  was  such 
that  she  required  the  most  careful  attention  ; 
indeed  even  a  very  moderate  loss  of  blood  at  that 
time  would  have  been  most  dangerous,  if  not 
fatal,  to  the  patient.  He  could  offer  no  explana- 
tion for  the  absence  of  blood  at  the  time  of  deliv- 
ery. He  had  a  case  in  private  practice  where  there 
was  a  very  slight  sanguineous  loss  at  the  time  of 
delivery.  This  was  a  case  of  profound  anaemia 
accompanying  valvular  disease  of  the  heart,  with 
cedema  of  the  legs,  violent  palpitation  of  the 
heart,  dyspnoea  and  general  cardiac  weakness. 
The  loss  of  blood  here  was  almost  imperceptible. 
He  thought  that  Dr.  Caineron's  case  showed  that 
heredity  is  not  a  strongly  marked  feature  of  the 
disease. 

Dr.  Armstrong  suggested  that  the  apparent 
absence  of  sanguineous  discharge  might  be  due  to 
the  small  proportion  of  red  corpuscles  in  the 
blood ;  a  proportion  of  one  white  to  four  red 
corpuscles  would  hardly  look  like  blood.  As 
pregnancy  seems  to  have  made  the  patient  much 
worse,  it  becomes  a  question  whether  it  would 
not  be  advisable  to  prevent  a  future  pregnancy. 

Dr.  Ross  thought  the  last  question  a  very 
important  one,    but   though    deleterious   to   her 


¥hE   CiANADA  MEDICAL   RECORD. 


health,  she  survived,  and  has  been  remarkably  well 
since.  He  did  not  think  interference  was  called 
for  in  this  case. 

Dr.  WiLKiNS  agreed  with  Dr.  Armstrong  that 
the  absence  of  blood  may  have  been  more  appa- 
rent than  real.  In  a  case  of  acute  pernicious 
anemia,  when  there  were  only  1,050,000  red  cells, 
the  blood  was  but  a  very  pale  pink.  If  such  a 
liquid  were  mixed  with  amniotic  fluid,  it  would  be 
very  difficult  to  identify  as  blood. 

Dr.  Johnston  called  attention  to  the  close 
similarity  in  the  condition  of  the  mother's  blood 
and  that  found  in  the  placenta  sinuses,  and  asked 
if  the  advisability  of  removing  the  spleen  had  been 
considered. 

Dr.  BULLER  referred  to  the  serious  consequences 
to  the  infant  which  followed  from  nursing  by  the 
mother,  and  asked  if  the  mother's  milk  had  been 
examined. 

Dr.  Cameron,  in  reply,  said  that  the  mother's 
milk  was  thin  and  acrid,  and  in  a  day  or  two  dried 
up,  so  no  thorough  examination  was  made. 
Splenotomy  was  not  considered  advisable  in 
the  case  as  it  is  chronic.  With  regard  to  the 
question  of  inducing  premature  labor,  he  thought 
that  nature  would  probably  settle  the  question. 
The  woman  is  again  pregnant,  but  it  is  doubtful 
if  it  will  go  beyond  the  seventh  or  eighth  month. 
If  the  alarming  epistaxis  were  again  to  appear,  he 
would  be  inclined  to  bring  on  an  abortion  to  save 
the  mother's  life.  The  absence  of  blood  at  the 
birth  was  real,  it  was  not  apparent  only,  as  the 
birth  was  almost  a  dry  one;  the  placenta  was 
glistening  and  the  child  quite  dry,  no  fluid  of  any 
kind  accompanied  it.  This  case  is  alone  in 
illustrating  the  effect  of  heredity  ;  no  mention  is 
made  of  it  in  the  literature  of  leuksmia. 

Peciilid)-  Cause  of  Blindness. — Dr.  Buller 
related  a  case  occurring  in  his  practice  two  years 
ago.  A  little  girl  had  a  squint  eye  quite  blind  ; 
on  examination,  the  optic  nerve,  or  the  place  for 
it,  showed  a  white  patch  with  pigmented  margin. 
He  learned  that  when  the  child  was  born  the  labor 
was  difficult  and  severe  ;  instrumental  aid  was 
necessary.  After  birth  it  is  said  this  eye  was 
found  out  of  the  orbit,  on  the  cheek,  and  was  piit 
back  by  the  physician.  Dr,  Buller  asked  if  any 
one  knew  of  similar  effects  from  the  use  of  forceps. 
Dr.  Cameron  said  he  had  seen  the  eye  protru- 
ded almost  beyond  the  lids  from  severe  use  of 
forceps  not  properly  applied  to  the  head. 


Annual  Afeeting,   October  141/1,  1887. 
J.  C.  Ca.merdn,  M.  D.,  President,  in  the  Chair. 
Drs.  A.  W.  Campbell  and  J.   H.  B.  Allen  were 
elected  members  of  the  Sosiety.  * 

The  Treasurer's  report  was  held  over  to  the 
next  meeting. 

The  report  of  the  Secretary  showed  that  there 
were  iS  meetings  held  during  the  year,  at  which  21 
papers  were  read,  besides  reports  of  cases  and 
exhibition  of  pathological  specimens.  The  aver- 
age attendance  for  the  year  was  over  19. 

Pathological  Specimens. — Dr.  Johnston  exhi- 
bited sjjecimens  from  two  cases  of  ainhum,  sent 
by  Dr.  C.  E.  Gooding  of  Barbadoes.  In  each 
case  a  constricting  band  of  fibrous  tissue  had  for- 
med about  the  proximal  phalanx.  The  bones 
were  extremely  small  and  thin,  and  seemed  atro- 
phied. He  also  exhibited  for  Dr.  Geo.  Ross 
specimens  from  a  case  of  chronic  Bright's  disease. 
The  patient  during  life  had  shown  marked  dysp- 
nrea.  The  pharynx,  soft  palate  and  epiglottis 
were  enormously  swollen  through  oedema,  but 
from  the  absence  of  stridor  it  had  been  inferred 
that  the  chink  of  the  larynx  itself  was  not  invol- 
ved. At  the  autopsy  the  oedema  was  found  not 
to  actually  involve  the  glottis,  the  rima  being  of 
normal  dimensions,  and  both  vocal  cords  and  ven- 
tricular bands  were  free  from  redema. 

Dr.   C.  E.  Gooding  of  Barbadoes  was  elected  a 
corresponding  member  of  the  Society. 

Periosteal  Sarcoma. — Dr.  James  Bell  exhibited 
the  thigh  of  a  patient  amputated  at  the  upjjer 
third,  and  related  the  following  history  of  the  case  ; 
The  patient  whose  leg  was  shown  was  a  young 
man  aged  18  years,  a  native  of  Montreal,  and  of 
Irish  extraction.  The  growth  began  in  April  last 
as  a  small  moveable  nodule  on  the  front  of  the 
femur,  just  above  the  knee.  It  grew  rapidly  and 
extended  around  the  lower  end  of  the  femur.  It 
was  painless  until  recently,  when  he  began  to 
suffer  from  pains  of  a  neuralgic  character,  chiefly 
in  the  foot  (doubtless  due  to  pressure  on  the  ner- 
ves). As  late  as  the  4th  of  June  he  walked  to  the 
Hotel  Dieu  Hospital,  where  he  remained  five 
I  weeks,  and  has  never  been  able  to  walk  since . 
He  was  admitted  to  the  General  Hospital  about 
the  middle  of  August,  where  Dr.  Bell  saw  him  for 
the  first  time.  The  whole  lower  end  of  the  femur 
was  then  uniformly  enlarged.  It  was  clearly  a 
periosteal  sarcoma,  and  amputation  was  suggested. 
He  took  fright  at  the  suggestion  and   went  away, 


THE  CANADA   MEDICAL   RECOUD. 


but  returned  on  the  30th  of  September.  The 
growth  had  increased  greatly  in  size  during  the  six 
weeks  which  had  elapsed  since  his  leaving  the 
hospital.  Mis  foot  and  leg  were  ccdcmatous,  and 
the  neuralgic  pains  very  severe.  He  was  exceed- 
dingly  weakened,  pale,  and  much  emaciated,  and 
his  temperature  ranged  from  100-103  °F.  On 
.Monday,  Oct.  3rd,  Dr.  Bell  amputated  through  the 
upper  third  of  the  thigh  by  the  circular  method. 
Since  the  operation  his  temperature  has  been  per- 
fectly normal,  and  his  general  condition  has  impro- 
ved very  much.  The  first  dressing  after  operation 
was  done  on  the  eighth  day.  On  section,  the 
tumor  was  found  to  have  involved  the  periosteum 
of  the  lower  third  of  the  bone,  but  had  not  inva- 
ded the  interior.  On  examination,  the  epiphysis 
separated  from  the  shaft  and  showed  a  diseased 
condition  (apparently  inflammatory)  between 
these  two  parts. 

Discussion.  —  Dr.  Johnston'  said  that  the 
microsco])ic  section  of  the  tumor,  which  was 
exhibited,  showed  the  growth  to  be  a  round-celled 
sarcoma,  showing  here  and  there  scattered  among 
the  round-celled  tissue  small  transparent  islets, 
within  which  a  few  branched  cells  could  be  seen 
(osteoblasts). 

Dr.  Roddick  thought  that  although  on  account  of 
the  man's  condition  it  was  probably  wise  to  ampu- 
tate in  the  upper  third,  as  had  been  done,  yet  he 
thought  that  the  surgical  rule  of  removing  the 
whole  bone  should,  if  possible,  have  been  fol- 
lowed. 

Dr.  Fenwick  did  not  agree  with  Dr.  Roddick, 
and  thought  that  in  periosteal  sarcoma,  if  the 
disease  were  entirely  removed,  there  was  no  dan- 
ger of  recurrence  in  the  stump,  at  least  for  a  long 
time,  and  mentioned  some  similar  cases  which  had 
occurred  in  his  own  practice. 

Dr.  Bell,  in  reply,  stated  that  in  the  cases  of 
this  disease  which  had  hitherto  come  under  his 
observation,  recurrence  in  the  stump  had  never 
occurred,  although  in  every  case  there  had  been 
an  early  recurrence  in  some  of  the  fibro-serous 
sacs  of  the  body — either  the  pleura,  the  perios- 
teum, or  the  dura  mater,  chiefly  the  pleura. 

RESOLUTIONS  OF  CONDOLENCE. 

Moved  by    Dr.  Geo.  Fenwick,  seconded  by  Dr. 

Godfrey  : 

Resolved.,  — "  That      the     Medico-Chirurgical 

Society  of  Montreal  has    learned  with  deep  regret 

of  the  sudden,  although  not  unexpected,   death   of 


their  late  esteemed  friend  and  associate,  Henry 
Howard,  M.R.C.S.,  Eng.,  the  oldest  member 
of  this  Society  ;  that  his  regular  attendance  at 
our  gatherings,  his  readiness  to  participate  in  dis- 
cussions, and  also  the  deep  interest  taken  l)y  our 
late  associate  in  all  scientific  questions  that  came 
up  before  us,  added  greatly  to  the  interest  and 
attractiveness  of  these  meetings  ;  and  that  this 
Society  desires  to  place  on  record  the  sense  of  the 
loss  which  has  fallen  upon  them  in  his  death." 

Dr.  George  Ross  moved,  seconded  by  Dr.  T. 
G.Roddick,  "That  the  members  of  this  Society 
extend  to  the  family  of  the  deceased  their  respect- 
ful sympathy  in  their  present  great  bereavement, 
and  that  the  Secretary  be  requested  to  forward  a 
copy  of  these  resolutions  to  the  family  of  our  late 
member,  and  also  give  copies  to  the  city  papers  for 
publication.  " 

Dr.  Proudfoot  then  referred  to  the  sudden 
death  of  Dr.  Wm.  Stephen  in  Buenos  Ayres,  and 
moved  the  following  resolution  seconded  by  Dr. 
T.  G.  Roddick  : 

Resolved,—'-'  That  the  members  of  this  Society 
have  heard  with  deep  regret  of  the  death  of  their 
late  member  and  confrere.  Dr.  William  Stephen, 
whose  many  good  qualities  and  kindly  disposition 
had  endeared  him  to  every  member  of  the  profes- 
sion, and  that  a  copy  of  this  resolution  be  sent  to 
the  friends  of  the  deceased. " 

ELECTION  OF  OFFICERS. 

The  officers  of  the  Society  for  1887-8  were  then 
elected  as  follows  : — 

President,  Dr.    Perrigo.     \st    Vice-President, 

Dr.  William  Gardner.     2nd   Vice  President,  Dr. 

Guerin.     Secretary,  Dr.  Ruttan.      Treasurer,  Dr. 

J.  A.  MacDonald.     Librarian,  Dr.  T.  D.  Reed. 

I   Council,  Drs.  George  Ross,  T.  A.  Rodger  and  A.  D. 

1   Blackader. 


J^'FO^^MS  O'f  Sdeme. 


THE  ADVANTAGES  OF  ANTIFEBRIN. 

Mr.  J.  K.  Murray  recommends  antifebrins  as 
possessing  advantages  over  other  antipyretics  on 
the  following  grounds  {British  Medical  Journal, 
April  23,  1887): 

Antifebrin  seems  much  more  powerful  than 
quinine,  kairin,  or  antipyrin.  It  equals  antipyrin 
in  the  duration  of  its  eff'ects,  and  in  this  respect 
surpasses  quinine  or  kairin.  It  is  only  excelled 
in  the  quickness    of  its    action    by  the   external 


tfiE   CANADA  MEDICAL  RECOfefi. 


application  of  cold.  Its  effects  are  evident  witliin 
an  hour,  and  thej'  last  from  ten  to  twelve  hours 
when  a  full  dose  has  been  administered.  When 
administered  for  a  long  time,  the  dose  must  be 
increased.  It  produces  i)rofuse  sweating  and 
redness  of  the  cheeks  ;it  diminishes  the  pulse-rate, 
and  distinctly  increases  arterial  tension.  He 
found  no  depressing  effects  follow  its  adminis- 
tration, even  when  full  doses  were  given.  Anti- 
pyretics belong  to  two  great  classes, — -namely, 
those  which  diminish  tissue-metabolism  ;  and 
secondly  those  which  increase  the  loss  of  heat. 
From  the  sweating  it  produces  and  the  rise  in 
arterial  tension,  one  might  conclude  that  antifebrin 
belongs  to  the  second  class  as  well  as  to  the  first  one. 
This  might  explain  the  quickness  of  its  action,  as 
antipyretics  of  the  second  class  act  more  speedily 
than  those  which  diminish  tissue-metabolism. 


IMPLANTATION  OFTEE  TH— VOUNGER'S 
METHOD. 

By  F.  Abpott,   M.D.,  New  York. 

The  operation  to  which  1  lave  the  pleasure  of 
calling  your  attention  for  a  few  moments  this 
evening,  aside  from  its  mechanical  features,  is 
very  little  understood,  even  by  those  who  have 
performed  it  the  greatest  number  of  times.  That 
teeth  which  have  been  for  a  long  time  out  of  the 
mouth,  and,  as  supposed,  entirely  devoid  of  life, 
are  inserted  into  artificial  sockets  made  in  the 
maxillary  bones  in  the  mouths  of  human  beings, 
and  there  remain,  become  firm,  useful,  and  to  all 
appearances  as  good  and  healthy  as  the  adjoining 
teeth  in  the  same  mouth,  there  can  be  no  doubt. 

Operations  in  the  same  direction,  such  as  the 
transplanting  of  teeth,  i.e.,  the  removal  of  a  badly 
decayed  tooth,  or  root,  and  the  placing  of  a  sound 
one,  previously  taken  from  the  mouth  of  another 
person,  into  the  socket,  and  there  held  by  ligatures 
for  a  time,  until  union  of  the  periosteum  upon  the 
root  with  the  tissues  of  the  socket  has  taken  places 
have  been  done  with  more  or  less  success,  occa- 
sionally, for  some  two  hundred  and  fifty  years, 
possibly  for  thousands  of  years  even.  However, 
the  first  published  statement  in  reference  to  it, 
that  I  am  aware  of,  is  to  be  found  in  the  work  of 
Ambroise  Par6,  published  in  1634.  He  says  : 
"  I  heard  it  reported  by  a  credible  person,  that 
he  saw  a  lady  of  the  prime  nobility,  who,  instead 
of  a  rotten  tooth  she  drew,  made  a  sound  tooth, 
drawn  from  one  of  her  waiting-maids  at  the  same 
time,  to  be  substituted  and  inserted  ;  which  tooth 
in  process  of  time,  as  it  were  taking  root,  grew 
so  firm  as  that  she  could  chaw  upon  it  as  well  as 
upon  any  of  the  rest.  But,  as  I  formerly  said,  I 
have  this  but  by  hearsay.  " 

I  say  the  operation  of  transplanting  has  occasion- 
ally been  done.  It  probably  would  have  been 
performed — and  would  be  at  the  present  time — 
more  frequently,  but  for  the  fear  many  people 
have  of  being  inoculated  with  some  dread  disease, 
should    they    have  a  tooth    taken    from   another 


person's  jaw  and  inserted  in  their  own.  I  judge, 
however,  that  a  hundred  years  ago  people  were 
less  fearful  of  such  a  catastrophe.  Judging  from 
the  every-day  manner  in  which  the  operation  is 
spoken  of,  it  would  seem  to  have  been  very 
common.  I  find  in  a  stnall  book  entitled  "  h 
Practical  Essay  on  the  Human  Teeth,  "  by  Paul 
Eurialius  Jullion,  Surgeon  Dentist,  published  in 
London  in  1781,  in  a  list  of  "his  accustomed 
charges,  "  the  following  : 

^  s.  d. 

Trans].ilantiiig  a  living  tooth 5    5  o 

Ditto    a  death  tooth  220 

In  the  "  Natural  History  of  Human  Teeth," 
by  John  Hunter;  1778,  may  be  found  a  description 
of  this  operation,  as  well  as  tliat  of  replantation. 
It  istrom  this  work  that  the  idea  of"  implantation  " 
was  fir£;t  suggested  to  Dr.  Younger.  Plunterthen 
recommended  that  a  tooth  be  replanted  when  taken 
out  through  mistake,  or  knocked  out  accidentally, 
immediately,  if  practicable  ;  if  not,  he  would 
replace  it  even  after  it  had  been  out  of  the  mouth 
twenty-four  hours,  or  "at  any  time  before  the 
socket  began  to  fill  up.  "  To  sustain  his  opinion  1 
that  a  tooth  would  become  firmly  fixed  in  its  I 
socket  again,  even  after  having  been  out  of  the 
mouth  so  long  a  time,  he  gives  his  own  experience 
in  replanting,  and  an  experiment  in  implanting  a 
freshly  extracted  tooth  into  a  cock's  comb  as 
follows  : 

"  I  took  a  sound  tooth  from  a  person's  head, 
then  made  a  pretty  deep  wound  with  a  lancet 
into  the  thick  j)art  of  a  cock's  comb,  and  pressed 
the  fang  of  the  tooth  into  this  wound,  and  fastened 
it  with  thread  passed  through  other  parts  of  the 
comb.  The  cock  was  killed  some  months  after, 
and  I  injected  the  head  with  a  very  minute  injec- 
tion ;  the  comb  was  then  taken  off  and  put  into  a 
weak  acid,  and  the  tooth  being  softened  by  this 
means,  I  slit  the  comb  and  tooth  into  two  halves, 
in  the  long  direction  of  the  tooth.  1  found  the 
vessels  of  the  tooth  well  injected,  and  also  observed 
that  the  external  surface  of  the  tooth  adhered 
everywhere  to  the  comb  by  vessels  similar  to  the 
union  of  a  tooth  with  the  gum  and  sockets.  " 

The  replantation  of  teeth,  ;'.  e.,  the  replanting 
of  teeth  removed  through  mistake  or  by  accident, 
and  the  removal  of  teeth  for  the  purpose  of 
enabling  the  operator  more  directly  to  treat  chronic 
alveolar  abscess,  or  difficult  cases  of  pyarrhea 
alveolaris,  and  replacing  them,  has  been  practised 
by  many  dentists  for  a  great  number  of  years. 
Hunter  speaks  of  replanting  teeth  removed  through 
mist.ike  or  accident,  as  though  it  was  at  that  time, 
and  had  been,  a  common  practice.  While  the 
removal  of  teeth  for  the  purj)ose  of  getting  at  and, 
treating  disease  is  a  more  modern  operation,  and, 
as  a  rule,  anything  but  satisfactory  in  its  results. 

It  was  while  reading  the  experience,  recommen- 
dation, and  experiment  above  quoted  of  Hunter 
that  the  question  suggested  itself  to  Dr.  Younger, 
that,  if  a  tooth  would  grow  fast  again  in  its  own 
socket  after  it  had  been  out  of  it  twenty-four  hours 


TUK   CANADA    MEDICAL   UECOUD. 


or  more,  and  tlial  a  freshly  cxlr.ictcd  tootli  would 
grow  fast  ill  .111  entirely  foreign  tissue  such  as  a 
cock's  comb,  why  would  it  not  grow  fast  in  an 
artificial  socket  made  in  the  maxillary  bone  of  a 
human  being?  Certainly  the  soil  ought  to  be 
better  suited  to  it  than  a  cock's  comb.  After 
considerable  reflection  upon  the  subject  he  con- 
cluded to  try  it.  This  he  did,  I  believe,  first  some 
three  or  four  years  .ago,  since  which  time  he  has 
done  the  operation  some  forty  or  fifty  times 
(perha])s  more),  and,  I  believe,  in  the  majority  of 
cases,  with   marked  success. 

The  operation  is  performed  in  the  following 
maimer :  A  tooth  for  the  place  is  first  selected, 
the  pulp-chamber  opened,  and  the  pulp  from  that 
and  the  canal  .is  perfectly  removed  as  practicable, 
and  the  canal  and  drillhole  are  filled  ;  it  is  then 
placed  into  an  antiseptic  solution  (bichloride  of 
mercury,  i  to  2,000).  A  cross  is  then  cut  through 
the  gum  to  the  bone,  at  the  point  where  the  socket 
is  to  be  m.ide  to  receive  the  tooth.  The  corners 
of  the  gum  thus  made  are  slightly  dissected  from 
the  bone,  and  a  trephine  the  size  required  is  then 
inserted  througn  the  opening  in  the  gum,  and  dri- 
ven with  the  dental  engine  to  within  about  a  fourth 
of  an  inch  of  the  depth  desired  ;  the  remainder  of 
the  socket,  owing  to  its  tapering  shape,  is  finished 
«  ith  different-sized  and  shaj^ed  buns  and  reamers. 
When  in  the  judgment  of  the  operator,  the  socket 
is  about  the  size  and  depth  to  receive  the  tooth, 
he  tries  it  in  ;  if  the  tooth  fits  as  desired  the  ope- 
ration is  proceeded  with,  if  not,  the  tooth  is 
removed  and  the  socket  enlarged  in  this  manner, 
cutting  and  fitting  until  the  tooth  stands  in  the 
.socket  in  a  correct  position.  The  tooth  is  then 
removed  and  again  placed  into  the  antiseptic. 
The  socket  is  now  washed  out  thoroughly  witli 
the  antiseptic,  and  the  tooth  placed  in  position. 
In  some  cases  it  is  necessary  to  ligate  it  to  adjoin- 
ing teeth  for  a  time ,  in  others  it  is  held  as  firmly 
as  required  by  the  impinging  walls  of  the  new 
socket.  The  gum  over  the  tooth  is  then  jiainted 
with  equal  parts  of  the  saturated  tincture  of  aco- 
nite root  and  the  tincture  of  iodine.  The  pain 
attending  the  operation  is  caused  chiefly  by  cut- 
ting through  and  dissecting  up  the  gum,  and  the 
trying  in  of  the  tooth.  This  may  readily  be  con- 
trolled by  the  ap]5lication  of  a  small  quantity  of 
muriate  of  cocaine  crystals  to  the  parts  for  a  few 
minutes,  before  the  cutting  is  done. 

I  may  add  that  different  kinds  of  instruments 
are  used  by  different  persons  for  making  the  socket, 
such  as  drills,  spear-shaped  burrs,  etc.,  but  those 
described  are  the  kind  Dr.  Younger  uses,  and  pre- 
fers to  any  others. 

The  question  which  more  particularly  interests 
lis  all,  in  connection  with  the  operation  of  implan- 
tation of  teeth,  is,  does  a  union  of  the  bone  and  the 
periosteum  upon  the  root  of  the  tooth  take  place  ? 
So  (iir  it  has  been  impossible  to  satisfactorily  settle 
this  question,  as  no  one  who  has  undergone  the 
operation  has  felt  disposed,  after  the  lapse  of  suffi- 
cient time  for   the  union   to  have  taken -place  (if 


such  be  the  case),  to  liave  the  tooth  removed  even 
for  scientific  investig.ition.  I  have  known  of  two, 
however,  which  have  been  taken  out,  one  after 
three  days  and  the  other  after  five  days  from  the 
time  they  were  inserted,  and  it  was  thought  in 
each  case  that  a  partial  union  had  taken  place. 

From  the  fact  that  many  of  the  a|)parcnily  suc- 
cessful cases  of  Dr.  Younger  and  others  have  been 
done  with  teeth  which  have  been  out  of  the  mouth 
three,  four,  six,  and  in  one  of  Dr.  Younger's  thirteen 
months,  it  would  seem  that  it  cannot  be  that  any 
growing  together  of  these  tissues  really  occurs,  but 
rather  that  the  tooth  is  mechanically  held  in  its 
new  socket.  I  will  now  ask  you,  gentlemen,  to  ex- 
amine a  case  which  I  have  here,  and  as  far  as  |)os- 
sible  satisfy  yourselves  upon  this  point.  The  case 
is  in  the  month  of  a  colored  man,  Calvan  Brooks  ; 
he  resides  in  this  city,  is  a  hard-working,  industri- 
ous man,  but  takes  not  the  best  care  of  his  teeth. 

Some  four  and  a  half  years  since,  he  had  the  right 
central  incisorof  the  upper  jaw  extracted.  After 
going  without  a  tooth  for  some  lime  he  had  a  jilate 
inserted  with  a  tooth  upon  it  (this,  I  believe,  was 
renewed  subsequently),  which  he  wore,  with  more 
or  less  discomfort,  until  October  5,  1886,  when  at 
a  clinic,  a  patient  was  wanted  for  Dr.  Younger  to 
operate  upon.  This  man  was  requested  to  submit 
to  it,  which  he  did,  and  the  operation  was  done  as 
before  described. 

No  tooth  suitable  for  the  place  being  at  hand, 
one  was  obtained  from  the  Colton  Dental  Associa- 
tion. When  presented  for  insertion  it  was  dry, 
so  much  so,  that  the  enamel  was  as  white  as  chalk, 
and  the  periosteum  upon  the  root  was  apparently 
as  lifeless  as  a  bit  of  parchment.  As  near  as 
could  be  ascertained,  it  had  been  extracted  some 
three  or  four  months  previously. 

In  examining  the  case  it  will  be  observed  that 
the  tooth  is  even  more  firmly  fixed  in  its  new 
socket  than  the  adjoining  teeth,  that  the  gum 
upon  the  labial  surface  and  between  the  teeth  i)re- 
sents  a  normally  healthy  apjiearance,  while  upon 
the  palatal  surface,  on  account  of  the  removal  of 
the  amount  of  bone  necessary  for  the  reception  of 
of  so  large  a  root,  it  has  slightly  receded.  Its 
irritated  appearance  at  that  point  is  in  a  mea- 
sure due  to  a  slight  deposit  of  tartar  upon  the 
neck  of  the  tooth.  It  will  also  be  okserved  that  a 
thickeningof  the  anterior  plate  of  bone  over  the 
tooth  has  taken  place,  an  apparent  reformation  of 
the  alveolar  ]irocess. 

This  tooth  was  not  ligated  to  adjoining  teeth, 
but  was  ]jlaced  in  position  and  allowed  to  take 
care  of  itself. 

The  instruments  I  have  here  are  Younger's, 
with  an  improvement  by  Dr.  W.  W.  Walker,  of 
this  city,  who  kindly  loaned  them  to  me  to  exhibit 
this  evening.  The  improvement  consists  in  a 
slight  tai)ering«of  the  trephine  upon  the  outside. 
This  prevents  binding  of  the  instrument  while  it  is 
being  driven  into  the  bone.  The  burrs  and  rea- 
mers I  have  been  unable  to  obtain.  In  summing 
up  the  subject,  it  would  seem  that  there  are   bm 


10 


THE   CANADA    MEDICAL   RECORD, 


two  serious  objections  wliirh  can  be  offered  to  this 
operation,  viz.,  the  pain  attending  it  and  the  dan- 
ger of  inoculation.  As  I  liave  before  stated,  the 
former  may  be  controlled,  and  it  is  believed  that 
all  danger  of  the  latter  is  effectually  removed  by 
the  use  of  antiseptics.  This  as  yet,  however,  is  an 
open  question. — N.  Y.  Medical  Review,  Ju/y<), 
1887. 

A  CLINICAL  STUDY  OF  ANTIPYRIN  AND 

ANTIFEBRIN. 

By  G.  Walter  Barr,  M.D.,  Bridgeport,  III. 

I  am  just  convalescing  from  an  attack  of  fever 
lasting  five  weeks,  during  which  I  made  a  careful 
study  of  antipyrin  and  antifebrin.  The  disease 
was  neurasthenia  complicated  with  malaria.  My 
notes  from  observations  taken  every  fifteen  minutes 
for  a  long  period  of  time  would  almost  fill  this 
journal,  and  therefore  only  generalizations  are 
given. 

The  dose  of  antipyrin  taken  was  at  first  10  gmins, 
which  was  increased  gradu.illy  to  23  grams  for  a 
person  of  nervous  temperament,  wlio  requires 
average  doses  of  other  drugs.  Toleration  of  anti- 
pyrin increases  after  a  week's  use  of  the  drug,  and 
the  dose  must  be  constantly  increased  if  it  be 
used  long. 

Ten  minutes  after  the  ingestion  of  a  dose  of 
antipyrin  in  gelatin  capsules,  an  aromatic  warmth 
is  felt  in  the  stomach  to  a  slight  degree,  and  ten 
minutes  later  a  glow  seems  to  spread  over  the 
whole  body,  and  is  followed  by  sweating  ;  and  in  a 
neurasthenic,  irritable  person,  considerable  tran- 
quillity of  mind  ensued  five  minutes  later.  This 
psychological  effect  lasted  half  an  hour. 

In  thirty-five  minutes  the  temperature  fell  i  °  F. 
The  sweating  gradually  lessened,  and  ceased  in 
two  hours  and  a  half  after  the  drug  was  taken.  In 
two  hours  from  its  ingestion  the  temperature  had 
fallen  about  3  °  F.  This  was  regardless  of  the 
temperature  when  the  antipyrin  was  taken,  which 
varied  from  loi  °  to  105  °  F.  However,  it  never 
lowered  the  temperature  below  the  norm. 

The  above  phenomeni  were  lo.ist  n'.  Almost 
constantly,  about  fifteen  minutes  after  the  dose 
was  taken,  the  breath  had  an  odor  of  ol.  carui, 
sometimes  very  strong  and  often  more  faint.  This 
lasted  for  about  an  hour. 

The  fever  invariably  began  to  rise  in  two  and  a 
half  hours  after  the  dose  of  antijiyrin  was  taken, 
and  the  antipyretic  effect  was  certainly  only  trans- 
itory. The  after-effect  was  a  general,  indesciibable 
feeling  of  greater  ina/aise.  The  only  effect  on 
the  pulse  was  its  slowing,  but  the  pulse  was  affec- 
ted in  great  disproportion  to  t!ie  temperature, 
and  became,  on  a  basis  of  temperature,  abnormally 
high,  though  absolutely  lower.  There  was  little 
or  no  change  in  the  anioiint  and  grogs^  appearance 
d}"  the  mine, 

Antifebrin  >yas  i|se4  aftjjr  antipyrin  vvas  begun, 
^nd  at  the  same  time  alternately  will)  the  latter, 
fhe  dose  ranged  from  5  grains  to  13  grjiiiis,    A 


tolerance  was  established  to  it.  A  number  of 
time-s  the  same  caraway  odor  on  the  breath  was 
perceived,  causing  very  interesting  speculations  as 
to  the  resultant  of  the  corporeal  chemistry  upon 
both  antipyrin  and  antifebrin.  The  aromatic,  stom- 
achic sensation  was  very  seldom  felt,  the  bodily 
glow  and  perspiration  being  generally  the  first 
effects  noticed  from  antifebrin  when  the  caraway 
breath  is  absent. 

Antifebrin  causes  a  tall  of  temperature  in  an 
hour  or  an  hour  and  a  half  after  its  ingestion  in 
gelatin  capsules.  The  fall  from  one  dose  is  about 
4°  F.,  though  the  norm  was  never  passed  in  its 
downward  tendency,  'i'he  decline  was  maintained 
for  an  average  of  six  hours,  after  which  the  tem- 
perature began  to  rise  again.  It  has  no  permanent 
effect  on  the  fever  if  its  constant  use  for  several 
weeks  is  a  criterion.  It  gently  stimulated  the 
mind  and  affected  the  muscular  system  almost 
precisely  like  coca.  I  was  several  times  as  strong 
while  imder  the  influence  of  antifebrin  as  at  other 
times,  and  iiitellei  tual  indolence  gave  way  to  more 
energy.  The  tonicity  of  the  pulse  was  mcreased 
and  the  rate  slowed.  Its  effect  on  the  pulse 
resembles  that  of  convallaria  majalis,  Antifebrin 
is  decidedly  diuretic  and  less  diaphoretic  than 
antipyrin.  There  were  no  after-effects,  not  even 
the  dejiression  to  be  expected  after  the  stimulation 
it  produced.  Once  the  dose  of  antifebrin  had  not 
the  slightest  physiological  effect.  The  conditions 
were  exactly  the  same  as  at  other  times,  as  near  as 
I  could  discover,  after  very  careful  examination. 
An  ordinary  dose  of  antipyrin  immediately  acted 
as  usual,  and  antifebrin  afterwards  did  well. 
Perhaps  some  internal  conditions  hardened  the 
capsule.  Every  dose  of  both  drugs  was  taken  in 
an  empty  stomach.  My  curiosity  led  me  to  wish 
for  another  failure  that  I  might  try  another  dose 
ofantifebrin.  but  the  opportunity  never  came.  To 
sum  up, — 

ANTIPYRIN.  ANTIFEBRIN. 

Lowers    temperature  in   In  an  hour  or  more. 

half  an  hour. 
Effect  lasts  two  hours.       Effect  lasts  six  hours. 
More  diaphoretic.  More  diuretic. 

Depressing  after-effects.   No  after-effects. 
Cerebral  sedative.  Cerebral  vaso-motor  and 

muscular  (?)  stimulant. 
Dose,  15  to  30  grains.       Dose,  5  to  15  grains. 
Tolerance  from  continu-  Ditto. 

ed  use. 

The  above  table  will  suggest  the  selective  use 
of  the  two  drugs.  From  the  patient's  ]ioint  of 
view  (which  is  really  coincident  with  the  physi- 
cian's), antifebrin  is  much  to  be  preferred  in 
continued  fevers,  because  the  dose  is  one  small 
capsule  instead  of  three  ;  the  effect  lasting  so 
long  requires  one-third  the  number  of  doses  ;  the 
tonic  stimulation  excels  the  depression  and  after 
ma/a  i  if,  and  the  cost  is  one  fourth  that  of  antipyrin. 
The  antipyretic  action  ofantifebrin  is  as  strong  or 
stronger  tlun  that  of  antipyrin,  and  its  only  objeo 


I 


tftfi  dANADA  MEDICAL  RECORD. 


11 


tion  is  its  slowness  of  aclioii.  In  isolnlioiv,  and 
otlier  cases,  where  a  (iiiickly  acting  antip^'ielic  is 
necessary,  and  wlien  it  lias  a  siiecific  action  on 
pathology  of  a  disease,  as  is  claimed  in  rheumatism, 
antipyrm  is  to  he  preferred.  Whenever  one  can 
wait  an  honr  for  the  antipyretic  action  to  begin,  1 
greatly  |)refer  antil'ebrin,  and  1  know  the  jiatient 
also.  1  believe  its  stimnlaiit  or  tonic  effect  to  be 
very  valuable  in  weak  patients. 


THE  THERAPEUTICAL  VALUE  OF 
BLOODLETTING. 

But  a  few  years  ago  it  was  customary  to  bleed  too 
frequently,  and  almost  every  morbid  condition  was 
ihought  to  demand  bloodletting.  Practically,  we 
never  resort  to  the  measure  now,  perhaps  because 
we  do  not  consider  to  their  fulle.vtent  the  advan- 
tages to  be  derived  from  it.  From  one  excess  we 
have  fallen  into  the  oiher.  The  disciples  of  the 
lancet  bled  according  to  a  system  ;  it  was  a  formula. 
Their  adversaries  abstained  by  convention,  not 
always  by  conviction  ;  that,  too,  was  a  formula. 
There  was  error  on  either  side.  Therapeutical 
truth  does  not  lie  in  a  mere  formula  ;  it  is  to  be 
found  in  facts  proved  clinically  and  e.\perui>entally, 
not  in  mere  systems.  It  is  in  some  such  strain 
as  this  that  ^I.  Eloy  calls  attention,  in  a  recent 
number  of  the  "  Gazette  lu-biiomadaiie  de  medeciue 
et  de  chirurgie^'  to  an  unporiant  essay  present- 
ed to  the  Belgian  Academy  by  M.  Fredericq,  of 
Liege.  The  essay  is  a  compendious  summary  of 
our  knowledge  of  the  physiological  action  of  blood- 
letting, and  embraces  an  attempt  to  establish  defi- 
nitely all  the  indications  and  contra-indications  of 
this  powerful  therapeutical  agent.  Incomplete  as 
it  is,  and  as  all  such  eflbrts  must  ever  be,  it  never- 
theless abounds  in  proofs  that  we  ought  to  throw 
aside  the  prejudice  occasioned  by  the  abuse  of 
bloodletting  in  the  past,  and  once  more  avail  our- 
selves of  a  measure  capable  of  rendering  s^ich 
valuable  aid.  What  there  is  still  to  condemn,  in 
spite  of  the  efforts  made  at  times  to  re-establish  it, 
is  the  bleeding  in  hemorrhagic  [iroportions  resort- 
ed to  by  those  enthusiasts  who  have  been  styled 
ironically  "  the  great  bleeders  of  past  times.  " 

As  was  said  by  Marshall  Hall  and  some  of  his 
contemporaries,  bleeding  modifies  more  or  less  last- 
ingly the  respiration,  the  temperature,  and  the 
circulation,  and  affects  the  nutritive  changes  still 
more  profoundly.  The  relaxation  of  the  respiratory 
movements  that  occurs  on  opening  a  vein  has  been 
accounted  for  in  many  different  ways.  A  haemorr- 
hage, provided  it  is  not  excessive,  does  not  notably 
diminish  the  quantity  of  blood  in  either  the  general 
or  the  pulmonary  circulation, the  withdrawal  of  from 
half  a  pint  to  a  pint. causing  on  an  average  the  loss  of 
from  one  two-hundred-and-fortieth  to  one  one-hun- 
dred-and-twentieth  of  the  weight  of  the  body.  It 
does,  however,  change  the  functional  relation  be- 
tween the  lungs  and  the  heart,  as  has  been  proved 
by  the  elaborate  researches  of  Embrodt  and  more 
recently  those  of  Fredericq.     The  last-named  ob- 


server has  shown  that  a  fall  of  pressure  amounting 
to  the  relation  of  i  to  2,  or  even  i  to  3,  takes  place 
after  a  loss  of  blood  hardly  etpiivalent  to  one  one- 
hundredth  of  the  weight  of  theaniiiiil  :  .ind  .\rloing 
and  \'inay  have  not  only  confirmed  tins,  but  have 
proved  in  addition  the  permanence  of  the  effect,  as 
shown  by  the  persistence  of  this  lowered  tension 
after  the  closure  of  the  vessel. 

As  regards  the  influence  of  bloodletting  on  the 
temperature,  putting  aside  the  incontestable  tact 
that  great  hitnionhages  produce  a  very  considerable 
lessening  of  the  lieat  of  the  body,  we  have  Heiden- 
hain's  demonsiKition  that  the  fall  and  rise  of  the 
therraometnc  c(-4iimn  are  synchronous  with  the 
corresponding  changes  in  the  meicuiy  of  the 
haemodynamomeier.  .\  plausible  deduction  from 
this  would  be  that  bloodletting  is  justifiable  in 
sthenic  inflammations  attended  with  hyijerpyrexia, 
but  a  little  reflection  will  show  that  it  is  not  a  de- 
duction fully  borne  out.  What  we  have  most  to 
fear  from  fever  is  its  pernicious  effect  on  nutrition, 
but  bleeding  also  deprives  the  body  of  its  tissue- 
forming  elements  ;  hence  the  ultimate  results  of 
both  are  the  same.  As  has  been  said  by  Lorain, 
the  fall  of  temperature  following  hsemoirhageis  only 
tempoiary  ;  it  is  a  mere  peripheral  cooling.  A 
remedy  truly  worthy  to  be  called  antipyretic,  how- 
ever, should  be  capable  of  affecting  the  heat-pro- 
ducing function,  not  merely  axillary,  vaginal,  rectal, 
or  buccal  temperature — since  the  danger  of  the 
hyperjiyrexia  does  not  lie  so  much  in  the  high 
temperature /tv  j'f  as  in  the  nutritive  changes  of 
which  it  is  merely  the  outward  expression. 

Bleeding. modifies  respiration.  Is  it  indicated 
in  pulmonary  affections  ?  Depletive  bleeding 
should,  according  to  the  theory  of  those  who  employ 
it,  diminish  the  initial  hyperaamia  of  inflammation 
of  the  lungs  by  enabling  the  pulmonary  to  profit  by 
a  lessening  of  the  general  circulation — a  bald  hope, 
in  the  face  of  the  fact,  experimentally  proved,  that 
bleeding,  within  therapeutic  limits,  does  not  sensibly 
lessen  the  quantity  of  the  blood.  On  this  assump- 
tion, nevertheless,  rests  M.  Bucquoy's  recommen- 
dation to  bleed  in  the  initial  stage  of  pericarditis, 
accompanied  by  grave  phenomena — always,  how- 
ever, on  the  condition  ofitseaily  employment  in 
sufficient  abundance,  the  fact  being  at  the  same 
time  borne  in  mind  of  the  danger  incurred  by  the 
irherent  feebleness  of  the  cardiac  muscle  in  this 
disease.  On  the  same  ground,  too,  M.  Peter 
advises  bleeding  in  cerebral  congestion  in  robust 
and  vigorous  individuals,  and  M.  Bouveret  insists 
on  the  good  results  to  be  obtained  by  bleeding  in 
capillarybronchitisandin  emphysema.  If  we  take 
this  view,  we  can  readily  appreciate  the  value  of 
bloodletting  in  the  treatment  of  cardiac  affections; 
indeed,  the  results  obtained  with  it  by  some  modern 
clinicians,  such  as  Bucquoy,  Jaccoud,  Peter,  Henri 
Huchard,  and  others,  have  at  times  resembled  re- 
surrections. In  cardiac  affections  accompanied 
by  extreme  feebleness  of  the  heart's  action,  blood- 
letting enables  us  to  relieve  the  organ  of  a  surcharge 
of  blood  e.xceeding  its  motive  power.     It  is  thus, 


12 


THE   CANADA   MEDICAL   RECORD. 


as  lias  been  shown  by  Hucliard,  in  the  "  Union 
A/hiiai/c,  "  that  digitalis  finds  its  full  action  when 
its  administration  has  been  preceded  by  copious 
bleeding ;  the  aim  being  to  diminish  the  resistance 
of  the  peripheral  portion  of  the  circulatory  appa- 
ratus and  the  embarrassment  of  the  right  heart.  It 
re-establishes  the  equilibrium  between  the  motive 
power  and  the  mass  to  be  moved.  The  therapeu- 
tic action  of  the  heart  tonics  consists  in  augmenting 
the  contractile  force  of  the  heart,  and  in  reducing 
the  volume  of  the  blood  by  setting  up  diuresis. 
Drastics  accomplish  the  latter  part  by  increasing 
the  intestinal  secretions  ;  bloodletting  does  it  in  a 
more  direct  way.  Its  employment  is  tlierefore 
rational  in  the  treatment  of  cardiac  affections, 
accompanied  by  insufficient  contractions  of  the 
heart  ;  and,  according  to  Bucquoy,  it  is  never  in  this 
way  the  cause  of  ansemia  or  irremediable  cachexia. 

What  are  the  indications  for  bloodletting  in  over- 
action  of  the  heart?  In  ilvjse  cases,  the  heart's 
action  surpasses  its  aim ;  the  vascular  pressure  is 
augmented,  and  the  patient  is  in  danger  of  conges- 
tion, cerebral  or  imlmonary.  The  indications  are 
tore-establish  the  circulatory  equiijoise.  A  vein 
is  opened,  and  thesysteius  are  mitigated,  to  return 
after  the  renewed  filling  of  the  vessels  by  interstitial 
absorption.  Shall  we  lepeat  the  bleeding?  Yes, 
if  the  general  nutrition  iiermits,and  if  other  remedies 
fail.  There  is  another  class  ofcas-es — aflectionsof 
the  aorta,  including  aortitis  and  aneurysm — in 
which  excessive  vascular  tension  plays  a  part. 
Here  conservatism  is  demanded,  but  there  is  no 
particular  stage  when  the  measure  is  specially  a])pli- 
cable. 

To  sum  up  :  Bloodletting  should  not  fall  into 
utter  disuse.  Weighty  accusations  have  been 
brought  against  it,  but  let  us  allow  only  what  is 
confirmed  by  modern  scientific  research — namely, 
its  powerlessness  in  inflammations  and  in  fevers, 
its  dangers  in  chronic  affections,  and  the  obscure 
role  it  plays  in  neuroses  and  in  eclampsia  ;  while 
physiology,  in  spite  of  its  gaps,  teaches  the  thera- 
peutist that  the  blood  is  always  being  renewed,  that 
the  stability  of  the  circulation  is  not  hindered  by  a 
moderate  bloodletting,  and  that  although  a  powerful 
modifier  of  the  circulatory  equilibrium,  this  agent 
has  no  other  dangers  than  those  that  arise  from  its 
over-abundant  employment,its  excessive  repetition, 
and  its  inopportune  use.  Physiology  teaches  us 
also  that  philosophy  of  this  theraiieutical  measure, 
around  which  too  much  majesty  and  solenuiity  have 
gathered,  is  found  not  in  systems,  but  in  modest 
language,  "  Use,  do  not  abuse  1  " — JV.  V.  Medical 
Journal. 


THE  PROPER  EMPLOYMENT  OF  PREPA- 
RED FOODS  FOR  INFANTS. 
By  Victor  C.    Yaughan,  M.D.,  Ph.  D., 

Professor    uf  Physiologial    Chemistry    in  the  University  o 
Michigan.  f 

The  feeding  of  infants,  which  for  any  reason  are 
denied  the  mother's  breast,  has  been,  and  continues 


to  be,  a  question  of  great  interest.  Even  the  matter 
of  the  selection  of  a  wet-nurse,  where  both  money 
and  opportunity  are  abundant,  is  one  of  the  greatest 
importance,  and,  as  all  know,  this  method  of  secu- 
ring nourishment  for  the  jchild  is  not  free  from 
danger.  First,  there  is  often  the  dread  that  the 
nurse  will  convey  to  the  child  some  constitutional 
disease.  Then  the  nurse  can  hardly  be  expected 
to  have  that  watchful  solicitude  for  the  child's 
health  which  is  the  peculiar  characteristic  of  its 
own  mother;  and  the  most  trusted  servants  have 
been  found  quieting  the  baby  with  opiates,  and 
even  narcotizing  it  with  alcohol.  Again,  the  nurse 
who  offers  herself  only  on  account  of  the  demands 
of  poverty  must  often  leave  her  own  child  to  be 
fed  artificially,  and  the  question  of  the  importance 
of  infant  feeding  is  only  transferred  in  its  applica- 
tion from  the  child  of  the  mistress  to  that  of  the 
servant.  Lastly,  in  a  large  number  of  cases,  from 
want  of  a  wet-nurse,  obtainable  at  any  price,  or 
from  want  of  money,  the  child  must  be  fed  artifi- 
cially. 

When  the  artificial  feeding  becomes  necessary, 
of  what  shall  the  food  consist  ?  In  this  country,  at 
least,  we  cannot  obtain  the  milk  of  the  ass  or  even 
that  of  the  goat,  in  quantities  sufficient  to  be  used 
by  many.  I  think  that  all  will  agree  that  cow's 
milk  must  continue  to  be  the  chief  .source  of  nour- 
ishment for  children,  and  in  a  recent  article  in  this 
journal.  I  endeavored  to  formulate  certain  rules  for 
the  better  care  of  milk.  As  soon  as  the  consumer 
demands  it,  the  dealer  in  milk  will  conform  to  those 
or  similar  rules.  The  result  of  the  application  of 
the  rule  will  not  be  to  injure  the  trade  of  the 
dairyman  ;  but  the  reverse  will  be  true,  inasmuch  as 
his  milk  will  be  greatly  improved  in  quality,  and  will 
command  a  better  price. 

In  the  article  referred  to  I  urged  that  no  milk 
should  be  given  to  the  child  sick  with  cholera  in- 
fantum or  other  summer  diarrhoeas.  This  prohibi- 
tion apijlies  to  all  prepared  foods  containing  milk  or 
to  which  milk  must  be  added.  Recently  I  obtained 
all  the  infant  foods  1  could  find  in  the  market,  pre- 
pared them  according  to  the  directions  accompany- 
ing them,  placed  them  in  four-ounce  bottles,  making 
a  duplicate  test  for  each  food,  added  some  of  the 
ferment  which  1  had  found  would  produce  tyrotoxi- 
coii  in  milk,  and  kept  the  tightly  stoppered  bottles 
at  a  temperature  of  38  ^'  C.  for  six  hours,  then  tested 
the  contents  of  each  bottle  for  the  poison,  and  found 
it  present  in  eveiy  one  of  them.  It  should  be  clearly 
understood  here  that  the  poisonous  ferment  was 
added  to  the  foods. 

This  experiment  fulfills  the  conditions  wln'ch  would 
exist  were  a  child  sick  with  cholera  infantum  to  be 
fed  with  one  of  these  foods  ;  provided  always,  of 
course,  that  my  theory  as  to  causation  of  this  and 
kindred  diseases  in  children  is  true.  Some  prepara- 
tions of  peptonoids  and  peptones, treated  in  the  same 
manner  as  the  infant  foods,  failed  to  develop  the 
poison,  at  least,  in  quantities  sufficient  to  be  recog- 
nized by  any  chemical  test.  I  may  add  here,  that 
a  similar  experiment  was  made  with  milk  which  had 


ttlE   CANADA   MEDICAL  RECORD. 


1  o 

10 


been  boiled,  and  in  this  also  the  poison  was  de- 
vel<>i)cd.  Jiiit  in  the  boiled  milk  to  which  no  fer- 
ment was  adtled,  as  well  as  in  the  unboiled  milk,  to 
which  no  fernienl  was  added,  the  poison  did  not  ap- 
pear, at  least  within  the  six  hours. 

Now,  from  these  e.viJeriments,  I  con(  hide  that 
foods  ])re[wred  from  milk,  or  to  which  milk  be 
added,  are  nut  suitable  for  children  who  are  sufkr- 
iiig  from  the  summer  diarrhceas.  Just  why  the 
poison  should  a|)|K-ar  in  ihc  milk  preparations  and 
not  in  the  peptonoids,  I  cannot  say.  There  are  seve- 
ral possible  expl.nnations.  'I'he  growth  of  the  germ 
may  simi)|y  be  more  rapid  in  one  than  in  the 
other,  and  the  difference  in  the  develojjnient  may 
be  only  one  of  time  ;  but  a  difference  of  this  kind 
is  sufficient  for  all  practical  purposes. 

Then  have  the  prepared  milk  foods  no  legitimate 
use.^  I  think  they  have,  and  desire  to  point  out 
what  I  consider  to  be  their  pro])er  employment. 

Even  under  the  most  favoraljle  conditions,  milk 
can  be  kept  michanged  only  for  a  short,  time  in 
summer.  There  is  the  same  reason  for  the  drying 
of  milk  and  the  preservation  of  its  solids  that  there 
is  for  the  curing  of  meat  or  the  canning  of  fruit. 
The  dried  milk  solids  may  be  transported  any  dis- 
tance and  ke]it  for  any  reasonable  length  of  time,  if 
properly  prepared,  without  undergoing  [lutrefactive 
changes.  But  the)'  are  to  be  used  with  children 
free  from  the  summer  diarrhoeas  rather  than  with 
those  suffering  from  those  complaints.  Where  the 
source  of  the  milk  sn|)ply  is  doubtful,  a  properly 
prepared  milk  food  would  be  much  more  reliable 
than  the  raw  milk.  Besides,  with  any  dilution  or 
addition  that  may  be  made,  cow's  milk  cannot  be 
rendered  identical  with  the  milk  of  woman. 

Can  the  milk  of  the  cow  be  rendered  more 
nearly  identical  with  that  of  woman  than  it  is  by 
the  simple  dilution  with  water  and  the  addition  of 
milk  sugar?  All  chemists,  I  think,  agree  that 
woman's  inilk  contains  more  peptone  than  does 
the  milk  of  the  cow.  Kirchner,  who  has  given 
much  attention  to  this  subject,  and  has  experimen- 
ted largely,  believes  that  the  difference  in  the 
digestibility  of  milk  from  the  cow  and  that  from 
woman  is  wholly  due  to  the  larger  amount  of  pep- 
tone in  the  latter.  I  cannot  see,  therefore,  why 
the  casein  of  the  cow's  milk  should  not  be  partially 
digested.  That  it  should  not  be  completely 
digested,  I  think  there  can  be  no  question.  It  is 
certainly  unscientific  to  feed  any  one  for  any 
length  of  time  upon  peptones  altogether  ;  especially 
is  this  true  of  children.  To  relieve  the  gastric 
juice  altogether  is  to  diminish  its  secretion.  The 
muscle  of  the  arm,  the  brain,  and,  indeed,  every 
part  of  the  body,  is  weakened  by  inactivity.  The 
stomach  can  be  no  exception  to  this  ride.  It 
must  have  something  to  do,  or  will  soon  be  un- 
able to  do  anything.  There  may  be,  and  doubt- 
lessly are,  exceptional  cases,  in  which  the  tempo- 
rary administration  of  peptones  exclusively  is 
desirable.  But  these  are  exceptional  cases,  and 
the  administration  of  the  completely  digested 
food  should  be  only  temporary.     Certainly  these 


cases  do  not  include  healthy  children.  For  these 
reasons  I  generally  ])refer  the  partially  digested 
meat  preparations  to  the  peptones. 

If  this  be  true,  will  it  not  be  sufficient  for  the 
nurse  to  digest  partially  die  cow's  milk  as  it  is  fed 
to  the  child?  'I'heie  are  these  objections  lo  giving 
advice  of  this  kind.  If  the  source  of  the  milk  is 
doubtful,  or  if  it  has  become  contaminateil  by 
unclean  vessels,  or  if  putrefactive  changes  have 
already  begun  in  it,  the  process  of  artificial  diges- 
tion will  not  destroy  the  poisonous  ferment. 
Indeed,  the  temperature  at  which  the  milk  is  kept 
during  the  artiticial  digestion  will  only  favor  the 
development  of  the  poison.  We  have  Dr.  Holt's 
evidence  that  the  use  of  peptonized  milk  is  not  lo 
be  recomn.e  ided  in  summer  diarrhteas.  The 
artificial  dige-.tion,  as  carried  out  by  the  nurse,  is 
not  likely  to  be  scieniilii  ally  done,  it  will  prob- 
ably be  neglected  or  auiount  to  only  a  form,  or  it 
may  be  overdone,  and  the  taste  of  the  milk  spoil- 
ed, and  too  great  a  pDportion  of  the  casein  con- 
verted into  peptone.  If  partial  artificial  digestion 
is  to  be  practised  at  all,  and  I  see  no  reason 
why  it  should  not  be,  it  should  be  done  under 
competent  direction,  and  when  the  milk  is  per- 
fectly fresh. 

Let  us  see  what  some  of  the  most  imjjortant 
properties  of  this  prepared  milk  food  should  be.  It 
should  not  contain  any  vegetable  matter  which  is 
difficult  of  digestion. 

This  prepared  milk  food  should  be  sufficiently 
nutritious  in  itself,  and,  consequently,  should  not 
require  the  addition  of  milk.  In  the  use  of  all 
those  prepared  food.s,  to  which  the  addition  of  milk 
is  necessary,  the  same  danger  of  introducing  the 
poisonous  ferment  into  the  alimentary  canal  e-xists 
as  in  the  use  of  the  raw  milk.  Many  of  the  prepa- 
red foods  contain  such  small  amounts  of  proteids 
that  the  addition  of  milk  becomes  necessary.  They 
should  contain  a  larger  per  cent,  of  milk  solids,  ob- 
tained by  the  evaporation  of  milk  in  vacuo. 

Attention  should  be  given  to  the  amount  of  in- 
organic salts,  especially  of  lime  and  phosphoric 
acid,  in  a  prepared  food.  A  proper  amount  of 
these  substances  is  as  necessary  to  the  health  and 
growth  of  the  child  as  are  fats,  proteids,  and  carbo- 
liydrates. 

The  carbohydrates  present  in  such  a  food  should 
not  be  in  the  form  of  grape-sugar,  but  as  milk 
sugar  and  dextrine.  The  grape-sugar  is  not  sui)po- 
sed  to  have  any  specially  injurious  or  poisonous  pro- 
perties ;  but  it  ferments  too  rajjidly,  and  for  this 
reason  is  objectionable.  By  roasting  wheat  flour 
its  starch  is  converted  into  dextrine,  and  this 
roasted  flour  mixed  with  milk  solids,  obtained  by 
tlie  evajioration  of  milk  in  vacuo,  forms  a  Ibod 
sufficiently  nutritious,  and  one  which  may  be  kept 
indefinitely  without  putrefactive  changes  occurring 
i.i  it. 

Prof.  J.  Lewis  Smith,  in  his  excellent  work  on 
Diseases  of  Infancy  and  Childhood^  speaks  well 
of  the  roasted  tiour  ;  and  this,  added  to  milk  solids, 
makes  the  best  infant  food  known  to  the  wrihet. 


14 


^ki:  CJANAi)A  MEDICAL   RECORD. 


THE   TREATMENT  OF  VARICOSE  VEINS 
OF  THE  LP:G. 

Ordinarily,  jiersons  afflicted  widi  varicose  veins 
of  tiie  leg  expect  nolliing  more  than  some  amelio- 
ration of  their  condition,  or  some  means  of  get- 
ting along  with  it.  The  trouble  is  regarded  as  incu- 
rable, just  as  a  hernia  would  be.  For  a  hernia  a 
truss  is  worn,  and  for  varicose  veins  an  elastic 
stocking  is  generally  used.  In  many  cases  noth- 
ing whatever  is  done  for  varicosities  of  the  leg,  and 
the  sufferer  has  to  bear  the  distress,  and  run  the 
risks  of  his  condition  as  best  he  cin. 

If  the  veins  are  not  very  much  enlarged,  this 
may  not  be  an  unwise  plan,  lint  in  a  case  in 
which  the  varicosity  is  very  ijronounced,  the  risks 
are  too  great  to  warrant  letting  the  veins  alone. 
The  risk  of  ulceration,  of  rupture  and  hemorrhage, 
of  phlebitis,  of  extension  of  the  v.;ricose  condition, 
is  so  great  'hat  something  ought  to  be  done. 

This  something  should  consist  in  the  adoption  of 
proper  medicinal,  mechanical,  or  surgical  treat- 
ment. Under  the  head  of  medicinal  treatment 
may  be  clashed  the  use  of  general  tonics,  the  relief 
of  constipation,  and  the  employment  of  drugs, 
which  act  upon  the  walls  of  tlic  veins  Of  these, 
none  now  enjoys  a  better  reputation  than  hama- 
melis,  strongly  recommended  to  the  profession  for 
this  purpose  by  Dr.  J.  H.  Musser  a  few  years  ago. 
It  can  be  given  in  teaspoonful  doses  of  the  fluid 
extract  three  or  four  times  a  day. 

Mechanical  treatment  consists  in  the  use  of  a 
well-fitting  elastic  stocking,  which  should  extend 
from  the  heel  to  a  point  well  above  the  highest 
dilatation,  or  of  a  carefully  applied  b.indage.  Ma:- 
tin's  ruljber  bandage  serves  a  good  purpose,  if  well 
put  on  and  if  kept  clean.  It  usually  produces  free 
sweating,  but  the  discomforts  of  sweating  can  be 
much  lessened  by  putting  the  bandage  on  over  a 
clean  white  cotton  stocking. 

Surgical  treatment  of  varicose  veins  consists  in 
injectmg  them  with  some  coagulating  substance, 
in  ligating  them,  or  in  excising  a  portion  of  them. 

If  injection  be  selected,  it  is  best  performed  as 
follows :  The  circulation  is  controlled  with  an 
Esmarch's  rubber  tube,  applied  round  the  leg 
above  the  point  where  the  injection  is  to  be  inser- 
ted, while  the  patient  is  standing  up.  At  first  only 
a  few  turns  should  be  put  on,  in  order  to  fill  the 
veins  u|i,  and  then  the  tube  should  be  wrapped 
tight  enough  to  cut  oft  all  the  circulation.  Then  a 
single  drop  of  pure  carbolic  acid  should  be  injected 
into  the  veins  at  several  points  about  an  inch  apart, 
and  the  site  of  each  puncture  should  be  touched 
with  collodion  and  covered  with  a  little  cotton  and 
collodion. 

I'he  Esmarch's  tube  should  be  left  in  position 
for  fifteen  nunutes,  and  then  be  gradually  removed, 
so  as  to  avoid  the  risk  of  having  an  embolus  swept 
into  the  heart.  After  the  operation,  the  patient 
should  keep  his  bed  for  at  least  a  week. 

The  operation  of  ligation  of  varicose  veins  of  the 
leg  is  best  performed  by  distending  them  fully,  and 


then  slip])ing  a  strong  cat-gut  thread  carefully  un- 
der them  and  over  them — passing  in  and  out  at 
the  same  oiienings  on  each  side — just  as  is  done  in 
ligating  varicose  veins  in  the  scrotimi. 

The  operation  of  excision  is  the  most  radical 
and  the  most  curative  of  all.  To  perform  this 
operation,  it  is  necessary  to  distend  the  veins  with 
a  bandage,  to  make  a  clean  cut  down  upon  them, 
and  to  pass  a  strong  catgut  ligature  around  the 
lowest  point.  The  vein  must  then  be  seized  above 
the  ligature  with  a  strong  pair  of  forceps,  and  lifted 
up  and  cut  oft"  below  the  forceps.  It  is  then  strip- 
ped up,  each  radicle  met  with  being  ligated  and 
divided,  until  several  inches  are  clear,  when  the 
main  vein  is  to  be  ligated  at  the  highest  accessible 
point,  and  cut  off  below  the  ligature.  The  wound 
should  be  treated  aseptically,  closed  up,  and 
covered  with  an  aseptic  dressing. 

Several  veins  may  be  operated  upon  in  this  way 
at  one  time,  and  even  both  legs  may  be  operated 
upon  at  once.  After  the  operation  the  patient's 
leg,  or  legs,  should  be  bandaged,  and  he  should 
be  confined  to  bed  for  eight  or  ten  days. 

This  operation  we  can  recommend  to  our  readers, 
if  it  be  performed  with  care  and  with  correct  asep- 
tic precautions.  By  this  we  do  not  mean  listerism, 
but  the  improved  aseptic  method  of  the  present 
day — Fhiladel/ihia  Medical  and  Surgical  Repor- 
ter. 


THE  INFLUENCE  OF  TEA,  COFFEE  AND 
COCOA    ON  DIGESTION.* 

Dr.  James  W.  Fraser,  in  a  recent  number  of  the 
Journal  of  Anatomy  and  Fhysio/oxy,  has 
recorded  the  results  of  an  interesting  series 
of  experiments  on  the  action  of  our  common 
beverages  on  stomachic  and  intestinal  digestion. 
His  observations  will,  in  the  main,  agree  with  that 
which  is  now  given  by  our  best  authorities  in  cases 
of  dyspepsia  ;  and  we  are  glad  that  experimental 
inquiries  aflbrd  so  strong  a  basis  of  support  to 
empirical  din  cal  o'jservations  ; — 

I.  That  it  is  better  not  to  eat  most  albuminoid 
food  stuffs  at  the  same  time  as  infused  beverages 
are  taken,  for  it  has  been  shown  that  their  diges- 
tion will  in  mo^t  cases  be  retarded,  though  there 
are  possibly  exceptions.  Absorption  may  be  ren- 
dered more  rapid,  but  there  is  a  loss  of  nutritive 
substance.  On  the  other  hand,  the  digestion  of  |! 
starchy  food  appears  to  be  assisted  by  tea  and 
coffee;  and  gluten,  the  albuminoid  of  flour,  has 
been  seen  to  be  the  principle  least  retarded  in 
digestion  by  tea,  and  it  only  comes  third  with 
cocoa,  while  coffee  has  apparentlya  much  greater 
retarding  action  on  it.  From  this  it  appears 
that  bread  is  the  natural  accompaniment  of  tea  and 
cocoa  when  used  as  the  beverages  at  a  meal. 
Perhaps  the  action  of  coffee  is  the  reason  why,  in 
this  countrv,  it  is  usually  drank  alone  or  at  break- 
fast, a  meal  which  consists  much  of  meat,  and  of 


*  London  Lancet,  May,  18S7. 


THE   CANADA    MKDICAL   RECORD. 


15 


meats  ("eggs  and  salt  meats)  which  are  not  much 
retarded  in  digestion  by  coffee.  2.  That  egus  are 
the  best  form  of  animal  food  to  lie  taken  along 
with  infused  beverages,  and  that  apparently  they 
are  best  lightly  boiled  if  te.i,  iiard  boiled  if  coffee 
or  cocoa,  is  tlie  beverage.  3.  'i'h.it  the  casein  of 
the  milk  and  cream  taken  with  the  beverages  is 
])robal)le  absorbed  in  a  large  degree  from  the 
stomach.  4.  That  the  l)iitter  used  with  bread 
undergoes  digestion  more  slowly  in  presence  of 
tea,  bill  more  quickly  in  presence  of  coffee  or 
cocoa;  that  is,  if  the  fats  of  butter  are  influenced 
in  a  similar  way  to  oleine.  5.  That  the  use  of 
coffee  or  cocoa  as  excipients  for  cod  liver  oil,  etc., 
ajipears  not  only  to  dejiend  on  their  juonounced 
J  tastes,  but  also  on  their  action  in  assisting  the 
digestion  of  fats. 


THE 


USE  OF  IXDIGO  AS  AN 
GOGUE. 


EMMEN.V 


i 


Dr.  S.  T.  YouxT,  of  La  Fayette,  Ind.,  in  a 
paper  read  before  the  Tippecanoe  County  Medical 
Society,  recommends  very  highly  the  employment 
of  indigo  as  an  emmenagogue.  He  writes:  "  It  is 
perfectly  safe,  thorovighly  reliable,  and  painless  in 
its  action.  It  is  insoluble  in  water  oralcoiiol,  but 
readily  dissolves  in  strong  sulphuric  acid.  This 
so  changes  its  character  that  it  is  then  readily 
soluble  in  water  without  changing  its  color. 

"  It  is  odorless  and  tasteless,  and  maybe  given 
in  doses  of  J  j.  to  3  ss.  The  great  difficulty  is 
tl  e  nausea  and  vomiting  which  the  crude  drug 
produces  when  given  in  very  large  doses.  There 
are  three  varieties  of  the  crude  drug :  Bengal, 
Turkey,  and  Chinese. 

"  The  Bengal  is  richest  in  coloring  matter,  con- 
taining about  fifty  per  cent.,  and  inasmuch  as  the 
virtue  resides  in  the  coloring  matter,  the  best 
effects  are  obtained  from  this  variety.  As  an  em- 
menagogue it  has  been  used  in  my  practice  about 
a  year  and  a  half.  My  attention  was  first  directed 
to  it  on  one  occasion  when  I  was  called  to  remove 
a  retained  placenta  in  a  case  of  abortion  at  the 
third  month.  Naturally  inquiring  what  had  been 
taken  to  prtdu  e  the  abortion,  I  was  told  that  the 
lady  had  taken  mdigo  in  teaspoonful  doses  three 
times  a  day,  that  she  had  taken  it  several  times,  and 
always  with  a  most  satisfactory  result  to  her. 

"  She  informed  me  at  the  time  that  it  always 
produced  great  nausea  and  watery  discharges  from 
the  bowels.  Acting  on  the  suggestion  offered  by 
this  case,  I  tried  it  in  many  and  various  cases.  In 
one  case,  where  a  young  lady,  aged  eighteen,  had 
niissed  for  thirteen  months,  the  menses  returned 
after  taking  the  crude  indigo  for  two  weeks  ;  but 
the  disgust  and  nausea  jsrodueed  by  the  bulky 
powder  rendered  her  unable  to  continue  it  longer, 
and  she  menstruated  three  uiore  months  ;  then 
they  stopped  again,  .\lter  using  the  remedy  for 
eight  or  nine  months  in  this  crude  state,  I  set 
about  to  find  some  way  of  condensing  it,  or  render- 


ing it  less  bulky,  for  it  is  the  bulk  of  the  dose,  not 
the  lemedy,  that  disturbs  the  stomach  and  disgusts 
the  patient,  .'\bout  a  month  later  Mr.  (J.  G. 
Zerse,  an  apothecary  of  La  Fayette,  turned  over 
to  mc  a  concentrated  extract,  as  he  called  it,  five 
grains  of  the  extract  equalling  twenty-six  grains  of 
the  crude  drug.  I  have  since  then  used  it  in  for- 
ty-eight cases  of  amenorrhoea,  of  all  kinds  and 
cauix's,  with  l)ut  three  failures,  and  a  colleague 
has  used  it  in  six  cases  without  any  failure.  To 
test  its  effect  I'  have  given  the  remedy  in  the 
amenorrhoea  of  phthisis,  and  have  always  had  a 
definite  result,  namely,  the  appearance  of  the 
menses,  the  menses  stopping  again  when  the  reme- 
dy was  stopjied.  The  effects  with  the  crude  drug 
and  the  concentrated  pre[)aration  are  identical, 
except  that  the  nausea  does  not  occur  when  the 
extract  is  used.  The  menses  come  on  painlessly 
and  very  suddenly.  There  is  no  warning  given. 
In  thirty  cases  the  effects  occurred  about  two 
days  after  the  last  dose,  the  menses  coming  on 
without  any  warning,  gushing  out  and  running 
often  to  flow.  The  hemorrhage  in  none 
of  the  cases  was  dangerous  or  alarming 
During  the  administration  of  the  drug  the  os  uteri 
becomes  soft  and  patulous,  admitting  the  end  of 
index-finger.  There  is  often  a  serous  dischaige  from 
the  vagina.  The  mine  becomes  of  a  brownish- 
green  color  and  offensive  odor.  The  stools  are  of 
a  bluish  color.  The  passages  are  watery  and 
offensive. 

"  To  summarize,  indigo  is  an  emmenagogue  of 
decided  value  in  any  case.  It  should  not  be  given 
to  pregnant  women.  It  should  not  be  given 
where  there  is  an  irritable  stomach.  It  should  not 
be  given  in  cases  where  there  is  a  history  of  a 
previous  pelvic  inflanunation.  It  should  not  begiven 
in  cases  there  where  is  marked  cerebral  anremia. 
It  may  be  given  in  doses  of  3  j.  to  5  ss.,  two  or 
three  times  a  day,  of  the  crude  drug,  or  in  five- 
grain  doses  of  the  concentrated  extract.  The 
powder  of  the  crude  should  be  given  mixed  with  a 
little  subuitraie  of  bismuth,  and  the  patient  should 
drink  a  little  whiskey  afterward.  In  cases  Avhere 
given  continuously  for  a  long  jieriod,  give  tr.  gen- 
tian comji.  after  each  dose.  Give  the  concentra- 
ted extract  in  cajjsules  mixed  with  extract  of  gen- 
tian and  subnitrate  of  bismuth."  — JV.  }'.  Medical 
Record. 


TREATMENT  OF  CHOLERA   INFANTUM 
IN  THE  NEW  YORK  INFANT  ASYLUM. 

Dr.  L.  Emmett  Holt  holds  that  as  pure  air  and 
])roper  feeding  are  the  most  important  things  in 
prophylaxis,  so  they  are  the  most  important  in  the 
treatment  of  this  disease.  Sick  or  well,  there  is 
no  food  for  a  baby  that  compares  with  good  breast 
milk.  If  this  is  being  used,  or  can  be  obtained, 
the  quantity  only  needs  to  be  regulated.  Not 
more  than  half  the  child's  allowance  when  well 
should  be  given  ;  and  if  the  stomach  is  very  irrit- 


16 


TJJE   CANADA   MEDICAL    RECORD. 


able,  all  food  should  be  withheld  for  half  a  day  or 
a  da> ,  giving  nothing  but  toast-water  or  thin  whey 
to  allay  thirst.  If  a  child  has  been  weaned,  or 
good  breast  milk  cannot  be  obtained,  cow's  milk 
iiad  be^t  not  be  trusted,  as  it  is  so  easily  changed 
in  hot  weather,  especialiy  in  cities  and  among  the 
poor.  In  the  country,  where  fresh  milk  can  be 
obtained  twice  a  day,  it  may  not  hold  ;  but  in  the 
city,  children  certainly  do  better  when  milk  is 
withheld,  andollicr  articles  not  so  prone  to  fermen- 
tation are  given.  Chicken,  beef,  and  mutton 
broths,  e.\])ressed  jtiice  of  roast  beef  or  steak, 
wine-whey,  white  of  egg  shaken  up  with  water, 
rice-water,  barley-water,  or  the  malted  foods^ 
koumyss,  and  in  some  cases  raw  scraped  beef' 
are  articles  which  may  replace  mil'c. 

The  first  indication  in  every  case,  except  true 
choleriform  diarihcea,  is  to  clear  out  the  bowels 
as  completely  as  jjossible.  by  a  good  dose  of  castor 
oil,  or  by  one  or  two  grains  of  calomel  in  the  form 
of  tablet  triturates.  This  will  be  sufticieiU  to  cure 
a  large  number  of  the  milder  cases,  if  taken  early, 
jjrovidcd  the  feeding  rules  laid  down  are  carefully 
followed.  In  more  severe  cases,  and  in  those  of 
longer  standing,  a  simple  clearing  out  produces 
only  temporary  iinproveirient ;  further  measures 
must  be  taken  to  restore  healthy  action  of  the  ali- 
mentary tract  and  stop  decomjiosition.  Salicylate 
of  sodium,  in  grains  j-ij  doses,  every  two  hours,  or 
naphthalin  in  double  the  amount,  we  have  found 
the  most  useful. 

High  tem|3eratine  should  be  reduced  by  baths 
or  cold  sjwnging.  It  should  not  be  forgotten  that 
this  may  come  from  septic  absorption  from  the 
bowels  ;  if  the  temperature  has  risen  coincidently 
with  a  great  reduction  in  the  number  of  discharges, 
a  brisk  cathartic  will  prove  the  most  efficient  anti- 
])yrelic. 

("erebral  sym|ni>ms  may  likewise  be  toxic,  and, 
if  .so,  should  be  treated  in  the  same  manner. 

The  object  of  treatment  is  not  simply  to  arrest 
the  discharges,  but  to  restore  their  healthy  charac- 
ter. Hence,  opiates  are  not  admissible  at  the 
outset,  and  never  during  the  course  of  the  disease 
when  the  discharges  are  foul  and  offensive.  The 
retention  in  the  intestinal  canal  of  such  matteis, 
loaded  with  bacteria,  can  only  result  in  harm. 

Last  summer,  in  this  Asylum,  a  trial  was  made 
of  the  method  of  irrigation  of  the  bowels  with  siin- 
]5le  water  or  weak  astringent  solutions,  in  twenty- 
one  cases.  Only  eleven  were  cured  by  this  treatment 
alone.  Although  the  results  were  not  so  gratify- 
ing as  was  anticipated  from  the  accounts  published 
in  Germany,  still  some  very  bad  cases  did  surpri- 
singly well  under  it.  It  is  certainly  deserving  of  a 
more  extended  trial,  as  a  valuable  addition  to  our 
therapeutics. 

True  choleriform  diarrhtca  was  treated  in  a  few 
cases  by  hypodermatics  of  morphia  and  atropia  ; 
one  or  two  yielded  quite  promi)tly ;  others,  no 
more  severe  apparently,  were  uninfluenced  b)'  it. — 
Med.  N'eivs. 


THE  PROPER  SELECTION  OF  ETHER  OR 
CHLOROFORM  A.S  AN  ANESTHETIC. 

Dr.  A.  P.  Gerster  lead  a  ])aper  upon  this  sub- 
ject before  the  New  York  Academy  of  Medicine, 
A]iril  7,  1887.  In  appro.^ching  this  subject,  he 
.said  it  was  necessary  to  cast  away  all  prejudice, 
considering  it  in  a  spirit  of  candid  inqui.ry  In 
the  first  place,  it  was  to  be  borne  in  mind  that 
both  ether  and  chloroform  were  dangerous  anes- 
thetics. Researches  with  the  aid  of  the  sphyg- 
mograph,  demonstrating  the  effect  ii]ion  the  jnilse, 
had  shown,  however,  that  chloroform  was  infinite- 
ly the  more  powerful  agent  of  the  two.  Still,  this 
fact  did  not  afford  groitnd  for  the  universal  con- 
demnation of  chloroform,  though  it  rendered 
greater  caution  necessary  during  any  operation  in 
which  it  was  used.  P)Ut,  while  chlorofoim  was 
the  more  jiowerful  agent,  and  consequently  atten- 
ded with  more  danger  at  the  time  of  the  operation, 
its  emplovment  was  not  followed  liy  the  secondary 
affections  of  the  hmgs  and  kidneys  which  were  apt 
to  result  from  that  of  ether. 

The  statement  frequently  made  by  partisan 
zealots,  that  ether  is  always  and  under  all  circums-_ 
tances  safe,  was  not  true.  In  hospital  practice 
it  was  found  that  in  a  considerable  number  of 
jjatients,  ])articularly  those  addicted  to  the  use  of 
alcohol,  it  was  e.'cceedingly  difticult  to  produce 
profound  anesthesia  with  this  agent,  and  in  such 
cases,  from  the  effect  of  the  excessive  and  irritating 
I  mucous  secretions  excited,  catarrhal  or  septic 
pneumonia  was  very  apt  to  ensue.  Admitting 
that,  on  the  whole,  ether  was  safer  than  chloro- 
form. Dr.  Gerster  pnjceeded  to  speak  of  the  man- 
ner of  administration,  and  recommended,  as  supe- 
rior to  any  other,  that  by  means  of  Ormsby's 
inhaler.  He  then  went  on  to  say  that  ether  was 
contraindicated  in  all  affections  impairing  the 
renal  functions,  a  circumstance  the  credit  for  first 
pointing  out  which  belonged  to  Dr.  Emmet. 
Having  referred  to  cases  shiwing  the  danger  of 
ether  when  nephritis  was  present,  he  expressed  the 
opinion  that  an  examination  of  the  urine  should  be 
made  in  every  case  before  administering  an  anes- 
thetic, except  where  the  urgency  of  the  circum- 
stances precluded  this  ;  when,  if  Bright's  disease 
was  discovered,  chloroform  was  to  be  jiref'erred  as 
the  safer  agent. 

Ether,  he  said,  was  also  contra-indicated  where, 
in  the  aged  or  in  young  children,  or  generally  in 
the  feeble,  there  were  catarrhal  conditions  of  the 
air-passages.  Having  related  three  cases  of  his 
own  practice,  in  which  he  claimed  that  fatal  or 
dangerous  pneumonia  was  set  up  by  ether  in 
patients  suffering  from  cancer,  he  stated  that,  in 
the  year  18S6,  three  cases  of  jiueumonia  occurred 
after  the  administration  of  this  agent  in  the 
Mount  Sinai  Hosjiital  in,  two  of  which  the  patients 
died,  while  in  the  third  recovery  took  place.  There 
were  also  five  cases  of  severe  bronchitis,  arising 
under  similar  circumstances,  reported  during  the 
year.     Dr,  Gerstt;r  said  he  had  four  more  cuses  in 


li 


THE  CANADA   MEDICAL   RECORD. 


17 


Ills  notes,  but,  as  these  operations  were  pcrfoinicd 
eitlicr  upon  the  tracliea,  hiryiix,  or  lower  jaw, 
it  was  possible  tiiat  tlie  entrance  of  blood  into  (he 
air-jjassagcs  might,  perhaps,  have  caused  the 
trouble,  and  he  would  not  therefore  insist  on  these. 
As  nnestliesia  by  ether  was  dangerous  in  young 
children  suffering  from  affections  of  the  aii-pas 
sages,  chloroform  was  always  lobe  preferred  und'ji' 
these  circumstances,  although  in  healthy  chiklien 
ether  was  borne  well. 

The  third  class  of  patients  in  which  <  hloroform 
was  to  be  preferred  was  those  who  could  not  be 
satisfactorily  brought  under  the  influence  of  ether. 
In  the  incomplete  anesthesia  caused  by  it,  there 
was  an  amount  of  muscular  rigidity  remaining, 
which  constituted  an  inseparable  difficulty  in 
quite  a  large  class  of  cases.  Not  only  loss  of 
sensation,  but  total  relaxation  of  all  the  voluntary 
muscles,  was  indispensable  in  many  ojierations  ; 
and,  in  spite  of  proper  preliminary  precautions, 
and  the  greatest  amount  of  care  in  the  administra- 
tion of  the  anesthetic,  in  eleven  cases  out  of  one 
hundred  and  twenty-five,  at  the  Mount  .Sinai  Hos- 
pital, it  was  found  impossible  to  produce  with 
ether  the  complete  ane.sthesia  required.  In  all 
these  instances,  however,  a  change  to  chloroform 
was  attended  with  the  hapiiiest  results.  Recapitu- 
lating, he  said,  then,  that  ether  should  not  be  used 
as  an  anestiietic  in  any  case,  (i)  where  acute  or 
chronic  nephritis  is  present,  or  is  suspected  to 
exist ;  (2)  where  there  is  any  chronic  pulmonary 
affection,  especially  in  the  aged  or  feeble;  (3) 
where  ether  will  not  produce  the  complete  anes- 
thesia and  relaxation  indispensable  for  the  suc- 
cessful performance  of  the  operation  in  ques- 
tion. 

Dr.  Gerster  then  went  on  to  say  that,  while  in 
general  the  administration  of  chloroform  undoubt- 
edly required  greater  caution  than  that  of  ether, 
there  was  only  one  contra-indication  against 
chloroform,  namely,  the  presence  of  a  fatty  or 
weak  heart.  In  the  hands  of  a  careless  giver  of 
anesthetics  chloroform  was,  no  doubt,  more  dan- 
gerous than  ether,  but  Eright's  disease  offered  no 
contra-indication  to  chloroform.  In  eight  years' 
hospital  experience  he  had  met  with  but  two  cases 
in  which  pneumonia  followed  the  administration 
of  chloroform,  and  in  both  of  these  the  probable 
cause  of  the  pulmonary  trouble  was  the  entrance 
of  blood  into  the  bronchi.  The  existence  of 
valvular  disease  of  the  heart,  again,  was  not  a 
contra-indication  to  chloroform,  provided  there 
was  satisfactory  compensation  by  muscular  hy- 
])ertrophy.  On  the  other  iiand,  if  the  heart  were 
leeble  from  any  cause,  chloroform  should  never 
be  used.  In  anemia,  also,  ether  was,  as  a  rule, 
safer. 

He  next  spoke  of  the  special  danger  of  chlo- 
roform in  cases  of  marked  nervous  depression,  and 
said  it  should  never  be  used  when  the  patient 
was  in  a  state  of  fright.  It  was  a  fact  that 
most  of  the  deaths  frcm  its  use  were  in  ca-ses  of 
slight  operations,  and  he  thought  this  was  explai- 


ned by  the  dread  of  theop.eration  or  the  anesthe- 
tic. In  severe  operations  the  |)aticnt  generally 
nerved  himself  for  the  ordeal,  and  hence  there  was 
less  danger  from  this  source. 

On  February  10,  1886,  Thomas  R.,  aged  thirty- 
two  years,  consulted  Dr.  Gerster  at  his  office,  for 
a  tumor  on  the  lower  part  of  the  face.  When  an 
exploratory  incision  was  i)roposed,  he  became  so 
much  alarmcil  that  he  begged  for  chloroform, 
which  was  not  given  at  this  lime.  Five  days  later 
he  was  admitted  to  Mount  Sinai  Hospital  as  a 
private  patient,  and  on  the  17th  Dr.  Gerster  pro- 
ceeded to  operate  on  the  tumor,  which  |)roved  to 
be  a  glandular  abscess.  He  subsecpienily  learned 
that  the  patient  expressed  the  conviction  that  he 
would  never  leave  the  operating  room  .dive.  When 
two  drams  of  chloroform  had  been  administered, 
by  means  of  ICsmarch's  mask,  opisthotonos  sud- 
denly occurred,  the  pupils  became  dilated,  and  the 
abdominal  muscles  were  found  to  be  rigid.  The 
pulse  ceased,  and  within  a  minute  the  patient  was 
dead,  all  efforts  at  resuscitation  proving  futile. 
The  experience  gained  in  this  case,  he  said,  had 
led  him  to  administer  stimulants  and  a  small  dose 
of  morphia  prior  to  operating  in  all  cases,  where 
the  patient  was  not  in  perfectly  good  condition, 
and  he  would  now  never  give  chloroform  to  any 
one  who  was  the  subject  of  deadly  fear.  In  every 
instance  in  which  it  was  feasible,  a  careful  physical 
examination  should  be  made,  and  the  probable 
prognosis  duly  announced  to  the  patient  or  his 
friends  before  proceeding  to  employ  this  anesthe- 
tic.— Boston  Medical  and  Surgical  Journal. 


THE  COMTARATIVE  ACTION    OF  ANTI- 
mklN  AND  ANTIFKBRIN. 

Although  antifebrin  has  just  come  into  use  as 
compared  with  its  fellow,  antipyrin,  little  doubt  ex- 
ists that  it  is  ijreferable  to  the  latter.  Aside  from 
the  results  obtained  by  comparative  tests  at  the 
bedside,  more  particularly  byEisenhart,  as  reported 
\\\  Aliinchener  Mid.  Wochenschrijt,  1886,  No.  47, 
and  by  Cahnand  Hepp  in  Berlin  Med.  Wochen- 
schrift,  1887,  Nos.  I  and  2,  the  general  profession 
has  not  reported  as  many  untoward  effects  from 
its  use  as  from  antipyrin,  while  its  cheapness, 
small  dosage  and  reliabilit}'  have  already  given 
it  a  place  of  high  esteem  among  clinicians.  Both 
Eisenhart  and  the  French  observers  reach  the  con- 
clusion that  five  grains  of  antifebrin  are  equal  to 
twenty  of  antipyrin,  and  although  this  is  somewhat 
below  the  estimate  made  by  the  profession  in 
America,  it  so  nearly  approaches  the  results 
obtained  here  that  the  matter  may  be  considered 
as  settled.  It  will  be  remembered  that  the  chief 
objection  to  antipyrin  was  that  it  was  capable  of 
causing  profound  collapse,  as  well  as  other  minor, 
but  scarcely  less  alarming,  symptoms,  and  it  should 
not  be  forgotten  that  antifebrin  may  produce  the 
same  result,  if  given  in  large  doses  in  susceptible 
cases. 


18 


THE  CANADA  MEDICAL  RECORD. 


Many  observers  have  noted  the  appearance  of 
an  exanthematous  rash  under  its  use,  and  Mun- 
chener  Meii.  Wochenschrift,  18S7,  No.  3,  reports 
cases  in  uhich  deafness  and  mydriasis  occured. 
These  instances  of  untoward  effects  produced  by 
antifebrin  are  fortunately  sufficiently  scattered  to 
permit  us  to  use  the  drug  with  great  freedom.  In- 
deed, the  only  manner  in  which  the  two  drugs  act 
identically,  other  than  as  antipyretics,  appears  to 
be  the  profuse  sweat  which  they  produce  about 
the  time  of  their  absorption  into  the  circulation. 

Sudden  caidiac  failure  has  been  produced  by 
both  drugs,  and  in  a  simple  case  of  pneumonia,  in 
which  antifebrin  was  administered,  which  has 
come  to  our  knowledge,  the  patient,  apparently 
convalescing,  while  sitting  up  to  bed  talking  to  a 
friend,  suddenly  dropped  back  dead  on  the 
pillow.  It  is  but  just,  however,  to  state  that  the 
patient  had  been  a  suffererfor  many  years  from 
disease  of  the  mitral  valve,  and  as  no  post-mortem 
was  allowed,  the  exact  cause  of  death  cannot  be 
stated  ;  although  the  attending  physician,  a  man  of 
good  judgment,  ascribed  it  to  the  drug,  with  suffi- 
cient reason  in  his  own  mind  to  prevent  his  using 
it  but  carefully  a  secone  time. 

'J'he  experience  of  the  profession  in  this  city  has 
certainly  engendered  the  belief  that  in  a  very  large 
proportion  of  cases  the  newer  antipyretic  may  be 
used  with  advantage  in  place  of  antipyrin,  and 
unless  some  as  yet  undetected  evil  influence  exerted 
by  it  is  discovered,  it  will,  without  doubt,  remain 
one  of  our  chief  aids  in  the  reduction  of  abnormally 
high  temperatures — Med.  News. 


THE  TRE.^TMENT  OF  COLDS. 

Dr.  Whelan,  R.  N.,  in  a  short  article  on  the 
treatment  of  colds,  says  :  It  is  recognized  generally 
that  catarrhs  are  excited  de  novo  by  exposure  to 
wet,  cold,  and  draughts ;  most  frequently  they 
develop  in  delicate  and  in  highly  neurotic  indi- 
viduals. When  once  a  catarrh  is  properly 
established,  the  affected  person's  breath  is  infec- 
tious, in  the  acute  stage  of  the  disease  at  least. 
The  question  arises,  What  is  the  nature  of  the 
affection?  i.  Is  it  a  specific  poison  comparable 
to  that  of  the  infectious  fevers?  2.  Does  the 
affection  start  as  an  idiopathic  inflammation  and 
develop  a  specific  poison  which  is  given  off  by 
the  breath  ?  3.  Is  it  of  nervous  reflex  origin 
purely  ?  An  epidemic  of  influenza  would  be 
explained  by  supposing  within  large  tracts  of 
country  all  catarrhal  micrococci  become  suddenly 
virulent,  owing  to  some  climate  or  telluric  foster- 
ing cause,  or  to  some  law  of  heredity,  or  evolution 
of  the  organisms  themselves.  The  usual  coddling 
treatments  of  colds  in  an  ordinary  healthy  person 
should  be  strongly  condemned ;  there  is  a  deal  of 
wisdom  in  the  saying  "Starve  a  fever,  feed  a  cold." 
A  person  with  catarrh  should  take  an  abundance 
of  light,  nutritious  food,  and  some  light  wine,  but 
should  avoid  spirits  and  tobacco.  In  the  very 
old  or  very  3'oung,  or  in  cases  where  the  general 


health  is  not  good,  due  care  must  be  taken,  and 
above  all  things,  depressants  should  be  avoided. 
The  author  recommends  as  a  specific,  both  as  a 
prophylactic  and  therapeutic  remedy,  the  following 
prescription;  R  quin.  sulphatis,  gr.  xviij  ;  liquor 
arsenical.,  M  xij ;  liq.  atropinfe,  m.  j ;  extract,  gen- 
tian., gr.  XX ;  pulv.  gum  acac,  q.  s.  to  make  twelve 
pills.  One  of  these  pills  should  be  taken  every 
three,  four,  or  six  hours,  according  to  circumstan- 
ces. If  these  pills  are  commenced  in  the  early 
stage  of  a  common  cold,  when  the  affection  is 
confined  to  the  nose  and  pharynx,  the  aifection 
will  be  nipped  in  the  bud.  At  first  one  pill  should 
be  taken  every  three  or  four  hours  :  later  on  every 
six  hours.  The  author's  exjierience  goes  to  prove 
that  a  cold  seldom  lasts  three  days  under  this 
treatment,  and  believes  that  the  remedy  acts  as  a 
powerful  nervine  and  general  tonic,  bracing  the 
patient's  tissues  to  resist  the  multiplication  of  the  or- 
ganisms which  cause  the  affection. — Practitioner, 
March,   1887. 


IN 


THE     VALUE     OF    HAEMORRHAGE 

TREATING  WOUNDS. 

Taruzza    publishes    a    note    {Ga::etta     Degli 
Ospitali,  April  13,  1887)   to    show  that  hemorr- 
hage from    wounds,  unless    due  to  lesion  of  large 
vessels    or    in    excess,    does    not    interfere  with 
primary  union.     He   does  not  think  it  necessary 
to    follow    strictly  the    rule    to   secure   complete 
arrest  of  hemorrhage  and  to  apply    firm  compres- 
sion.    He    relies    on    perfect  disinfection  of  the 
bleeding   surface,  as    far  is  possible,  by  means  of 
weak    solutions    of    carbolic    acid    or    mercuric 
chloride,      .\fter  this  he    leaves    the  cavity  of  the 
wound  full  of  blood,  the  edges    being  accurately 
sutured,  and  without  fear  that  primary  union  will  1 
not  result.     From   his    experience    he  formulates 
the  rule :   "  In  wounds  perfectly   disinfected  and 
free  from    foreign  substances,  effusion  of  blood  is 
not  a   source  of  danger,    but    the  reverse,  as  the 
effused     blood   fills    the   wound-cavity   perfectly, 
preventing    the  formation   of  empty   spaces,  and] 
making    compression    and  drainage    superfluous, 
and  the    organization  of   the  clot  favors  union. 
He  is    opposed  to  the  drainage    tube,    thinking  j 
that  it  increases  risks  of  sepsis,  and    may  remove  j 
from  the   wound  fluids    which,  when  aseptic,  mayj 
be     useful    by    reabsorption. — Jour.  Am.  Med.\ 
Assn. 


A  POINT  IN  THE  TREATMENT  OF 
CHORE.A.. 

Dr.  Flood,  of  Minnesota,  says  that  he  has  almost! 
constantly  found  tenderness  on  pressure  over  the  | 
fifth  cervical  vertebra  in  choreic  cases.  In  these 
he  applies  the  ether  spray  over  the  tender  spot,  j 
and  follows  that  with  a  mild  counter-irritant.  Then,  J 
with  a  judicious  use  of  tonics  and  ergot  he  has* 
generally  been  successful  in  the  treatment. — Chi- 
cago Aledical  Times. 


THE   CANADA   MEDICAL   RECORD. 


I'J 


IRON  AND  SODIUM  SAIJCYLATE   IN 

RHEUMATISM  AND  RHEUMATIC 

AFFECTIONS. 

By  Solomon  Solis-Couek,  A.  M.,  M.  D., 

Chief  of  Clinic,  Out-patient  Medical  Department,  Jefferson 
Medical  College  hospital. 

For  sonic  four  years  I  have  been  in  the  habit, 
in  certain  classes  of  rheumatic  affections,  usually 
chronic,  of  employing  a  combination  of  tincture 
of  chloride  of  iron  and  sodium  salicylate,  ])repared 
according  to  the  following  formula,  which  I  have 
been  informed  by  Dr.  Rice,  of  Eellevue  Hospital, 
New  York,  and  other  experienced  pharmacists, 
is  the  first  successful  combination  of  these  drugs 
in  an  eligible  preparation.  In  the  House  Phar- 
mac(ipi_eias  of  the  Philadel]3hia  Polyclinic,  where 
it  was  first  used  in  1883,  and  of  JelTerson  Medical 
College  Hospital,  it  is  known  as  the  Mistura  F'erro- 
salicylata  ; — 

R.     Sodii  salicylatis,  3  iv. 

Glycerini,  f  r  ij. 

01.  gaultherice,  ifl.xx. 

Tinct.  ferri  chloridi,  f  3  iv. 

Acidi  citrici,  gr.  x. 

Liq.  ammonii  citrat.(B.  P.), 

q.  s.  ad  f  3  iv.       M. 
The  mixture  is  clear,  and  is  not  unpalatable. 
The  usual  dose  is  two  fluidrachms  in  water,  three 
or  four  times  a  day.     The  quantities  and  propor- 
tions of  the  active  ingredients  may,  of  course,  be 
varied    according  to  the    intended  frequency    of 
dosage  and  other  circumstances.     In  cases  which 
are  rather  subacute  than  chronic,  it  is  sometimes 
given   every  second  hour,  until  the  piiysiological 
effects  of  the  salicylate  are  produced,  and  then  at 
longer  intervals.     I  have  also  employed  it,  with 
apparently  good  resuls,  in  acute  articular  rheuma- 
tism, and  in  some  cases  of  acute  tonsillitis,  espe- 
cially in  that  group  where  the  diagnosis  is  at  first 
in  doubt  between  rheumatic  angina  and  diphtheria. 
Some  of  my   friends   have  reported  to   me  good 
results  in  acute  rheumatism.      Its  particular  ap- 
licabilty  is  in  that  group  of  patients  in  whom  Dr. 
Russell  Reynolds  strongly  urges  the  iron  treatment 
— a  recommendation  endorsed  with  equal  earnest- 
ness  by    Bartholow — namely,    anemic,    delicate, 
poorly-nourished    or     broken-down     individuals, 
usually  old  people,   children  or  adolescents,   but 
met  with  at  all  ages,  whether  the  disease  be  acute, 
subacute    or   chronic.     In    adults,    indeed,    as   a 
rule,  and  quite  frequently  in  children,  even  when 
the  disease  is  not  plainly  chronic,  the  patient  will 
give  a  history  of  repeated  acute  attacks  ;  or  there 
will  seem  to  have  been  a  long  series  of  recurrences, 
with  intermissions  of  doubtful  health.  Recognizing 
the  weight  of  the  testimony  in  fiivor  of  tcnic,  and 
especially  ferric,  treatment  of  such  cases,  and  yet 
desiring  to  obtain  also  the  specific  action  of  tne 
salicylic   compounds,    I    succeeded,   after  several 
ineffectual  trials,  in  obtaining  a  clear  mixture  by 
the  use  of  the  formula  given  above,  and  four  years' 


experience,  latterly,  with  the  ample  material  fur- 
nished by  the  Out  patient  Department  of  Jefferson 
Medical  College  Hosijital.  has  abundantly  con- 
firmed my  expectations  of  its  usefulness. — Med. 
and  Sur^.  RKportcr,  May  28th,  1887. 


INCUI5.VriON  OF  THE  INFECTION  OF 
MEASLES. 

Dr.  Sevestre,  in  a  thesis  recently  published,  de- 
monstrates the  fact  that  the  period  of  incubation 
in  measles  is  almost  invariable — -between  thirteen 
and  fourteen  days  elapsing  between  the  moment 
of  infection  and  the  appearance  of  the  rash.  The 
fever  appears  four  days  earlier,  viz.,  between  the 
ninth  and  tenth  day.  Another  fact,  and  one  of 
far  greater  importance,  has  been  determined  by  Dr. 
Sevestre,  and  that  is  that  the  infective  power  of 
the  disease  commences  with  the  first  moment  of 
prodromic  manifestations,  viz.,  of  the  appearance 
of  fever,  and  continues  with  unabated  virulence 
until  the  eruption,  after  vvhich  its  infective  power 
diminishes  very  rapidly,  vanishing  entirely  on  the 
fifth  day  thereof.  In  the  analysis  of  many  hundred 
cases,  not  one  instance  of  infection  after  the  fifth 
day  of  eruption  (the  18th  or  19th  after  exposure) 
could  be  found.  The  practical  bearing  of  these 
facts  are  manifest.  They  furnish  a  sure  and  valu- 
able guide  on  points  upon  which  the  profession 
and  laity  have  strangely  blundered  hitherto,  viz  , 
the  proper  time  for  isolation  of  the  patient.  The 
habit  of  sending  off  the  apparently  unaffected 
members  of  a  family,  while  the  fever  in  an  affected 
one  is  at  its  highest,  is  the  surest  method  of  trans- 
porting the  infection  and  creating  new  foci  of 
disease. — St.  Louis  Med.  and  Surg.  Journal. 


TREATMENT  OF  DYSENTERY. 

Ipecacuanha  as  a  remedy  for  dysentery,  has  now 
been  before  the  profession  for  a  time  sufficient  to 
fully  establish  its  worth  or  otherwise,  and  favorable 
reports  of  it  are  still  received. 

"  Technics^'  quoting  from  Progres  Medical,  gives 
a  correspondence  from  Dr.  C.  MacDowell  of 
Bombay,  physician  in  the  British  army  of  East 
India,  whb  speaks  with  great  enthusiasm  of  the 
treatment  of  dysentery  by  ipecacuanha.  Like 
other  friends  of  this  treatment,  such  as  Bocker, 
Ewart,  Cunningham,  Mulun,  etc.,  he  says  that  it  is 
almost  a  specifice,  renders  the  disease  easy  to  cure, 
and  prevents  the  complication  most  feared,  /.  e., 
hepatic  suppuration.  But  he  emphasizes,  partic- 
ularly "  that  the  remedy  be  given  early  in  the 
disease,  at  the  time  and  in  the  proper  manner." 
The  principles  of  the  treatment  are  : 

1.  To  give  a  large  dose  of  ipecac,  at  least  30 
grains,  for  an  adult. 

2.  To  prepare  the  stomach  to  accept  and  retain 
such  a  large  dose  by  about  twenty  drops  of  laud- 
anum an  hour  before  giving  the  ipecac  ,  also  the 
application  of  a  sinapism  over  the  stomach ;  and  to 


20 


The   CANADA   MEDICAL   RECORD. 


administer  the  ipeac  in  the  form  of  large  pills,  not 
in  a  solution.  It  must  also  be  given  at  night,  at 
the  time  of  going  to  sleep,  never  in  the  morning, 
and  not  during  the  day  and  no  liquid  is  to  betaken 
after  the  dose  has  been  given. 

Sometimes  the  jiatient  vomits  a  little  mucus 
towards  the  morning  hours,  but  the  greater  portion 
of  the  remedy  has  by  that  time  absorbed.  This 
treatment  nwist  be  renewed  every  night,  and  usu- 
ally the  improvsment  is  marked  by  the  third  mor- 
ning or  sooner,  blood,  mucus,  pain  all  three  have 
disappeared.  A  disease  which  formerly  made  us 
despair  has  now  lost  its  terror  to  us. 

I'he  opium  may  be  substituted  by  a  hypodermic 
injection  of  morphia.  Bissmuth  subnitrate  may  be 
given  during  the  day.  Small  doses  of  ipecac  are 
more  than  useless;  they  have  been  tried  in  India 
for  more  than  two  centuries  without  lessening  the 
mortality  in  dysentery.  Since  more  than  twenty 
years  the  above  has  been  adojned  as  almost  the 
only  treatment  in  British  India  and  has  given  the 
best  results. —  Week/y  iMedical  Review. 


DELLVERY  AFTER  DEATH. 

Last  Saturday,  Mrs.  Rosseau  living  in  Eugene 
Sue  street,  succumbed  to  a  peiitonitis  occurring 
at  full  term. 

The  medical  certificate  having  been  filled  in,  the 
employes  of  the  undertaker  called  Sunday  to  place 
her  in  the  cofiin,  when  to  their  horror  they  found 
that  she  had  been  delivered  of  a  child,  that  like- 
wise was  dead. 

The  burial  was  delayed — a  new  certificate  was 
made,  and  this  circumstance,  that  had  given  rise 
to  the  strangest  ideas,  was  explained  in  a  natural 
way. 

This  confinement  or  delivery  after  death,  was 
but  the  normal  consequence  of  the  developmen, 
of  gases,  due  to  the  very  rapid  decomposition] 
consequent  upon  great  heat. — Le  Petit  Joural 
Paris,  August  loth,  18S7,  translated  for  Record. 


TREATMENT  OF  LATE  CASES  OF  PUER- 
PERAL INFECTION. 

Dr.  Hirst  {Philadelphia  Med.  jViivs)  rejiorts 
four  cases  of  late  ijuerperal  infection,  successfully 
treated  by  curetting  the  cavity  of  the  uterus  with 
antiseptic  precautions.  More  or  less  decomposing 
decidua  was  thus  removed  in  each  case,  and  the 
temperature  fell  promptly. 


LINDSAY  AND  BLACKISTON'S    YISITING 
LIST. 

This,  the  pioneer  visiting  list  of  this  continent 
is  early  on  our  table.  It  still  maintains  its  place, 
as  being  the  very  best,  in  spite  ofnumerous  rivals. 
We  speak  from  a  twenty  years'  experience  of  it. 


The  Canada  Medical  Record. 

A  Montlily  Journal  of  Medicine  and  Surgery- 

EDITORS  : 

FRANCIS  ",V.  CAMPBELL,   M.A.,  M.D.,  L.K.t'.P.  LOND. 

KtUtoi-  and  rroprietur. 
R.  A.  KENNEDY,  M.A.,  m!d.,  Managing  E.litor. 
ASSISTANT  EDITOR: 
GEORGE  E,  ARMSTRONG,  CM.,  M.D. 

SDBSCRIPTION    TWO    DOLLARS    PER    ANNOM. 

All  comnmnications  and  Kxchanges  muxl  be  aidressed  to 
the  Jiditors,  fJrdwei  SdH,  Posl   V/>ice,  Mntilreal . 

MONTREAL,  OCTOBER,   1887. 

I'HE  CANADIAN  MEDICAL  ASSOCIATION. 

The  annual  meeting  of  this  Association  was  held 
in  Hamilton,  Ont.,  on  the  last  day  of  August  and 
the  first  day  of  September.  The  attendance  was 
about  equal  to  what  it  generally  has  been,  but  not 
by  any  means  what  it  should  have  been.  The  reason 
for  this  lack  of  interest  it  is  hard  to  understand, 
unless  we  come  to  the  conclusion  that  the  bulk  of 
the  Canadian  profession  are  absorbed  in  gathering 
what  our  America  cousins  call  "  the  Almighty  Dol- 
lar." Yet,  in  a  sordid  point  of  view,  attendance  on 
these  association  meetings  is  not  without  its  value. 
Much  that  is  valuable,  in  a  practical  point  of  view, 
is  always  to  be  obtained  at  these  meetings,  and 
tliose  who  attend  are  sure  to  return  home  with 
new  ideas,  new  points  which  are  valuable  ad- 
ditions to  their  store  of  knowledge.  It  is  this 
knowledge  which  we  charge  for,  and  the  more  we 
have  the  better  we  will  be  paid  for  it.  We  fear 
another  reason  for  non-attendance  is  that  want  of 
national  enthusiasm,  which  is  so  characteristically 
present  with  our  friends  across  the  lines,  and  so 
markedly  absent  with  us.  We  did  hope  that  Com 
federation  would  remove  this  blot  from  us,  and  that 
it  has  done  something  towards  that  end  is  beyond 
question  ;  but  we  have  still  too  much  Provincialism, 
too  much  Quebec,  too  much  Ontario,  for  our  na- 
tional prosperity.  1  he  Pies  dent, Dr.  J.  H.  Graham, 
of  Toronto,  delivered  an  admirable  address,  dealing 
with  the  general  interests  of  the  profession.  Gen- 
eral addresses  upon  special  subjects  named  at  the 
previous  meeting  were  read.  This  was  the  first 
time  that  this  had  been  attempted,  and  the  result 
proves,  we  think,  that  the  move  was  a  wise  one 
Several  prominent  medical  men  from  abroad  were 
present,  among  them  our  old  Montreal  friend 
and  confrere, Dr.  Osier, Professor  of  Clinical  Medi 
cine  in  the  University  of  Pennsylvania.  The 
next  meeting  will  take  place  in  Ottawa. 


k 


THE   CANADA   MEDICAT,   RECORD. 


21 


INTERNATIONAL  MEDICAT,  CONGRESS. 

The  fust  nircliiin  of  the  Congress  on  this  ('on 
tinent  has  been  held,  nnd  is  now  ninon^;  the  events 
of  tlie  ]iast.  'I'he  divisions  whieh  occuned  nnmng 
the  niedieal  men  of  tlie  United  States,  coneernii-.j; 
it,  caused  no  hitle  anxiety  ns  to  its  probable  suc- 
cess. It  is,  therefore,  satisfactory  to  know  that  it 
was  fairly  successful,  though, of  course, it  cannot  be 
denied  that  the  absence  of  the  majority  of  those 
who  have  niadc  American  medicine  known  abroad 
militated  considerably  against  its  eclat.  Many 
eminent  men  from  abroad  were  also  induced  to 
absent  themselves,  on  account  of  this  division 
among  the  American  profession.  The  numbers  pre- 
sent were,  however,  very  large,  the  Western  States 
being  well  represented,  and  Canada  sent  a  fair 
contingent.  Montreal  as  usual  being  well  to  the 
front.  Several  very  valuable  papers  were  read  and 
ably  discussed; but,  upon  the  whole,  the  foreign  re- 
presentatives think  that  the  meeting  was  deficient 
in  purely  scientific  work.  We  need  hardly  say 
that  the  social  work  of  the  Congress  was  just  that 
for  which  the  large-hearted  generosity  of  our  Ameri- 
can friends  are  so  noted.  Those  who  came  from 
abroad,  we  are  satisfied,  returned  home,  feeling 
that  they  had  been  visiting  a  great  nation,  whose 
people  are  alive  to  all  the  great  issues  which  affect 
the  human  race. 


FRESH  AIR. 

The  advantage  of  pure  air,  uncontaminated  w-ith 
the  impurities,  wliich  surround  all  cities  of  a  con- 
siderable size,  is  admitted  by  every  one,  in  a  hy- 
gienic point  of  view.  Physicians  know  that  bad 
hygienic  surroundings  not  only  predispose  to 
disease,  but  prevent  a  return  to  health,  when  disease 
has  once  been  developed.  It  does  more,  it  stunts 
growth,  prevents  muscular  development,  and  ren- 
ders the  various  organs  of  the  body,  especially  those 
concerned  in  alimentation,  until  to  perform  their 
fimctions  in  a  healthy  manner.  From  various 
causes,  some  preventtble,  and  others  not,  a  large 
portion  of  the  population  of  cities  are  born  and 
reared  under  such  surroundings.  As  a  result, 
when  the  warm  summer  days  come  round,  disease 
attacks  those  thus  situated  ;  and  being  unable  to 
obtain  the  proper  remedy,  pure  air,  the  mortality 
becomes  excessive.  This  condition  of  things  has, 
for  several  years  past,  been  attempted  to  be  reme- 
died in  New  York,  and  in  a  few  other  large  cities, 
by  the  formation  of  a  fiind  known  as  "  the  Fresh 
Air   Fund."     Tiie  object  of  this  Fund  has  been  to 


send  to  the  country,  and  to  the  sea  shore,  such 
(hildrcn  of  the  poor,  who  being  ill  or  even  in  del- 
icate health  would,  it  was  believed,  be  benefited  by 
the  change.  I  )uring  the  past  summer,  through  the 
energy  of  Mr.  Hugh  ( Iraham,  Proprietor  of  the 
Montreal  F.vcniiif;  Star,  our  good  city  fell  into 
line,  and  established  its  Fresh  Air  Fund.  Willing 
workers  were  not  wanting,  and  willing  contributors 
came  forward  with  the  means  in  money  and  in  kind. 
The  result  was  that  for  the  first  time  in  the  history  of 
Montreal,  a  very  large  number  of  the  sick  jjoor 
were  enabled  to  visit  the  country,  for  a  long  or  short 
period,  as  the  c  Inumstances  of  each  case  seemed  to 
demand.  TIk^  complete  result  of  the  charity  has 
only  just  been  given  to  the  public.  From  the 
report  of  the  chairman,  it  is  learned  that  the  com- 
mittee rented  two  buildings  for  the  season.  One 
of  these  at  Murray  Bay, a  famous  watering-place  on 
the  Lower  St.  Lawrence,  accommod.itcd  fifty 
])ersons,  and  was  intended  for  those  who,  in  the 
judgment  of  physicians,  required  sea  air  to  restore 
them  to  health.  At  this  pla-'e  no  fewer  than 
159  persons  were  maintained.  It  was  ascertained, 
however,  that  a  very  large  number  of  delicate 
mothers  and  sick  children  would  be  benefited  by  a 
simple  change  of  air,  and  plenty  of  wholesome  food. 
Steps  were  therefore  taken  to  secure  a  home  for 
these  nearer  Montreal,  and,  as  a  consequence,  the 
second  building,  an  hotel  at  Varennes  Springs, 
about  13  miles  from  the  city,  and  boidering  on  the 
St.  Lawrence, which  had  been  vacant  for  sometime, 
was  secured.  The  period  during  which  each  guest 
was  entertained  here  was  ten  days.  At  one  time  the 
Home  had  160  inmates, and  during  the  entire  season 
it  accommodated  550  poor  guests.  In  addition  to 
the  sick  poor  sent  to  Varennes  and  Murray  Bay,  a 
number  of  children  with  their  mothers  were  provi- 
ded for  in  the  homes  of  farmers  living  at  some  dis- 
tance from  Montreal.  Some  of  these  weie  paid  for, 
but  others  were  entertained  gratuitously  by  gener- 
ous faiTiilies.  But  this  is  not  all.  The  committee  did 
not  content  itself  with  the  care  of  the  actual  sick. 
The  chairman  says  it  was  known  that  there  were 
hundreds  living  in  the  low  places  of  the  city,  not  ill, 
it  is  true,  but  whom  a  day's  ''  outing  "  in  the  country 
or  down  the  river  would  prevent  many  a  visit 
from  the  doctor.  Accordingly,  the  committee 
arranged  a  series  of  weekly  excursions  by  boat  and 
rail.  "In  this  way,  5,537  persons  shared  the  im- 
''  mense  blessing  of  God's  fresh  air,  for  one  day. 
"  The  glowing  cheek  and  sparkling  eye  testified  to 
"  the  benefits  which  hundreds  had   derived   from 


22 


THE   CANADA   MEDICAL   RECORD. 


'.'  even  those  few  hours'  change.  An  abundance 
"of  plain  and  wholesome,  refreshments  was  sup- 
"  plies  to  these  excursionists, free  of  charge,and,it  is 
" needless  to  say,  disappeared  as  if  by  magic' 
Altogether  6,247  children  and  women  were  treated 
either  to  a  one-day  or  to  a  ten-day  excursion,  and  to 
all  the  fresh  air  that  such  an  outing  means  ;  and 
the  total  cost,  owing  to  the  kindness  of  railway 
companies  in  giving  reduced  fares,  of  our  profession 
in  rendering  their  professional  services  gratui- 
tously, and  of  other  persons  in  contributing  in  kind, 
was  but  $4,829. 

The  amount  of  good  performed  for  this  small 
amount  of  money  was  very  great.  Had  those  who 
contributed  to  the  Fund  read  the  letters  of  grati- 
tude which  the  work  elected,  or  had  they  seen  the 
parents  coming  personally  to  give  thanks,  whose 
"  dimmed  eye  and  quivering  lip  told  the  story 
"  which  the  faltering  tongue  refused  to  tell,"  they 

would  have  felt  that  the  little  self-denial  they 
had  practised,  in  order  to  aid  the  work,  had  been 
more  than  repaid.  There  can  be  no  doubt  that  the 
Fresh  Air  Fund  in  Montreal  has  given    health  and 

life  to  many  little  ones,  who  in  their  homes 
would   have   been  condemned  to  die. 


THE  EIGHTH  VOLUME  OF  THE  INDEX- 
CATALOGUE. 

The  eighth  volume  of  the  "  Lidex-Catalogue  of 
the  Library  of  the  Surgeon-General's  Office  United 
States  Army,"  including  headings  from  "  Legier" 
to  "Medicine  (Naval),"  has  recently  been  issued 
from  the  Government  Printing  Office.  It  contains 
10  pages  of  preliminary  matter,  and  1,078  pages  of 
references.  We  have  so  often  expressed  our  admi- 
ration of  this  great  work,  that  we  need  not  now  say 
more  than  that  the  new  volume  is  quite  on  a  par 
with  those  that  preceded  it. 


LITERARY  NOTES. 
The  following  works  will  be  issued  during 
December  by  the  New  York  Publishers,  Leonard 
&  Co.,  141  Broadway.  Diseases  of  Women,  a 
work  based  upon  the^practical  experience  and 
teachings  of  the  following  eminent  Gynecologists  : 
Drs.  Thomas,  Munde,  Hunter,  Lusk,  McLane, 
Skene,  Garrigues,  Barker,  Emmet,  &c.,  436  pages. 
Cloth,  $1.50.  Diseases  of  Infancy  and  Childhood, 
with  over  400  Formuls  and  Prescriptions,  by  Drs. 
Jacobi,  Hammond,  Flint,  Loomis,  Janeway,  Bul- 
kley,  Agnew,  &c.,  300  pages  ;  cloth,  $i.oo-  Disea- 
ses of  Heart  and  Lungs,  with  over  350  Formulje  and 
Prescriptions,  by  Drs.  Draper,  Delafield,  Learning, 
J.  Lewis  Smith,  Loomis,  Clark,  Janeway,  &c.,  204 
pages;  Cloth,  $1.25. 

The  Archives  of  GynKCology,  New  York,  has 
just  closed  another  successful  year,  having  furnish- 
ed its  readers  with  the  resume  of  no  less  than  584 
articles.  The  Publishers  do  not  send  sample 
copies,  but  announce  that  any  subscriber  may 
return  the  first  number  and  cancel  the  order. 
Subscription  $3.00.  Payment  is  not  asked  till  end 
of  year.  Leonard  &  Co.,  Pubhshers,  141  Broad- 
way, New  York. 

Bromo-Soda:  On  a  recent  trip  to  Europe, 
on  both  the  outward  and  homeward  passages,  I 
used  Warner  &  Co.'s  Effervescing  Bromo-Soda 
with  great  success  in  preventing  and  relieving  sea- 
sickness, the  quantity  given  was  a  lieaping  dessert- 
spoonful, repeated  hourly  if  necessary. 

I  believe  Bromo-Soda  to  be  a  very  valuable 
preventive  and  remedy  for  sea-sickness,  it  certainly 
was  unfailing  in  my  hands.-W.  H.  Keim,  M.  D., 
2015  Ridge  Ave.,  Phi  la. 


THE  ILLUSTRATED  LONDON  NEWS. 

This  well  known  journal  is  obtaining  a  very 
large  circulation  for  its  American  edition,  now 
published  simultaneously  with  its  London  edition, 
at  Potter's  building.  New  York.  We  do  not  wonder 
at  this,  for  its  yearly  subscription  is  one  half  of  the 
London  issue,  viz.,  $4.00.  It  is  just  the  paper  for 
physicians  to  have  on  their  waiting-room  table. 
Patients  who  find  it  there  will  not  feel  the  time 
long  while  waiting  for  the  doctor.  We  place  it 
on  ours  and  vouch  for  our  statement  being  correct. 


PERSONAL. 

Dr.  A.  P.  Scott,  M.  D.  (Bishops  1887),  has  re- 
turned from  London.  He  received  the  L.  R.  C. 
P.  Lond.,  at  the  examination  in  July  last.  He  in- 
tends commencing  practice  in  Montreal. 

Dr.  Wolfred  Nelson,  M.  D.  (Bishops  187 2), For- 
eign Medical  Inspector  of  the  New  York  Life 
Iifsurance  Company,  returned  the  middle  of 
this  month  from  the  Continent  of  Europe,  where 
he  has  been  for  several  months  on  official  busi- 
ness. 

Dr.T.orne  Campbell,  son  of  the  late  Dr.  George 
W.  Campbell,  after  an    absence  of  several  years 


THE   CANADA  MEDICAL   RECORD. 


23 


in  Euio|)e,  has  returnci]  to  Montreal,  wIil-ic  wc  inc- 
siune  lie  will  t'nter  upon  the  practice  of  his  ])iofes- 
sion. 

i)r.  James  l!ell  has  been  ajipoinled  iMedical 
Adviser  of  the  Manufacturers'Life  Insnrancc  Com- 
pany of  Toronto,  for  the  City  of  Montreal. 

Sir  James  A.  Grant,  M.D.,  tlelivered  the  Intro- 
ductory Lecture  of  the  Medical  Faculty  of  McGill 
University,  on  the  3rd  of  October.  In  the  even- 
ing of  the  same  day  he  was  entertained  bv  the 
Faculty  at  a  Dinner  in  St.  James'  (^lub. 


revif:w. 

The  Archives  of  Pediatrics,   a   monthly  Journal, 

devoted  to  the  diseases  of  infants  and  children. 

I'hiladelphia,  J.  P.  Lipjuncott  &  Co. 

This  is  a  very  valuable  monthly,  and  we  are 
jileased  to  hear  of  its  continued  prosperity.  That 
the  publishers  intend  to  deserve  the  support  they 
are  receiving,  they  announce  that  with  the  num- 
ber for  next  Jantiary  they  will  begin  a  series  of 
articles  on  the  Therapeutics  of  Infantry  and  Child- 
hood,by  Dr.  A.  Jacobi, Clinical  Professor  of  diseases 
of  children  in  the  College  of  Physicians  and  Sur- 
geons of  New  York.  In  writing  to  the  Editor, 
accepting  the  task,  Dr.  Jacobi  says  : 

"I  will  prepare  an  essay  often  or  twelve  pages 
for  every  monthly  issue  of  your  Journal.  The  sub- 
jects will  be  therapeutical.  The  first  paper  will 
probably  contain  general  princijjles  in  their  appli- 
cation to  the  disorders  of  early  age.  The  follow- 
ing will  treat  of  the  therapeutics  of  the  diseases  of 
the  new  born,  of  developmental  and  infectious 
diseases,  those  of  the  organs  of  circulation  and 
respiration,  genitourinary  organs,  stomach  and 
other  abdominal  viscera,  muscles  and  bones,  skin, 
nervous  system,  etc.  Other  subjects  which  will  be 
treated  of  afterwards  are  certain  classes  of  re- 
medies, such  as  anaislhetics,  narcotics,  anti-febriles, 
purgatives,  absorbents,  roborants,  and  stimulants, 
etc.  If  there  be  time  and  room,  the  most  interest- 
ing diseases,  such  as  epilepsy,  chorea,  whooping- 
cough,  and  growths,  may  become  the  subjects  of 
special  pajiers." 


I 


Transactions  of  the  Association  of  American 
Physicians. — Second  session  held  at  Washing- 
ton, D.C.,  June  2nd  and  3rd,  1SS7,  Philadelphia. 
Printed  for  the  Association,  1887. 

We  have  to  acknowledge  the  receipt  of  this  vol- 
ume, which  is  the  record  of  work  done  by  men 
who  are  earnestly  engaged  in  the  field  of  Medical 


Science.  We  are  pleased  to  notice  that  the  first 
article  is  from  tiie  pen  of  Dr.  R,  Palmer  Howard 
of  Montreal,  who,  by-the-by,  is  one  of  the  vice- 
l)residents  of  the  Association.  Dr.  Howard  writes 
upon  a  subject  of  much  interest,  viz.,  the  occurrence 
of  Hepatic  Cirrhosis  in  children — fortunately  a 
rare  disease.  He  gives  the  details  of  two  cases 
occurring  in  his  practice,  and  strange  to  say  both 
the  children,  in  whom  the  diseases  ajjpeared,  were 
members  of  the  same  family.  There  was  not  any 
history  of  alcoholism  or  of  syphilis.  The  subject  is 
well  treated  and  elicited  considerable  discussion. 
An  interesting  article  appears  from  our  old  Mont- 
real friend,  Dr.  Osier,  now  of  Philadelphia,  on 
Ha;morrhagic  infarction,  .^s  one  would  anticipate, 
it  is  most  credible  to  its  author,  who  is  rapidly 
rising  to  the  front  10  rank  as  a  scientific  physician- 
In  every  way  the  volume  is  most  creditable  to  the 
Association,  to  which  we  wish  increased  prosperity. 


Insanity,  its  Classifications,  diagnosis  and  treat- 
?nent,  a  manual  for  Students  and  practitioners 
of  Medicine.  By  E.  C.  Spitka,  M.D.,  President 
of  the  New  York  Neurological  Society,  New 
York,  E.  B.' Treat  &  Co.,  771  Broadway,  1887. 
Price  $2.75. 

This  work  seems  to  be  especially  valuable  to 
medical  students— for  there  is  a  conciseness  and 
completeness  about  it  which  is  really  remarkable. 
For  the  same  reason,  perhaps,  it  will  commend 
itself  to  the  busy  practitioner. 


A  Practical  Treatment  on  the  Diseases  if  the 
Hair  and  Scalp.  By  Geo.  Thos.  Jackson,  M.D., 
Instructor  in  Dermatology  in  the  New  York 
Polyclinic;  New  York,  E.  B.  Treat,  771  Broad- 
way.    Price  $2.75. 

In  this  age  of  specialism,  we  have  not  yet  heard 
of  any  man  who  has  taken  the  scalp  and  its  adorn- 
ment under  his  special  protection.  AVe  have, 
however,  heard  of  enquiries,  having  more  than 
once  been  made  for  such  a  specialist,  so  that  if 
demand  creates  supply  his  appearance  is  not  dis- 
tant. In  the  meantime,  it  must  be  confessed,  the 
diseases  of  the  hair  and  scalp — especially  the 
former,  have  received  from  most  authors  but 
shabby  treatment.  In  the  work  before  us,  we  have 
a  really  excellent  little  treatise,  valuable  also  on 
account  of  its  eminently  practical  character,  and 
as  such  we  commend  it  to  all  who  desire  to  post 
themselves  on  a  subject,  in  which,  if  pro])erly 
handled,  there  is  money. 


24 


THE   CANADA    MEDICAL   RECORD. 


OBITUARY. 
Hrnry  Howard,  M.R.C.S.,  Eng. 
It  is  with  very  deep  regret  that  we  have  to  re- 
cord the  death  of  Dr.  Henry  Howard,  one  of  the 
oldest  practitioners  in  Montreal,  wliich  event,  not 
unexpected,  took  place  c5n  the  i2ih  of  October. 
For  over  a  year  it  was  evident  that  his  health  was 
failing  ;  but,  notwitlistanding  more  than  one  warn- 
ing, he  continued  to  look  after  his  work  and  move 
about.  For  several  weeks  before  ilie  end  came, 
he  was  confined  to  the  house,  and  on  the  date 
named  he  passed  quietly  away.  Dr.  Howard  was 
born  in  Nenagh,  Ireland,  on  the  ist  of  December, 
1815.  He  studied  medicine  in  Dublin  with  ihe 
celebrated  Dr.  Jacob.  He  came  to  Canada  in 
1842,  first  living  in  Kingston,  and  in  1845  '""^ 
came  to  Montreal.  He  was,  we  tliink,  the  first 
specialist  in  tliis  city  on  diseases  of  the  eye  and 
ear,  and  for  several  years  conducted  the  Montreal 
Eye  and  Ear  Institution,  where  thousands  of  the 
jioor  were  treated,  the  Government  giving  it  a  small 
grant.  Dr.  Howard  was  a  jnolific  political  writer, 
and  about  1S58  wrote  a  series  of  iJolitical  letters, 
which  apj)eared  in  the  Montreal  Evening  Pi/ot 
under  the  name  of  ''  L  ttlc  Bo-Fccp."  These 
attracted  the  attention  of  the  great  political  leader, 
Sir  John  A.  Macdonald,  and  when  a  year  or  two 
later  the  Government  decided  to  establish  a 
Lunatic  Asylum  at  St.  Johns,  Q  ,  Dr.  Howard 
was  appointed  its  Medical  Superintendent.  The 
wisdom  of  thisap|iointuient  was  at  tlie  time  vigor- 
ously assailed,  but  whatever  truth  there  was  then 
in  the  statement,  that  he  was  totally  inexperienced 
for  such  an  office,  it  is  beyond  question  that  his 
vigorous  and  scientific  mind  soon  grappled  with 
the  subject  of  insanity,  so  that  before  long,  even 
his  enemies  admitted  that  he  had  fully  quilified 
himself  for  the  position.  Hamjiered  as  he  was  at 
St.  Johns,  with  what  was  perhaps  the  worst  make 
shift  for  an  Asylum  that  the  world  ever  saw,  he 
produced  results  which  were  hardly  credible,  but 
redounded  to  his  ability  and  foresight.  When 
Confederation  placed  the  care  of  the  insane  under 
Provincial  management,  and  the  Asylum  at  St. 
Johns  was  closed,  and  the  insane  removed  to  the 
St.  Jean  de  Dieu  Asylum  at  Longue  Pointe,  Dr. 
Howard  was  appointed  its  Government  Medical 
Inspector.  Here  began  the  troubles  of  his  life, 
for  his  scientific  mind,  now  thoro\ighly  trained  to 
his  special  work,  was  entirely  ojiposed  to  tlie 
system  of  farming  out  lunatics.  We  have  seen  and 
read  in  manuscript  report  after  report,  which  he 


sent  to  the  Local  Government,  protesting  against 
the  system,  and  the  general  management  of  those 
placed  within  the  walls  of  this  large  Institution  ; 
but  so  far  as  we  have  any  knowledge,  not  one  of 
these  reports  have  ever  been  printed,  and  certainly 
the  result  he  wished  and  worked  for  was  never 
acconijilished.  His  work  as  Medical  Inspector, 
under  these  circumstances,  can  hardly  have  been 
called  a  labor  of  love  ;  and  of  late  years,  owing  to 
disagreements  between  the  Government  (Contrac- 
tor")  and  the  Lady  Superior,  his  ]wsition  was  de- 
decidedly  unpleasant  ;  the  constant  worry  and 
vexation  to  which  he  was  subjected  had  great 
effect  upon  his  system,  so  much  so,  that  more 
than  once  lie  expressed  to  the  writer  the  fear  that 
it  was  undermining  his  constitution.  In  the  hope, 
however,  of  yet  accomplishing  something  for  the 
benefit  of  his  suffering  fellow  creatures,  he  endured 
it  all,  and  at  a  time  of  life,  when  nature  called  for 
cpiiet  and  repose.  We  have  the  hope,  however,  that 
what  we  may  call  his  life-work  has  not  been  in 
vain.  In  his  views  on  insanity.  Dr.  Howard  was 
in  advance  of  most  of  his  co-temporaries.  He 
believed  that  all  criminals  were  insane,  and  there- 
fore irresponsible  ;  some  held  that  the  future  would 
prove  his  theory  as  correct,  others  that  it  was 
wild  and  Utopian.  He  wrote  many  articles  on 
subjects  allied  to  his  speciality,  which  were  read 
before  the  Medico-Chirurgical  Society  of  Montreal, 
and  subsequently  aiijicared  either  in  this  Journal 
or  in  the  Caniida  Mfdical  and  Surgical  Journal. 
In  1SS2  he  published  a  small  volume  upon  "The 
Philosophy  of  Insanity,  Crime  and  Responsibil- 
ity.'' He  was  an  Ex-President  of  our  Medical 
.Society,  and  till  a  few  months  before  his  death, 
the  most  regular  attendant  at  its  meetings,  setting 
an  example  to  some  of  the  elders  of  the  profession 
in  Montrcil,  which,  we  are  sorry  to  say,  they  do 
not  follow.  At  its  meeting,  his  familiar  figure 
with  his  flowing  white  beard  and  accompanying 
snuffbox,  was  ever  a  welcome  sight  to  his 
yoiuiger  brethern,  who,  it  may  truthfully  be  said, 
"  loved  him  for  his  kind,  warm  and  generous 
nature."  He  was  a  warm  debater,  hit  hard  some- 
times, but  always  gentlemanly.  It  will  be  many 
long  years  before  the  present  members  will  cease 
to  feel  the  want  wliich  his  absence  creates.  We 
fully  endorse  the  closing  words  of  his  obituary  in 
the  Canada  ^fed!cal  and  Surgical  Journal  oi  this 
city  :  "A  brave  manly  life,  fought  with  unwaver- 
ing cheerfulness  through  many  and  grave  difficul- 
ties, and  laid  down  at  last  with  the  quiet  calmness 
begotten  of  conscious  rectitude." 

His  remains  were  removed  to  St.  Johns,  Que., 
where  they  were  interred, 


THE  CANADA  MEDICAL  RECORD, 


Vol.  XVI. 


MONTREAL,    NOVEMBER,    1S87. 


No.  2. 


COnSTTEItTTS. 


ORIGINAL  COMMUNICATIONS. 

Ki-tioB|if.l   111'  <lync.'ol..>;y 25 

'J'lio   ,^liirlii(l  Changes  and  Surgery  of 
tlio  Nail 28 

COIIUKSI-ONDEXCE 

PROGRESS  OF  SCIENCE. 

Menstrual i(in,  its  Nerve  *_>rigin  not   a 

Shedding  of  .Mucous  Menihrano. ...     31 
'riie  Treatment  of  Palpitation 34 


.Sick  llenilnclio .'« 

Tlie  Treatun'iit  of  Ulipumati.sm 3G 

AUeadyMelhod  for  Kenioving  Foreign 

Uodies  from  tlie  Anterior Nurea... .  37 

Philadelphia  Hospital        37 

Injections  of  Warm  Water  in  Dy-entery  3!i 

Fibroid  Tumors  of  the  Uterus 40 

(.;lironi(!  «;oii8tipaliou 43 

Tho  Alnises  of  Milk  Diet  in  'J  herapou 

ties 45 


Foraeie  Acid  in  the  Treatment  of  I.eu- 

corrhea 46 

C.Tiise  and  f'urc  of  a  Certain  Form  of 

IJacIiaehe 47 

Treatment  o£  Psoas  Abscess... 48 

EDITORIAL. 

New  Hospital  in  Toronto 4* 

OMIuary 4S 

Peusonals 48 


&M0mai  BnmmunkaUoni. 


RETROSPECT  OF  GYNECOLOGY. 

By  A.  Lapthorn  Smith,  B.A.,  M.D.,  M.R.C.S.,,  Eng  . 

Professor  of  Medical    Jurisprudence  and   Lecturer  on 

Gynecology  in  Bishop's  College  Medical  Facidty- 

The  past  year  has  been  an  eventful  one  in  the 
history  of  the  medical  sciences,  but  in  no  depart- 
ment of  them  have  the  workers  been  more  active 
than  in  Gynecology.  The  reason  for  this  is  not 
difficult  to  find  ;  the  field  is  large,  almost  unlimited  ; 
the  workers  are  comparatively  few ;  and  the 
rewards  won  by  success  are  larger  than  in  almost 
any  other  branch.  Such  being  the  case,  it  has 
attracted  to  the  ranks  a  considerable  number  of 
very  able  men,  with  the  result  that  it  has  rapidly 
advanced  from  the  position  of  an  uncertain  and 
indefinite  science  to  that  of  one  of  the  most  exact. 
In  the  limits  of  this  article  we  can  only  attempt  to 
give  a  very  brief  outline  of  the  most  important  im- 
provements in  treatment.  One  of  the  most  remark- 
able changes  which  have  lately  taken  place  in  gyne- 
cological practice  is  the  almost  complete  abandon- 
ment of  the  pessary,  and  the  substitution  for  it  of 
operative  procedure.  This  is  due  to  the  more 
rational  comprehension  of  the  causeswhich  lead- 
to  displacements  of  the  uterus.  So  that  instead  of 
trying  to  bolster  up  a  too  heavy  organ  with  a  hard 
mechanical  and  unnatural  support,  such  as  a 
pessary,  the  modern  gynecologist  takes  immediate 
steps  to  reduce  its  size  and  weight,  and  then  to 
lighten  up  the  weak  and  relaxed  ligaments.  This 
result  is  obtained  in  various  ways  by  different 
operators.     Thus   Martin  of  Berlin   and  Soleris 


of  Paris  at  a  single  sitting  perform  partial  ampu- 
tation of  the  cervix,  then  anterior  and  then 
posterior  colporrhaphy.  The  three  operations  are 
generally  completed  in  one  hour,  for  being  perform- 
ed under  constant  irrigation  with  vv-eak  antiseptic 
solutions,  no  time  is  lost  in  sponging;  while  for 
the  colporrhaphies  the  running  catgut  suture  is 
used  in  one,  two,  or  three  layers,  according  to  the 
size  of  denudation,  and  this  saves  the  time  wliich 
would  be  spent  in  tying  the  knots  in  the  interrupted 
suture.  Others,  such  as  Alexander  of  Liverpool, 
make  use  of  the  round  ligament,  which  they  shorten 
to  drag  the  uterus  uinvards  and  forwards.  Kellog 
of  Battle  Creek  combines  Alexander's  operation 
with  Lefort's  operation  of  medium  colporrhaphy, 
which  consists  in  making  a  bridge  or  raphe  in 
the  vagina  by  uniting  the  anterior  and  posterior 
walls  for  such  a  distance  as  the  case  may  require. 
A  strip  of  surface  from  three-fourths  of  an  inch  to  an 
inch  in  width  is  denuded  from  each  wall,  from  a 
point  about  an  inch  below  the  iitero-vaginal  junc- 
tion, as  low  as  may  be  necessary  to  turn  in  complete- 
ly both  the  rectocele  and  the  cystocele  present. 
The  edges  are  properly  brought  together  with 
sutures.  Dr.  Kellog,  in  speaking  on  this  subject  be- 
fore the  International  Congress,  said:  "  A  woman 
who  is  dependent  upon  a  pessary  is  almost  equal- 
ly dependent  upon  a  doctor  to  inspect  the  appli- 
ance at  stated  intervals,  and  substitute  a  new  one 
as  each  successive  ring  or  lever  or  other  device 
loses  its  efficiency  by  the  stretching  of  the  vaginal 
walls,  or  other  injurious  modification  of  the  parts, 
and  has  little  or  no  hope  of  radical  cure,  even 
after  years  of  treatment.  "  And  he  added  :  •"  If 
this   operation    succeedj   half  as   well  as   presisnc 


26 


THE   CANADA    MEDICAL   RECORD. 


predictions  seem  to  indicate  that  it  will,  many 
thousands  of  pessary  pestered  women  will  rise  up 
and  call  great  and  blessed  the  fortunate  di  scoverer 
of  this  most  valuable  surgical  procedure." 

Others  again,  while  recognizing  the  uselessness 
of  the  pessary,  are  not  quite  so  ready  to  advocate 
operative  procedure.  They  hold  that  the  weight 
of  the  organ  can  be  reduced  by  faroring  invo- 
lution and  activating  the  general  and  local  circu- 
lation by  appropriate  treatment,  while  the  uterine 
supports  can  be  made  to  do  their  duty  by  exer- 
cising the  abdominal  and  pelvic  muscles,  and  by 
building  up  the  general  health.  Their  method  is 
perhaps  the  most  rational  one.  Formerly  their 
treatment  consisted  in  the  introduction  of  glycerine 
of  tannin  tampons,ialternately  with  the  hot  douche, 
in  the  vagina,  and  the  application  of  Churchill's 
iodine  to  the  endometrium  and  cervix.  This 
treatment  though  tedious  is  fairly  successful  in 
cases  of  slight  or  medium  severity.  But  in  severe 
cases  Apostoli's  discovery  of  the  wonderful  trophic 
influence  of  the  galvanic  current  in  causing  the 
absorption  of  fibro-plastic  exudation,  by  which 
involution  can  be  rapidly  artificially  produced,  and 
his  application  of  Tripier's  method  of  toning  up 
relaxed  muscular  tissue  with  the  Faradic  current 
of  low  tension  has  already  begun  to  work  a  revo- 
lution in  gynecological  treatment.  Veit,  Wyder, 
and  Martin  consider  the  mucous  membrane  as 
the  starting  point  of  uterine  disease,  and  they  re- 
move it  in  nearly  every  case  with  the  semi  sharp 
curette.  Apostoli  removes  it  with  thegalvano-chem- 
ical  cautery,  which  at  the  same  time  renders  the 
uterus  more  able  to  form  anew  and  healthy  lining 
membrane.  It  is  remarkable  to  see  how  much 
interference  the  uterus  can  bear  on  condition  of  a 
rigorous  antisepsis.  One  sees  many  times  a  day 
in  Berlin  the  uterus  dilated,  the  mucous  membrane 
scraped  away  until  one  hears  the  steel  scratching 
on  the  raw  muscle  beneath,  and  then  injected  with 
tincture  of  iodine,  and  irrigated  with  sublimate 
or  carbolic  solution,  without  the  slightest  risk. 
And  yet  without  antispetic  precautions,  the  mere 
passing  of  the  sound  alone  has  often  proved 
fatal.  It  is  thus  that  Goodell  practises  rapid  dila- 
tation of  the  uterus  to  one  and  a  half  inches, 
with  the  vagina  full  of  antiseptic  solution,  while 
some  honest  country  doctor  sends  for  his  instru- 
ment and  soon  has  a  fatal  case  ot  peritonitis. 
The  first  lesson  for  everyone  to  learn  who  intends 
to  practice  gynecology  is  the  thorough  appreciation 
of  the  importance  of  keeping  himself,  his  instiu- 


ments,  and    his    patient    clean,  with  or   without 
antiseptics. 

The  treatment  of  cancer  of  the  uterus  has  also 
made  much  progress,  principally  through  the 
labors  of  Freund,Schroeder,  Martin,  Olshausen,  and 
Gusserow  in  Germany,  in  perfecting  the  method 
of  total  extirpation  of  the  uterus  per  vaginam  or 
vaginal  hysterectomy,  as  it  is  called.  The  mortal- 
ity which  was  29  per  cent,  in  1881  has  now  been 
reduced  to  15  per  cent,  in  1886. 

The  following  is  Martin's  method  :  The  bowels 
are  thoroughly  emptied,  the  vagina  thoroughly 
disinfected  by  an  antiseptic  irrigation,  the  patient 
placed  on  her  back  and  anffisthctized.  The  vault 
of  the  vagina  is  exposed  by  means  of  a  Simons 
speculum  and  side  pieces ;  the  cervix  is  seized  by 
bullet  forceps  on  its  posterior  border,  and  drawn 
forward  as  much  as  possible  toward  the  symphisis 
pubis.  This  stretches  the  posterior  arch  of  the 
vagina  and  the  insertion  of  the  vagina  can  be 
nicely  determined.  He  then  makes  an  incision 
along  the  whole  length  of  this  insertion  so  as  to 
get  into  Douglas'  cul  de  sac  as  quickly  as  possible. 
This  is  frequently  attained  with  the  first  cut.  This 
accomplished  he  enlarges  the  cut  so  that  the  fore- 
finger of  the  left  hand  can  enter,  and  then  with  a 
small  needle  very  much  curved  he  sews  the  perito- 
neum and  vagina  together  all  along  the  cut,  thereby 
arresting  haemorrhage.  The  cervix  is  then  drawn 
forcibly  backwards,  and  the  anterior  vaginal  vault 
is  cut  through  in  the  same  way,  the  bladder  is 
peeled  back  from  the  cervix  with  the  thumb  nail, 
and  the  peritoneum  sewed  to  the  vagina  as  behind. 
The  fundus  is  then  grasped  with  the  bullet  forceps 
and  retroverted  little  by  little  until  it  is  dragged 
into  the  vagina.  The  left  broad  ligament  is  then 
sewed  with  strong  thread  in  a  double  row  of 
stitches  and  the  tissue  is  cut  between  them.  The 
uterus  is  then  further  dragged  down,  being  only 
held  by  the  right  broad  ligament  which  is  tied  in 
several  segments  and  divided.  During  the  oper- 
ation a  weak  warm  solution  of  carbolic  acid  plays 
constantly  on  the  field,  doing  away  with  sponges, 
except  when  the  operation  is  over  to  dry  out  Doug- 
las' pouch,  into  which  he  then  introduces  a  thick 
aseptic  drainage  tube  which  is  held  in  place  by  a 
cross  piece  ;  and  the  other  end  of  which  is 
turned  into  the  vagina  which  is  filled  with  iodoform 
gauze.  Of  course  vaginal  hysterectomy  will  be 
followed  by  recurrence,  unless  it  is  performed  at 
thebeginning  of  the  disease  before  the  neighboring 
tissues  have  become  infiltrated.     When  this  has 


THE    CANADA   MEDICAL    UKCORD, 


27 


happened  the  disease  may  be  delayed,  and  life 
made  tolerable  for  a  long  time,  by  destroying  the 
diseased  tissues  with  the  "  Paquelin's  cautery,  " 
and  then  carrying  out  the  dry  treatment  with  in 
sufflations  of  iodoform,  and  plugging  the  vagina 
with  tampons  of  sublimated  absorbent  cotton.  We 
have  at  present  a  case  under  our  care  where  the 
disease  comjjletely  fills  the  pelvis,  and  yet  the 
patient  only  requires  treatment  every  five  or  six 
days.  Fritch  employs  iodoform  gauze,  and  he 
says  that  it  relieves  the  pain,  foul  discharges 
and  haemorrhage  so  that  the  patients  think  they 
are  well. 

Dr.  Chauvrin,ofNew  York,  recommends  Alveloz 
which  has  the  power  of  diminishing  to  a  marked 
degree  the  amount  of  the  discharge,  and  rendering 
it  decidedly  less  offensive. 

Dr.  Carpenter,  of  Cleveland,  says  that  Lactic 
acid  has  the  power  of  dissolving  sloughing  tissue, 
leaving  a  healthy,  granulating  surface.  It  is  app- 
lied freely  on  absorbent  cotton,  and  then  washed  off. 

The  Gynecologist  often  needs  to  know  whether 
the  uterus  is  gravid  or  not,  and  sometimes  this  is  a 
difficult  matter  to  decide.  We  recently  had  a  case 
of  fibroid  sent  to  us  for  Apostoli's  treatment,  and 
having  just  previously  read  an  article  by  Dr.  Mc- 
Kee,  of  Cincinnati,  on  the  characteristic  color  of  the 
vagina  in  pregnancy,  we  were  able  to  state  our 
opinion  to  that  effect  at  the  first  examination. 
It  may  be  described  as  greyish  purple,  or  dark 
purple.  Dr.  Z.  W.  Farlow  {Bostoji  Med.  &  Surg. 
Journal,  ]vi\Y  21,  1887)  calls  it  a  blue  color,  and  he 
gives  the  following  analysis  in  1 4 1  cases  : 

36     no  color. 

55     color  suggestive. 

70     color  characteristic. 

In  our  case  an  abortion  a  month  after  beginning 
the  treatment  bore  out  our  conclusion.  In  this 
case  we  went  on  with  the  treatment  with  our  eyes 
open,  because  she  was  so  much  reduced  by  suffer- 
ing that  her  life  was  in  danger,  and  her  abdomen 
was  so  distended  with  fibroids  that  the  uterus 
could  not  expand  much  farther.  Besides,  she  had 
come  a  journey  of  nearly  a  thousand  miles  to  be 
treated  with  electricity,  and  was  determined  not 
to  go  back  until  their  growth  was  stopped.  The 
tumors  are  diminishing,  and  she  has  passed  through 
the  miscarriage  at  five  month  ssafely  and  without 
any  haemorrhage  whatever,  although  she  suffered 
severely  from  the  dragging  on  the  adhesions  of 
one  of  the  tumors  to  the  abdominal  wall,  caused  by 
the  return  of  the  uterus  to  its  non-pregnant  size. 


She  would  probably  have  miscarried  soon  at  any 
rate,  and  now  the  tumors  will  be  rapidly  reduced 
in  sire  by  the  electric  current. 

Dr.  Weeks  reported  a  case  of  myoma  in  a  preg- 
nant lady,  where  after  consultation  an  abortion 
was  brought  on,  and  which  was  followed  by  death. 
In  that  case  there  were  no  urgent  symptoms  for 
interference,  and  we  thought  it  would  be  better  to 
leave  such  cases  alone  until  after  delivery  ;  for  as 
Dr.  'Rtiii{Ci?icinnali Lancet-CiinU,  Dec.  3,  1887) 
says  many  women  not  only  go  through  their 
pregnancy  and  delivery  without  any  trouble,  but 
their  fibroids  participating  in  the  general  resorptive 
process  of  involution  sometimes  disappear. 

Apostoli's  treatment  not  only  bids  fair  to  com- 
pletely do  away  with  the  knife  in  the  treatment 
of  fibroids,  but  also  promises  to  throw  considerable 
light  on  their  nature  and  cause.  We  know  that 
the  uterus  will  become  heavy  and  indurated 
whenever  the  processes  of  nutrition  and  circula- 
tion are  slow,  and  a  sectioii  of  such  an  organ 
reveals  an  abnormal  amount  of  fibrous  tissue. 
And  it  is  no  longer  a  theory  but  a  fact  that  this 
exudated  fibrous  tissue  can  be  called  back  into 
the  circulation  under  the  stimulating  influence 
of  the  galvanic  current,  so  that  the  organ  becomes 
soft  and  muscular.  To  us  it  seems  that  a  fibroid 
tumor  is  but  a  deposit  of  lymjjh  which  has  exuded 
from  the  vessels  under  the  influence  of  a  tardy 
vital  power  and  circulation.  Under  certain  con- 
ditions of  improved  health  the  trophic  nerves  call 
back  this  exudation  into  the  circulation,  while  in 
others  this  can  be  done  artifically  by  the  aid  of 
electricity.  As  an  instance  of  this  we  may  cite 
a  case  under  our  care,  and  which  will  be  reported 
in  due  time,  where  a  uterus  which  was  hanging 
several  inches  outside  of  the  vulva  and  into  which 
the  sound  entered  five  and  a  quarter  inches,  has 
with  less  than  thirty  applications  of  the  galvanic 
negative  current  been  so  much  reduced  in  size, 
that  the  sound  only  enters  three  inches,  and  the 
weight  is  so  much  less  that  it  can  very  rarely  be 
seen  at  the  vulva  at  all. 

The  teachings  of  Macan,  Master  of  the  Dublin 
Rotunda  hospital,  are  beginning  to  make  his  British 
brethren  realize  that  the  uterus  has  no  fixed  posi- 
tion either  antero  posteriorly,  or  with  regard  to 
its  height  in  the  pelvis.  We  have  long  held  this 
view,  that  the  organ  is  never  for  ten  consecutive 
seconds  in  the  same  position.  It  is  carried  back- 
wards when  the  bladder  is  full,  and  forwards  when 
the  latter  is  emptied ;  and  in  the  same  way  its  posi- 


28 


THE   CANADA   MEDICAL   RECORD. 


tion  is  modified  by  the  state  of  the  rectum.  We 
showed  in  a  paper  read  before  the  International 
Congress  that  its  height  in  the  pelvis  varied  also 
from  hour  to  hour  according  to  the  degree  of 
strength  or  fatigue  of  the  muscles  in  its  so  called 
ligaments  or  supports.  For  the  uterus  to  lie  helpless 
on  the  pelvis  flow  is  not  a  normal  position  be- 
cause every  movement  communicates  a  jar  to  it. 

It  matters  little  whether  it  is  anti-verted  or  retro- 
verted,  as  long  as  it  is  floating  or  suspended.  The 
result  of  the  appreciation  of  this  fact  will  be  that, 
fresh  air,  good  food,  removal  of  corsets  and  healthy 
exercise,  wtth  iron  and  strychnine,  will  be  pres- 
cribed more,  and  pessaries  less  and  less. 

Principally  owing  to  the  teachings  of  Lawson 
Tait,  a  new  method  of  treating  peritonitis  has 
been  introduced.  Instead  of  keeping  the  bowels 
rigorously  locked  with  opuim  he  gives  large  con- 
centrated doses  of  salines  (we  prefer  sulphate  of 
soda  in  5  ss  doses),  repeated  several  times  and 
aided  by  large  turpentine  enemata.  Dr.  Baldy 
(American  Journal.  Obstetrics,  Dec.  '87)  says  the 
symptoms  begin  to  subside  almost  immediately 
when  the  bowels  commence  to  discharge  watery 
stools.  Osmosis  takes  place  from  the  lighter  to 
denser  fluid,  so  that  if  the  saline  solution  is  many 
times  denser  than  the  peritoneal  effusion,  the  latter 
will  be  drawn  into  the  intestine  and  thus  leave 
less  pabulum  for  the  microbic  fermentation.  Be- 
sides there  will  be  less  chance  for  the  formation 
of  adhesions,  and  even  when  formed  they  maj  be 
broken  up. 

Some  doubt  has  been  cast  on  the  abilty  of  elec- 
tricity to  kill  an  e.\tra  uterine  foetus,  and  conse- 
quently laparatomy  has  been  advised  the  moment 
intra  uterine  fcetation  is  diagnosed.  We  can  say 
that  1 25  milliamperes  of  the  constant  current  does 
not  kill  it  when  applied  directly  to  it  in  the  uterus, 
for  in  the  case  mentioned  above,  the  fcetus  was 
born  alive  after  having  had  that  strength  applied 
several  times.  But  of  course  it  had  been  applied 
without  shock. 

We  shall  review  some  other  advances  in  Gyne- 
cology in  a  future  article. 


THE  MORBID  CHANGES  AND  SURGERY 

OF  THE  NAIL.* 

By  J.  Leslie  Foley,  M.  D.,  Bishop's  College,  L.  R  C.  P., 

of    London,    formerly    Professor   of   Anatomy, 

Mediciil  Faculty,  University  of 

Bishop's  College. 

Mr.  Pre.sident  and  GentlemiiN  :  I  read  this 
paper  more  for  my  own  instruction  than  for  yours, 
hoping  that  it  may  provoke  discussion,  and  that  I 

*Read  before  the  Srn-gical  Section  of  the  Suffolk  District 
Medical  Society,  April  6,  1SS7. 


may  thereby  learn  the  views  of  members  of  riper 
experience  and  maturer  judgment  than  my  own. 
The  nail  seeins  a  somewhat  trivial  and  ordinary 
subject  to  occupy  the  minds  of  learned  inembers 
of  this  Society,  but  it  iS  only  by  contemplating 
the  smaller  objects  that  we  are  fully  able  to 
appreci;ite  the  larger  ;  and  in  practice,  as  in  life, 
the  careful  attention  to  little  things  often  tends 
greatly  to  oit's  success.  In  order  proi-erly  to 
understand  the  morbid  changes  of  tl.e  nail,  it  is 
necessary  to  be  familiar  with  its  noimxl  structure. 
Pardon  me,  therefore,  if  I  refresh  your  inemories 
by  briefly  referring  to  its  anatomy.  A  nail  is  a 
peculiar  ar  angement  of  epidermal  cells  :  the 
undermost  of  which  are  rounded  or  elongated;  the 
superficial  are  flattened,  and  of  a  more  hairy 
consistence.  Thatmodified  portion  ofthecorium 
by  which  the  nail  is  secreted  forms  the  tiiatrix,  and 
extends  leneath  its  root  and  body.  The  back 
edge  of  the  nail  or  root  is  received  into  a  shallow, 
crescentic  groove  in  the  matrix.  The  front  part 
is  free,  and  jjrojects  beyond  the  extremity  of  the 
digit.  The  intermediate  portion  of  the  nail  rests 
by  its  broad  undcr-surface  on  the  front  part  of  the 
matrix,  which  here  forms  its  bed.  The  pari 
between  the  root  and  free  extremity  of  the  nail 
makes  up  its  body.  The  matrix  beneath  the 
body  is  not  uniformily  smooth  on  the  surface,  but 
is  raised  in  the  form  of  longitudinal  and  nearly 
parallel  ridges,  on  which  are  moulded  the  epider- 
mal cells  of  which  the  nail  is  made  up.  The 
growth  of  the  nail  is  effected  by  a  constant  produc- 
tion of  cells  from  beneath  and  behind 

Excessive  growth  of  nail  substance  occurs  either 
by  multiplication  of  the  nails  or  increase  in  bulk. 
This  anomaly  includes  the  occurrence  of  nails  in 
unusual  places,  such  as  on  scapular  region,  on  last 
phalanx  of  stipernumerary  fingers  or  toes,  double 
nails  on  fingers  or  toes,  etc. 

Both  go  by  the  name  of  onychauxis  or  hypertro- 
phy. These  vary.  In  the  first  it  appears  spher- 
ically curved,  glossy  on  surface  ;  a  grayish  white 
color,  unshapely,  thick,  opaque,  has  a  massive 
feel,  and  is  very  hard.  When  the  whole  nail  is 
affected,  its  free  border  has  a  tendency  to  curve 
downwards.  It  may  occur  in  various  directions, 
according  as  it  is  disturbed  in  the  vertical  or 
transverse  way  (onycbogryphosis).  In  its  simplest 
form,  it  becomes  clam-like.  In  other  cases,  it  tuay 
curve  spirally. 

SynpUms.  Loses  its  elasticity  ;  becomes 
thickened.  Loss  of  tactile  sense.  It  is  very  much 
diminished,  and  reduced  to  a  minimum.  Patient 
unable  to  execute  fine  work,  and,  when  enlarge- 
ment considerable,  incapacitated  for  work.  When 
toe-nails  affected,  walking  interfered  with  ;  and, 
at  the  sariie  time,  most  unpleasant  effects  (inflam- 
mation and  suppuration)  are  produced  by  nails 
enlarged  laterally.  If  uncared  for,  they  penetrate 
toward  the  lateral  groove  and  grow  in.  In  the 
second  form  they  are  slightly  lustrous,  dirty, 
yellowish-brown,  or  yellowish  grayish  white.  Ex- 
ternally, have   well-marked   longitudinal  ribs ;  at 


TUE   CANADA   MEDICAL   RECORD. 


^9 


intervals,  transverse,  more  or  less  elevated  ridges, 
and  here  and  there  liorny  plates. 

Elio/o};}'.  Onychauxis  may  be  congenital  or 
aciiuired.  In  the  former  case,  il  dates  from  the 
theembryoral  period,  and  the  anomaly  appears  in 
the  course  of  life  in  the  great  majority  of  cases 
acquired. 

Defective  or  altogether  neglected  care  of  nail 
may  cause  it.  Uncleanlincss,  accumulation  of 
all  sorts  of  substances  on  the  nail-bed  act  as 
irritants.  This  sometimes  occurs  in  old  people 
and  bed-ridden  patients. 

Traumatic  InAuencc^.  Any  considerable  pres- 
sure for  some  time  from  in  ^front  or  sideways  on 
tiie  extremities,  as  too  short  or  narrow  shoe, 
increases  nutrition  ofnailbed  by  augmented  afflux 
of  blood,  and  gives  rise  to  hypertiopliy. 

Extension  of  morbid  inflammatory  processes  of 
the  corium  and  the  connective  tissue  of  the  cutis 
to  the  matrix  of  the  nail,  as  psoriasis,  eczema, 
etc. 

Defective  formation  of  the  nail,  atrophy,  etc., 
absence  of  the  nails  (anonychia),  or  their  retarded 
growth,  may  also  be  congenital  or  acquired — 
causes  much  the  same  as  in  hypertrophy.  Tiier- 
mic  and  chemical  irritations,  traumatic  influences, 
knock,  blow,  or  pinch,  inflammations  associated 
with  suppurative  and  ulcerative  processes,  febrile 
diseases,  and  all  chronic  wasting  diseases,  may  be 
ranked  as  etiological  factors.  The  cutaneous 
and  nervous  affections  causing  hyperplasia  may 
also  give  rise  to  aplasia. 

Characteristics  of  an-imperfectly  developed  nail. 
I^ustritous,  delicate,  a  whitish-gray  color,  giving 
the  impression  of  a  thickened  membrane,  posses- 
sing but  a  slight  hardness,  readily  broken  and 
flexible.  Dr.  Ashurst  observes,  in  a  foot  note  in 
his  "  Principles  and  Practice  of  Surgery,''  that 
Guenthre,  a  Danish  surgeon,  and  Nillien,  of 
Illinois,  have  noticed  that  the  growth  of  nail  is 
retarded  during  the  early  stages  of  fractures,  to 
be  resumed  as  repair  goes  on.  They  suggest  this 
as  a  means  of  testing  the  progress  of  the  cure, 
without  disturbing  the  dressings  in  cases  of  delay- 
ed union  or  false  joint.  The  growth  of  nail,  how- 
ever, may  be  checked  by  any  cause  which  inter- 
feres with  the  nutrition  of  the  part.  Hence  the 
test  might  not  be  universally  applicable.  Mitchell 
has  noticed  an  arrest  of  growth  incases  of  cerebral 
paralysis.  Gay  the  same,  as  a  result  of  compres- 
sion of  the  subclavian  artery. 

Nails  may  be  deformed,  degenerated,  or  discol- 
ored. They  may  be  abnormally  long  or  short, 
|broad  or  narrow,  flat  or  curved.  A  cut  of  a  pen- 
snife  will  cause  a  bending  of  the  nail.  These 
ieformities  are  not  generally  amenable  to  treat- 
nent.  Too  much  stress  is  laid  in  works  on 
clinical  medicine  as  to  the  value  of  the  color  of 
[the  nail  in  various  diseases.  These  are  due  to 
processes  of  nail-formation. 

Animal  and  vegetable  parasites  affect  the  nail. 
The  sarcoptes  scabiei  attacks  the  nail.  In 
tropical  regions,  there  are  a  number  of  flies  which 


lay  their  eggs  under  the  nails.  Sand-fleas  will 
cause,  first,  violent  pain,  and  subsetiuently, 
paronychia,  associated  with  loss  of  nail. 

Vegetable  parasite,  onychomycosis.  In  only 
two  mycoses  of  the  skin,  favus  and  herpes  tonsu- 
rans, has  it  been  clearly  demonstrated  that  trans- 
ference of  their  fungi  will  cause  changes  in  the  nail, 
that  is,  onchomycosis.  Tinea  favosa  is  rarer  than 
tricophyton  or  tonsurans.  'J'lie  clinical  features 
are  similar.  Nails  brittle,  frayed  out,  intersected, 
are  lifted  up  according  to  the  quantity  of  epider- 
mis under  them,  become  gryphotic,  thickened, 
flake  off,  faded,  dirty  yellow  color,  and  often 
become  greatly  disfiguring.  Both  the  achorion 
schonleinii  and  tricophyton  tonsurans  produce  the 
above  alterations.  In  a  few  cases,  the  nail  pre- 
sents a  yellow-suli)hur  color,  due  to  favus. 

Horny  growths  sometimes  spring  from  bcneatii 
the  nail. 

Ungual  exostosis  frequently  appears.  Both 
require  excision. 

The  nail  is  closely  related  to  the  hair.  I  might 
mention,  in  passing,  an  instance  known  to  me, 
which  will  serve  to  bear  out  this  remark.  A 
gentleman  was  camping  out,  some  summers  ago, 
in  the  Hudson  Bay  region.  One  night  a  dread- 
ful lightning-storm  took  place.  The  following 
morning,  not  only  every  hair  on  his  body  fell 
out,  but  he  was  also  bereft  of  every  nail,  and 
remains  hairless  and  nailless  to  this  day,  notwith- 
standing the  use  of  the  whole  armamentarium  of 
the  pharmacopoeia.  The  matrix  of  the  nail  is 
sometimes  the  seat  of  inflammation,  etc.  In  its  sim- 
pler form,  we  have  onychia  simplex;  in  the  more 
severe,  onychia  maligna.  This  last  occurs  almost 
entirely  in  children  under  ten  years.  It  is  not 
very  frequent.  In  Holmes' "  System  of  Surgery," 
Mr.  Thomas  Smith  states  that  out  of  seven  thou- 
sand surgical  out-patients  of  children  under  ten, 
he  found  the  disease  in  nine  instances  only,  and 
these  cases  occurred  between  the  ages  of  one  and 
seven  years.  May  commence  from  a  pinch  or 
crust  of  finger-end,  or  result  from  explosion  of  fire- 
crackers. The  swollen,  bulbous-looking  finger-end  ; 
the  fluid  effused  beneath  the  nail ;  the  thickened, 
flattened,  orcurled-up,  unnatural-looking  nail ;  the 
foul  and  painful  ulcer  exposed  beneath  it,  with 
its  peculiar,  characteristic  fcetor,  and  the  hardened, 
shiny,  and  livid-red  integument  around  it,  are,  no 
doubt,  familiar  to  you  all.  The  disease  may  go 
on  until  the  joint  is  lost,  or  the  phalanx 
necrosed. 

I  take  a  paronychia  to  be  an  acute  inflammation 
of  tissues  underlying  the  nail.  The  ancients  de- 
fine a  paronychia  as  an  inflammatory  tumor  near 
the  nail,  involving  its  pulp  or  matrix.  But  in 
most  modern  works  on  surgery  you  will  find  des- 
cribed under  the  head  paronychia,  whitlow,  felons, 
and  even  inflammation  extending  up  to  the  hand 
or  arm.  The  middle  or  side  of  the  subungual 
tissues  may  be  affected.  Puncture,  concussion, 
contusion,  laceration,  etc.,  may  give  rise  to  a 
paronychia,     If  the  nail   enlarges   in    width,    it 


so 


tlI3   CANADA    MEDICAL    RECORD. 


will  press  on  the  lateral  furrow,  and  this,  coupled 
with  compression  from  a  shoe,  will  cause  a 
paronychia  lateralis.  At  first,  there  will  be  great 
irritability  of  the  parts,  later,  inflammation,  sup- 
puration, great  proliferation  of  granulations,  des- 
truction of  the  cutis,  of  the  tendon,  opening  of  the 
phalangeal  joint,  caries  and  necrosis  of  bones. 
Usually  the  internal  angle  of  the  great  toe  is 
affected,  rarely  the  outside  of  the  little  toe,  seldom 
any  other  toe.  It  may  assume  a  mild  form  or 
become  chronic,  with  now  and  then  an  exacerba- 
tory  character,  may  be  covered  with  irregular, 
spongy,  easily-bleeding  granulations.  It  may  last 
for  years. 

Ingrowing  toe-nail  almost  invariably  occurs  on 
the  outer  side  of  the  nail  of  the  great  toe.  Psoria- 
sis may  affect  the  nail.  It  may  be  although  not 
necessarily  so  an  evidence  of  syphilis.  Central 
part  of  nail  diseased  ;  scabrous  tiiickened,  rough, 
convex,  splits,  deep  fissure  between  the  skin  and 
finger.  Nail  resembles  the  concave  shell  of  an 
oyster.  Affection  chronic  and  difiicult  to 
cure. 

Syphilis  may  attack  the  nail.  Jonathan  Hut- 
rhinsonf  was  one  of  the  first  to  draw  attention,  not 
only  to  the  state  of  the  nail  in  syphilitic  psoriasis 
but  in  congenital  syphilis.  Nails,  symmetrically 
affected,  dry,  brittle,  fissured  and  broken  at  their 
edges,  superficial  layers  alone  diseased.  There  is, 
however,  a  more  remarkable  affection  in  the  form 
of  a  chronic  general  onychitis.  'I'he  nails  decay  and 
fall  off ;  they  first  become  opaque  and  much  thicken- 
ed, their  substance  is  soft.  The  disease  is  due  to 
inflammation  of  the  matri.x  which  is  swollen 
and  readily  bleeds.  Syphilitic  onychia  usually 
attacks  the  toe-nails,  and  is  often  associated  with 
ulcerative  fissures  between  the  toes.  The  inflamma- 
tion is  not  so  severe  as  in  the  non-syphilitic  form. 
Perionyxis  is  a  syphilitic  inflammation  surround- 
ing the  nail,  exists  in  a  dry  and  moist  form.  It 
also  has  a  simple  and  ulcerative  variety.  Deep 
ulcerations  forming  in  the  latter.  Mucus  patches 
are  sometimes  seen  under  the  free  border  of  the 
nail. 

The  surgery  of  the  nail  resolves  itself  into  oper- 
ative and  general  treatment.  If  it  be  troublesome 
on  account  of  its  longitudinal  growth,  this  must  be 
removed  with  the  scissors  in  simple  cases  ;  when 
the  thickness  is  increased  at  the  same  time,  use 
cutting  pliers  or  saw.  Paronychia  lateralis  in  its 
early  stage  may  be  treated  by  removing  that  part 
of  the  nail  wliich  threatens  to  grow  in,  besides 
putting  into  the  groove  fine  threads  of  charpie,and 
ordering  wide  shoes.  When  tlie  inflammation  is 
extensive  it  isAvell  to  use  the  method  of  complica- 
ted pressure,  as  devised  by  Kaposi  of  Vienna. 
This  consists  in  first  removing  that  portion  of  the 
nail  projecting  into  the  inflamed  surface,  then  the 
swollen  edge  of  skin  is  carefully  pressed  downward, 
and  the  widened  space  thus  gained  at  the  furrow 
is  filled  with  accurately  inserted  threads  of  charpie 

tBritish  Medical  Journal,  1865,   p.  45. 


cotton.  In  doing  this,  care  should  be  taken  that 
the  sliarp  edge  of  the  nail  does  not  come  in  con- 
tact with  the  irritated  part  of  the  skin.  This  done, 
strips  of  adhesive  plaster  (emplas  diachylon)  are 
wound  round  the  ungual  phalanx,  commencing  at 
the  affected  part  from  above  downwards,  each 
turn  being  moderately  strefthed,  so  as  to  remove 
the  border  of  the  skin  as  much  as  possible  from  the 
edge  of  the  nail,  to  crowd  it  downwards.  If  this 
is  done  skilfully,  it  will  cause  no  pain  to  tho 
patient,  and  eases  his  condition  at  once.  He  can 
not  only  walk,  but  wear  his  shoes.  After  twelve 
or  twenty-four  hours,  the  dressing  is  taken  off, 
foot  bathed  and  bandaged  anew.  Kaposi  claims 
tliat  this  will  cure  the  patient  in  from  two  to  four 
weeks.  Some  add  medicated  solution  to  the 
charpie,  carbolic  acid,  etc.  If  greatly  developed 
fungous  granulations  are  present,  thty  should  be 
cut  with  the  scissors,  down  to  the  base,  and  the 
bleeding  points  touched  with  nitrate  of  silver.  In 
rare  cases  will  be  obliged  to  resort  to  Dupuytren's 
radical  operation,  that  is,  inserting  pointed  end  of 
scissors  beneath  the  nail,  divide  it  into  two  parts 
firmly  seizing  the  diseased  side  of  the  nail  with 
pliers,  and  pulling  it  out.  The  nail  usually  re-ap- 
pears. A  great  object  in  in-growing  toe-nail  is  to 
give  the  feet  all  necessary  room.  In  the  early 
stage,  when  there  is  no  considerable  mass  of 
overhanging  integument  or  fungous  granulations, 
pressure  of  the  nail  on  the  soft  parts  may  be  re- 
lieved by  packing  into  the  groove  on  the  affected 
side,  oiled  cotton  wool  with  the  flat  end  of  a  probe 
or  pen-knife.  This  may  be  done  without  pain. 
The  quantity  of  wool  may  be  increased  at  each 
application,  until  the  soft  parts  are  raised  and 
pushed  aside.  The  free  edge  of  the  nail  is  expo- 
sed, beneath  which  wool  should  be  inserted  until 
the  natural  state  is  restored.  Nails  should  be 
allowed  to  grow  so  as  to  form  a  right  angle  at  the 
outer  corner.  If  much  inflammation,  the  toe  may 
be  kept  in  water  dressing  during  treatment. 
Overlapping  integument  kept  in  natural  relation 
to  the  nail  by  strips  of  adhesive  plaster.  Dr. 
Tribury  Fox  says,  "In-growing  toe-nail  is  easily 
cured  by  softening  it,  and  then  scraping  off  as 
much  as  possible,  so  as  to  thin  it  in  the  middle." 
A  simi'ar  jilan  may  be  adopted  to  remove  splinters 
imbedded  in  the  nail.  Nail  scraped  thin  over  the 
splinter  and  then  cut  through.  It  can  in  this  way 
be  painlessly  removed.  When  the  nail  cuts  deep- 
ly into  the  flesh,  causing  ulceration  and  fungous 
granulations,  remove  it  at  once,  using  either  spray 
or  cocaine.  Dupuytren's  method,  as  described 
above,  is  the  one  usually  employed  by  surgeons. 
Nails  may  be  cut  by  knife  instead  of  dividing  by 
scissors.  Some  surgeons  prefer  to  remove  the 
whole  nail. 

Dr.  Monks  lias  kindly  called  my  attention  to 
Dr.  Cotting's,  of  Boston,  method  of  treating  in- 
growing toe-nail.  Anything  emanating  from 
Boston  is  sure  to  bear  the  nnpress  of  sterling 
worth.  It  seems  to  me  to  be  the  most  feasible  of  all 
methods.    He  removes  the  fleshy  part  of  the  toe  at 


tllE   CANADA   MEDICAL   RECORD. 


31 


tlie  side  of  the  nail  so  that  it  will  have  nothing  in 
which  to  imbed  itself.  It  is  no  doubt  well  known 
to  you  all.  In  treating  onj'chia,  remove  the  nail 
by  evulsion,  then  dress  the  ulcerative  surface  with 
lilack  wash,  or  the  old  standby,  Abcrnethy's  solu- 
tion, ii  3  lin.  potass;  arsenitis  ad  aq.  i.  3  Arsenic  has 
a  beneficial  effect  on  onychia.  Dr.  Moreloosc,  of 
(ihent,  was  the  first  to  recommend  the  powdered 
nitrate  of  lead  in  onychia  maligna.  It  has  after- 
wards been  used  with  great  success  by  Prof.  Vau- 
zetti,  of  Padua,  and  Sir  William  MacCormac,  of 
London.  It  causes  considerable  pain  when  aj)- 
])lied,  but  its  results  are  excellent.  In  severe  cases 
a  great  portion  of  the  disease  with  nail  may  be 
sliced  off  In  syphilitic  onychia  a  Black,  wash  is 
the  remedy  "  par  excellence.  "  Aminitation  has 
occasionally  been  performed  for  the  cure  of  ony- 
chia maligna.  Tonics  should  always  be  given.  Dr. 
Livinq  recommends  very  highly  the  giving  of  arse- 
nic in  non-syphilitic  psoriasis  ;  a  tonic  will  add  to 
the  effect.  In  the  syphilitic,  mercury  is  of  course 
tiie  remedy.  Appearance  of  nail  improved  by 
filing  down  with  sand-paper.  Skin  near  the  mar- 
gin dressed  with  white  precipitate  ointment.  We 
must  trace  and  treat  the  etiological  factors.  If  an 
eczema  exist  this  must  be  treated  on  derniatologi- 
cal  principles,  diachylon  ointment,  etc.  In  stub- 
born cases,  Prof.  Geben  recommended  using 
vulcanized  rubber  stockings  and  gloves.  When 
all  these  diseases  associated  with  connective  tissue 
and  papillary  hypertrophy  at  the  terminal  plialan- 
ges,  pachyderma,  ichthyosis,  verucca,  etc.,  little  can 
be  done  except  keeping  the  affected  part  clean,  and 
removing  injurious  influences.  When  syphilis 
attacks  the  matrix,  anti-syphilitics  required  ;  when 
animal  and  vegetable  parasites  are  present,  anti- 
parasitics indicated.  Ulcerative  perionyxis  is  one  of 
the  bugbears  of  surgical  therapeutics.  Iodoform  and 
nitrate  of  silver  might  be  tried.  In  defective  nail- 
formation,  endeavor  to  find  out  the  causes  and 
treat  them.  Build  up  the  system  with  tonics. 
Pressure  by  means  of  the  wax  nail  is  useful  here. 
In  all  cases  we  sliould  see  that  the  shoe  is  not  at 
fault,  that  it  fits  well,  not  too  loose  nor  loo  tight.  If 
the  patient  is  a  baker,  carpenter,  etc.,  and  liable  to 
irritation  of  the  fingers,  it  is  well  to  surround  the 
end  of  the  phalanx  with  soft  wax. 

To  the  Editor  of  the  Canada  Medical  Record. 

Sir, — In  'your  last  number,  just  received,  I 
observe  a  quotation  from  ' '  Le  Journal  de 
Gtneve, "  that  a  woman  has  given  birth  to  seven 
children  within  an  interval  of  four  years,  and  that 
they  are  all  alive. '' 

Very  good-  !  brave  woman-  !  I  am  sorry  to  take 
from  her  any  portion  of  her  claim  as  the  largest 
benefactress,  but  she  is  eclipsed  in  that  direction, 


in  the  city  of  Montreal,  where  a  woman  has  given 
birth  to  twelve  children  in  five  years.  There  were 
two  arrivals  every  ten  months.  And  let  me  tell 
ladies  with  fewer  children  and  greater  wealth  her 
happiness  was  in  direct  ratio  to  the  number. 

Yours, 

Veritas. 
Montreal,  Oct.  6th,  1887. 

J^m^kM  of  Science. 


MEN.STRUATION,    ITS  NERVE-ORIGIN— 
NOT  A  SHEDDING  OF  MUCOUS 

MEMBRANE. 
By  James  Oliver,  M.  B.,  F.  R.  S.    Edin., 
Mcmljer  of  the  Royal  College  of  Physicians,  Assistant 
I'liysician  to  the  hospital  for  women,  and  Honoiary   Physi- 
cian  to    tlie    Farringdon     General    Dispensary,    London, 
England. 

In  every  healthful  human  female,  during  the  so- 
called  childbearing  epoch,  which  extends,  on  the 
average,  over  a  period  of  thirty-two  years,  the 
uterus  becomes  the  seat  of  a  periodically  recurring 
functional  disturbance,  evidenced  by  the  emission 
of  a  more  or  less  marked  hemorrhagic  discharge. 
As  the  initial  establishment  and  each  subsequent 
recurrence  of  this  monthly  phenomenon  is  fre- 
quently accompanied  by  symptoms  of  a  general 
as  well  as  local  character,  we  shall  designate 
under  the  appellation  menstruation  the  whole 
essential  train  of  events,  and  not  its  mere  out- 
ward manifestation. 

The  molecular  world,  organic  as  well  as  in- 
organic, exists  in  a  perpetual  state  of  trepidation, 
and  equilibration  of  a  vital  character  is  the  out- 
come of  an  inherent  power  of  adaptation.  Nor- 
mally the  structural  and  functional  integrity  of 
the  organism  is  maintained  by  a  mutual  depen- 
dence of  the  organs  upon  each  other,  and  according 
to  the  manner  in  which  these,  each  and  all, 
respond  to  those  multifarious  changes,  which 
from  time  to  time  arise  in  the  environments  of 
the  individual.  The  variations  in  the  waves  of 
molecular  motion  occurring  in  every  organ,  and 
associated  with  physiological  activity,  are  radiated 
to,  and  affect,  however  feebly,  every  ultimate 
tissue  of  the  body.  So  completely  is  this  inter- 
communication, through  the  medium  of  the 
nervous  system,  carried  on,  and  so  apt  are  the 
different  structures  of  the  organism  to  perform 
functions  other  than  those  for  which  they  have 
apparently  become  specialized,  that  vicarious 
compensation  may  be  readily  established.  In  the 
case  of  double  organs  it  is  a  noteworthy  fact,  with 
which  everyone  is  familiar,  that  the  removal  of 
one  may  affect  but  little,  if  at  all,  the  well-being 
of  the  body ;  generally  the  remaining  organ  at 
the  same  time  becomes  of  augmented  functional 
activity,  undergoing  slight  or  even  well-marked 
enlargement.     This  compensatory  change  will  be 


32 


ffiE  CANADA  MEDICAL   RECORD. 


manifested,  not  only  by  organs  recognized  as 
active,  but  also  by  such  as  have  hitherto  been 
viewed  as  obsolete.  In  many  of  the  lower  organ- 
isms, where  structural  differentiation  is  ill  defined, 
vicarious  function  is  readily  fulfilled.  The  animal 
may,  for  examiile,  be  turned  outside  in  with  im- 
punity, the  vital  integrity  of  the  organism  being 
still  maintained  unimpaired — the  endodcrm, 
already  but  feebly  specialized,  although  set  apart 
for  assimilation,  performing  with  ease  the  function 
of  the  ectoderm,  that  of  elimination;  while  the 
ectoderm,  in  turn,  assumes  forthwith  the  power  of 
assimilation,  and  discharges  effectually  a  function 
hitherto  foreign  to  it  and  performed  previously 
by  the  inner  layer.  In  the  animal  economy  we 
see  constantly  enunciated  the  fact,  too  frequently 
ignored,  that  functional  activity  and  structural 
integrity  proceed  together,  hand  in  hand,  and  are 
regulated  by  a  mutual  action  and  reaction  upon 
each  other. 

If  the  functional  activity  of  any   organ  be  aug- 
mented,  but   not  unduly,  the  structural  integrity 
■will  be  maintained  and  be  rendered  more  perfect. 
Again,  the  more  complete  the  structural  arrange- 
ment has  become,  the  more  likely  we  are  to  find 
the    function    actively   performed.       All   \'isceral 
activities  are  now,  through  habitation,  fulfilled  in 
a   somewhat    automatic    manner ;    and    although 
these  transitional   states   may  at   one    time    have 
excited    a  conscious   sensation,   they    are   at   the 
present  stage  of  evolution  wholly  ignored  by  the 
higher  cells  of  the  cerebral  lobes  which  participate 
in  feeling.     What  is  true  of  one  organ  of  the  body 
is  likewise  true  of  all  the  others.     It  is,  therefore, 
more  than  probable  that  the  physiological  changes 
recurring   from   time    to    time  in  the   uterus  are 
anticipated   by,   and  in   reality    the  sequence  of, 
a  molecular  disturbance  arising  spontaneously  in 
some   centre   located   in    the  higher   part  of  the 
cerebro-spinal  tract,    possibly  somewhere  in  the 
medulla  oblongata.  The  mere  fact  that  the  functions 
of  the  uterus   may  be    revealed  uninterruptedly 
after  the  spinal  cord  has  been  completely  severed 
in  the  dorsal  region    is  no  criterion,  and  cannot 
justify  us  in  concluding  that  there  exists  no  repre- 
sentative  higher    centre.       Structural    evolution 
itself  forbids  the  acceptance  of  such  an  hypothesis. 
Like  all  other  nerve-centres  fulfilling  a  similar  dis- 
pensation,   this    uterine    centre    is    undoubtedly 
beyond  all  volitional  control,  but  is,  nevertheless, 
capable  of  being  disordered  by  emotional  impres- 
sions.    With    this   fact    everyone   is  familiar.     A 
sudden  shock  experienced   during    menstruation, 
and  apart  from  any  bodily  injury,  will  produce,  as 
I  have  frequently  noted  in  some  females  immediate 
cessation  of  the  flow,  and  even  interrupt  for  a  more 
or   less   indefinite    length    of    time   thereafter  its 
amount  and   periodic    regularity.     The    resulting 
disturbance  will   depend     essentially    upon    the 
state  of  the  nervous  system  and  its  proneness    to 
molecular  instability. 

With    the    approach    and    appearance  of   the 
monthly   flow,   the    whole  frame,    as   one   would 


naturally  expect,  participates  more  or  less  in  the 
change,  and  the  amount  of  disturbance  experien- 
ced, as  well  as  manifested,  is  commensurate  with 
the  power  the  organism  possesses  of  adaptation, 
and  hence  of  equilibration.     The  simple  determin- 
ation of  blood,  because  of   incieased    functional 
activity,  to  the  genital  and,  in  many  cases,  to  the 
other  pelvic  organs,  of  itself  produces  a  definite 
alieration  in  the  waves  of  molecular  motion  pro- 
ceeding   therefrom,  and    which,    radiated  in  all 
directions,  must  necessarily    affect    the    vascular 
state  of  other  very  important  structures.     In  many 
chronic  disorders,  of  whatever  system,  affecting 
the  female,  every  observer  must  have  remarked 
that,  according  to  the  menstrual  type  of  the  indi- 
vidual, there  is  often,    either    in  anticipation    or 
with  the  appearance  of  the  flow,  a  proneness  to 
aggravation,    or  in  some  very  exceptional  cases,  it 
may  be,   to  alleviation  of    symptoms,    and   with 
the  cessation    or  disappearance  a  corresponding 
gradual  reversion  to  the  original  already  stationary 
or  slowly  progressive  state.     In  some  few  cases 
the  loss  of  blood  may  account  for  much  of  the 
disturbance  manifested,  yet  it  cannot  be  the  sole 
factor.     In  many    women,  where,  from  some  in- 
explicable cause,  there  is  for  a  more  or  less  inde- 
finite period  a  total  suppression  of  the  characteristic 
discharge,    we    may    dectect   frequently     such  a 
regularly    recurring    alteration  in    the  symptoms 
or  manner  of  the  patient  as  to  place  beyond  denial 
a  direct  relationship.     In  no  class  of  functional 
disorder   do  we  find    so  regularly  and   markedly 
an  interference  with  the    outward    manifestation 
of  uterine    activity  as  in    epilepsy,  a  disease  the 
])athology  of  which  is  still    undetermined.     It  is 
more  than  probable,  however,  that  as  we  may  con- 
sider the  epileptic  fetnale  as  epileptic  throughout, 
even  to  the    finger-tips,  the    interruption  of   the 
periodically    recurring    functional   change  in  the 
uterus  is  the  result  of  some  occult  condition  of 
the  corpuscular    elements  governing  the  activity 
of  this   organ,    and  wholly  independent    of  any 
defective  structural  state  of  the  viscus  itself.     The 
stuctural    integrity  of  the  uterus~may,  however, 
eventually  suffer,  for  inaction  and  overaction  alike 
tend  to  exert  a  prejudicial  influence. 

Gestation,  as  a  rule,  although  not  invariably,  de- 
termines for  a  period  of  nine  months  a  cessation  of 
the  monthly  recurring  flow.  Not  infrequently, 
however,  we  see  women  who  throughout  one 
or  more  pregnancies  continue  perfectly  regular, 
the  amount  or  character  of  the  flow  being  unalter- 
ed by  the  physiological  process  going  on  in  the 
uterus.  Usually  the  fertilized  ovum  affects  in  some 
unknown  manner  the  uterine  organ,  thereafter  des- 
tined to  be  its  source  of  nutrition,  and.the  gradual 
molecular  variations  so  produced  are  radiated  to  the 
uterine  centre,  alter  the  corpuscular  state,  and 
determine  the  sequence Jof  events.  During  the 
period  of  lactation,  and  consequent  activity  of  the 
mammary  glands,  we  find  not  only  the  manifesta- 
tion of  the  monthly  recurring  functional  change  of 
the  uterus  held  in  abeyance,  but  also  the  activity 


TUE    CANADA    MKDICAL    RECORD. 


33 


of  the  generative  glands,  as  impregnation  rarely 
occurs  while  the  mother  continues  to  suckle  the 
offspring.  Should,  however,  lactation  be  prolong- 
ed indefinitely,  the  secretion  of  milk  may  become 
more  or  less  habitual,  as  in  the  case  of  the  cow, 
and  the  generative  glands  regain  their  activity. 
The  life  of  every  organism  is  twofold  :  first,  the 
maintenance  of  the  individual,  and  then  the  per- 
petuation of  the  s[)ecies.  The  latter,  however,  is 
always  subservient  to  the  former,  and  so  long  as 
there  exists  a  demand  for  nourishment  from  the 
mother  on  the  |)art  of  the  child  in  utero,  so  long 
will  the  reproductive  power,  as  a  rule,  continue 
latent.  Occasionally,  however,  I  have  noted  that 
while  the  child  is  being  suckled  by  the  motlier,  the 
uterus  itself,  and  the  generative  glands,  may 
throughout  continue  active ;  and  impregnation 
resulting,  signs  of  early  constitutional  enfeeble- 
ment  are  apt  to  accrue.  In  inflammation  of  the 
mucous  lining  of  the  Fallopian  tubes  with  puro- 
fibrinous  e.xudation,  menorrhagia  is  frequently  an 
associated  symptom,  and  apparently  results  from 
some  in'erference  with  the  nerve  supply  to  the 
uterus.  In  all  mammals  there  are  two  ovaries, 
and  the  oviducts  are  known  as  tlie  Fallo- 
pian tubes.  Each  oviduct  dilates,  on  its  way 
to  the  external  surface,  into  an  uterine  cavity, 
which  in  turn  opens  into  the  vagina.  In  the 
monkey  and  man  only  do  we  find  the  two  uteri 
coalesce  inferiorly,  producing  a  single  cavity,  into 
the  fundus  of  which  the  Fallopian  tubes  enter. 
It  is  more  than  likely  that  the  nerves  governing 
the  functions  of  the  uterus  are  transmitted  along 
the  Fallopian  tubes,  and  although  menstrual  dis- 
order may  frequently  result,  with  distinct  path- 
ological changes  existing  in  these  tubes,  we  must 
not  too  hastily  conclude  that  these  structures, 
per  se,  govern  the  uterine  changes. 

The  true  nature  of  the  catamenia!  discharge  is 
still  conjectural ;  yet  its  elimination  from  the  body 
renders  it  highly  probable  that,  having  already 
served  some  special  end,  its  detention  in  the  blood 
may  exert  some  deleterious  influence  on  the  an- 
imal economy. 

It  is  generally  admitted  that  ovulation  and  men- 
struation are  coincident ;  that  they  may  or  may 
not  be,  I  am  not  prepared  to  dispute  ;  that,  how- 
ever, they  are  invariably  associated  there  seems 
to  me  much  reason  for  doubt.  That  the  discharge 
of  an  ovunn  may,  and  frequently  does,  occur  quite 
independently  of  menstruation,  I  have  no  mis- 
givings. No  one  would  entertain  the  idea  of 
gauging  the  reproductive  power  of  the  female 
either  from  the  regularity  or  amount  of  the  cata- 
menial  discharge.  I  have  occasionally  noted  that 
women  who  menstruate  with  marked  irregularity 
are  specially  prolific. 

It  is  alleged  as  an  established  theorem,  that 
from  the  period  of  puberty  to  the  climacteric  age 
there  is,  besides  a  gradual  death  of  the  mucous 
n^enibr^ne  lining  thq  ^yhole  uterine  cavity — which 
must  ever  occur  to  be  compatible  with  life — a.  more 
or  less   regularly  recurring  and  complete  death  of 


this  coat.  In  the  whole  animal  kingdom  we  search 
in  vain  for  a  jjhy.siological  change  truly  analogous 
with  this,  'i'he  serjient,  it  is  true,  may  shed  its 
skin  more  or  less  intact;  but  ere  it  casts  off  the 
old  coat  a  new  one  is  already  regenerated  to  pro- 
tect its  body  from  all  extraneous  injurious  influ- 
ences. In  vital  structures  change  is  wont  to  be 
gardual — creation  and  destruction  proceed  to- 
gether. There  is  apparently  no  departure  from 
this  inexorable  law.  Death  of  the  mucous  lining  of 
the  uterus  takes  place  imperceptibly  ;  the  change 
is  one  ever  going  on,  as  in  all  organs  of  the  body. 
In  several  cases  I  have  examined  uteri  removed 
from  women  who  have  died,  not  only  during 
menstruation,  but  just  before  an  expected  period. 
In  two  ca  es  the  death  was  sudden,  the  patient  at 
the  time  being  in  apparent  good  health.  In  three 
cases  the  uterine  organ  was  invaded  by  growths  of 
filjroid  character,  which  were  chiefly  submucoid. 
To  the  naked  eye  the  mucous  lining,  in  all, 
appeared  in  every  respect  like  that  of  a  normal 
uterus  examined  at  any  time  indiscriminately.  In 
no  case  did  I  detect  any  breach  in  the  continuity 
of  the  lining  membrane  of  the  uterus,  except  in 
those  in  which  this  organ  had  become  the  seat  of 
fibroid  growths.  In  such  the  mucous  lining  had 
in  places  become  markedly  thinned,  or  even  van- 
ished altogether,  because  of  a  constant  vital  pres- 
sure exerted  on  this  coat  by  the  underlying  new- 
growth.  Here  gradual  absorption  had  resulted, 
very  much  in  the  same  manner  as  bone  and  soft 
tissues  disappear  before  the  constant  ])ressure  of 
an  increasing  aneurism.  I  have  never  at  any  time 
detected  any  evidence  of  structural  change,  micros- 
copically, tTi  the  inner  linings  of  the  uterus,  in 
cases  in  which  this  organ  has  been  removed  from 
the  bodies  of  females,  who  have  died  either  during 
or  just  before  an  expected  menstruation.  The 
glands  which  stud  the  inner  coat  of  the  uterus  in 
its  entirety,  consisting  of  columnar  cells,  lined  by 
a  basement  as  well  as  a  limiting  membrane,  have, 
however,  shown  marked  enlargement,  in  many 
cases  so  pronounced,  that  the  outline,  not  only  of 
the  separate  cells  but  even  of  the  gland  itself,  has 
been  lost.  The  columnar  cells  appear  swollen, 
and  contain  frequently  large  corpuscular-looking 
bodies,  which  I  believe  to  be  the  simple  manifes- 
tation of  increased  functional  activity.  Prior  to 
cutting,  by  freezing  in  gum,  the  tissues  had  been 
hardened  for  two  days  in  spiiits,  and  finally  in  a 
weak  solution  of  chromic  acid.  The  sections  I 
stained  in  a  variety  of  ways,  my  best  stain,  how- 
ever, and  that  affording  clearest  definition,  being 
iron  and  pyrogaUic  acid. 

Those  who  support  the  denudation  theory 
assert  that  each  recurring  monthly  flow  is  antici- 
pated by  a  fatty  degeneration  of  the  mucous 
lining  of  the  uterus  ;  that  blood  is  e.xtravasated 
into  its  substance,  and  eventually  the  whole, 
becoming  disintegrated,  is  washed  away  impercep- 
tibly with  the  escaped  blood.  A  new  mucous 
membiane  is  thereafter  by  degrees  regenerated 
I  from  the  inner  layer   of  the  muscular  coat^  which 


34 


THE   CANADA   MEDICAL    RECORD. 


in  its  turn,  too,  like  its  predecessor,  must  undergo 
a  similar  degenerative  change,  and  ultimately  be 
removed  from  the  body.  Some  of  the  lower  ani- 
mals, it  is  true,  retain  the  power  of  re|iroducing 
limbs,  and  possibly  other  parts  of  the  body  removed 
by  accident.  If,  however,  the  separation  of  the 
]iart  be  too  frequently  practised,  we  eventually 
exhaust  the  power- — wholly  irrecoverable — the 
structural  integrity  of  the  regenerated  limb  or  tissue 
becoming  less  and  less  marked  with  each  removal. 
Clinically,  if  the  mucous  membrane  were  shed 
with  each  catamenial  flow,  it  must  be  capable  of 
completing  its  cycle  of  degeneration,  shedding, 
and  regeneration,  in  an  incredible  number  of  days. 
Many  are  the  menstrual  anomalies  which  preclude 
the  acceptance  of  such  a  phenomenon. 

Taking  all  the  facts  into  consideration,  it  is 
more  than  probable  that  the  iccurring  monthly 
discharge  in  the  human  female  is  a  secretion,  or 
rather  excretion,  from  the  inner  lining  of  the  ute- 
rus and  Fallopian  tubes,  without  degenerative 
change  other  than  that  commonly  associated  with 
augmented  functional  activity, and  comparable  with 
tliat  occurring  in  any  other  organ  of  the  body 
under  similar  circumstances.  — N.  Y.  Med.  Re- 
cord.   

THE  TREATMENT  OF  PALPITATION. 

By    Benjamin  Ward  Richardson,  M.  D.,  F.  R. 

S.,  London,  Enciland. 

The  treatment  of  palpitation  is  moral,  hygienic 
and  medical,  and  the  value  of  these  stands  in  the 
order  in  which  I  have  placed  them. 

I.  Moral  Treatment. — 'In  the  moral  treatment 
the  grand  point  is  to  impress  the  sufferer  that  there 
is  no  instant  danger  from  the  seizure;  for  palpita- 
tion is  fed  by  fear,  and  so  little  as  an  expression 
of  fear  by  the  looker-on  increases  the  intensity  of 
the  over-action.  In  like  manner  all  hurry  and 
worry  aggravate  the  symptom,  and  so,  during  the 
attack,  the  utmost  care  should  be  taken  to  avoid 
noise,'  haste  and  fussiness.  A  gentle  persuasion 
toward  quietness,  a  firm  assurance  that  the  seizure 
will  very  soon  pass  away,  and  the  best  help  of  an 
encouraging  kind  is  supplied. 

^  2.  Hygitnic  T/'^rt/w/r/;/.— The  hygienic  measures 
for  the  treatment  of  palpitation  have  reference  to 
the  directions  which  should  be  given  for  warding 
off  the  attacks,  and  for  removing  the  unhealthy 
conditions  of  body  which  disijose  toward  them. 
In  these  directions  it  is  essential  to  include,  first 
and  foremost,  the  removal  of  all  possible  causes  of 
excitement,  worry  and  exhaustion,  mental  or 
physical.  To  this  must  be  enjoined  regular  habits 
of  life.  Early  hours  for  bed  are  requisite, 
and  a  continuance  in  bed  in  the  recumbent  posi- 
tion for  eight  hours  out  of  the  twenty-four  at  least 
is  very  important.  During  the  day  moderate 
out-door  exercise,  with  avoidance  of  rapidity  and 
of  over-action  from  climbing  steep  ascents,  should 
be  specially  enforced. 

To  the  moderate  open-air  exercise  above  sug- 


gested should  be  added  daily  and  free  ablution  in 
water  just  sufficiently  warm  not  to  create  a  shock 
or  leave  a  sense  of  chilliness  of  the  skin.  Brisk 
friction  and  the  use  of  a  flesh  brush  may  follow 
the  bath  with  advantage.  I  would,  however, 
while  on  the  subject  of  Baths,  offer  a  word  of 
warning  as  to  the  Turkish  or  Roman  bath  in  this 
class  of  cases.  Good  as  that  liath  is  in  cases  of 
disease  properly  selected  for  it,  it  is  not  good  for 
persons  subject  to  acute  and  extreme  palpitation. 
The  stimulus  of  the  heat  has  caused  in  two  patients 
I  have  known  a  severe  and  troublesome  seizure. 

Meals  should  be  taken  at  regular  times  ;  at  no 
time  sliould  a  heavy  meal  be  indulged  in,  and  the 
simpler  the  diet  the  better.  Some  articles  of  diet 
in  ordinary  use  should  be  limited.  Too  much 
animal  food  is  bad.  Light  and  eas  ly  digested  foods, 
in  moderate  quantities,  and  fresh  fruits  are  always 
good.  In  one  of  my  cases  a  trial  of  a  purely 
vegetarian  system  of  diet  had  unquestionably  a 
very  good  result,  but  as  different  scales  of  diet  are 
suitable  for  different  i)ersons,  I  cannot  here  lay 
down  any  hard-and-fast  rule.  1"he  plan  I  am 
accustomed  to  follow  in  prescribing  diet  is  to  find 
out  from  the  patient's  own  report  what  articles  of 
diet  suit  best,  and  then  to  use  my  own  judgment, 
at  the  time,  for  advising  the  selection. 

As  regards  drinks,  there  are  three  which,  in  my 
experience,  are  always  unfavorable  in  cases  of 
palpitation.  These  are  tea,  coffee,  and  alcohol  in 
every  shape.  I  know  of  no  cases  of  the  kind  in 
which  tea  has  not  proved  injurious.  Coffee  is  not 
so  bad  as  tea,  altogether,  but  there  are  very  few 
instances  in  which  coffee  can  be  readily  tolerated. 
Alcohol  is  oftei)  much  craved  after,  but  it  is  a  most 
deceitful  ally.  A  little  excess  of  it  is  prone  of 
itself  to  excite  the  over-action  without  any  other 
spur,  and  soon  after  it  has  been  removed  from  the 
body  it  causes  a  depression  which  favors  a  recur- 
rence of  palpitation,  under  any  excitement,  in  the 
most  marked  degree.  The  quantity  of  fluid  taken 
should  be  limited  in  amount ;  and  as  to  quality, 
the  nearer  it  comes  to  water  pure  and  simple  the 
better. 

Something  requires  to  be  said  about  mental  as  well 
as  physical  food.  Readings,  amusements,  and  pas- 
times, which  keenly  affect  the  emotional  faculties, 
are  to  be  avoided  as  much  as  any  more  plainly 
physical  forms  of  excitement.  \\'hatever  mental 
food  keeps  the  mind  awake,  whatever  makes  the 
sufferer  hold  his  breath  with  wonder  or  anxiety, 
is  bad  as  bad  can  be.  Exciting  novels,  plays, 
exercises,  games  of  chance,  should  most  surely  be 
put  aside.  But  good,  pleasant,  steady  mental 
work  is  not  harmless  merely  ;  it  is  useful ;  it  pre- 
vents the  mind  from  brooding  over  the  bodily 
incapacity,  and  it  becomes  an  element  of  cure. 

Under  this  head  of  hygienic  practice  there  is 
one  habit,  bearing  chiefly  on  the  male  sex,  to 
which  I  must  allude,  and  against  which  it  is  abso- 
lutely necessary  to  protest.  I  refer  to  the  habit 
of  smoking  tobacco,  and  to  the  use  of  tobacco  as  a 
luxury  in  every  way.     Tobacco  is   the    worst   of 


■hlE   CANADA   MteblCAL   RECORD. 


35 


enemies  to  soundness  of  heart  and  stcadint'ss  o( 
heart  work.  To  those  who  are  subject  to  acute 
]ial])itation,  tobacco  is  so  mischievous  that  it  is 
luipclcss  to  attempt  to  treat  them  until  the  iiabit  is 
abandoneii.  On  this  point  there  must  be  llo  mis- 
taive. 

3.  Medical  Treatment. — During  an  attack  of 
acute  palpitation,  medical  treatment  of  a  direct 
kind  can  only  be  ])alliative.  It  is  a  (.onmion 
jiractice  to  |)lace  the  i)atient  in  the  perfectly 
recumbent  jiosition,  but  as  this  position  leads, 
frequently,  to  breathlessness  and  much  discomfort, 
I  never  enforce  it  unduly.  The  sufferers  usually 
find  out  the  best  position  for  themselves,  and 
standing  up,  and  even  gentle  walking  backward 
and  forward  commonly  appear  to  bring  relief,  as 
if  the  general  muscular  action  equalized  the  local 
over-action. 

For  the  actual  jxilpitation,  digitalis  is  the  only 
remedy  I  have  found  of  any  ])0siti\e  service,  and 
it  combines  well  with  remedies  which  have  a  ten- 
dency to  promote  quickly  the  cutaneous  and  renal 
excretions.  I  usually  prescribe  the  tincture  of 
digitalis  in  five  or  ten  minim  doses,  with  half  a 
fluid  drachm  of  nitric  ether,  and  two  fluid  drachms 
of  the  liquer  ammoniaj  acetatis.  In  instances 
where  there  has  been  prolonged  sleeplessness,  with 
palpitation,  I  have  combined  morphia,  in  full 
doses,  with  digitalis,  with  good  effect,  adding  the 
narcotic  dose  to  the  formula  just  named. 

In  general  treatment  lam  accustomed  to  follow, 
whether  the  heart  be  organically  sound  or  unsound, 
the  saine  methods  as  those  prescribed  in  my 
previous  essay  on  intermittency.  The  organic 
bromides  of  iron,  quinine,  and  morphia,  and  the 
mixture  of  iron  carbonate,  ammonia,  and  morphia 
{Asc/epiad,  Vol.  i,  p.  204)  are  excellent  remedies. 
The  only  difference  in  treatment,  in  fact,  relates 
to  the  use  of  alcohol,  which,  valuable  in  some  cases 
of  intermittency,  is  less  comi)atible  in  cases  of  pal- 
pitation. 

4.  Treatment  of  Epigastrie  Palpitation. — The 
rules  already  ordered  for  the  management  of  car- 
diac apply  equally  to  the  epigastric  palpitation. 
There  is,  however,  in  cases  of  epigastric  palpita- 
tion more  frequent  necessity  to  meet  dyspeptic 
symptoms,  including  flatulency  and  consumption, 
by  alternative  and  mild  aperient  correctives. — As- 
clej>iad. 


SICK  HEADACHE. 
By  Philip  Zenner,  A.M.,  M.D,,  Cincinnati. 

There  are  few  diseases  which  are  the  source  of 
so  much  suffering  as  that  which  is  the  subject  of 
this  paper.  Beginning  usually  at  an  early  period 
of  life,  most  frequently  about  the  time  of  puberty, 
it  returns  as  an  unwelcome  visitor  for  the  greater 
part  of  the  remaining  life.  Often  it  recurs  with 
such  frequency  and  severity  as  to  make  existence 

terrible  burden, 

Like  most  diseases  which,  in  themselves,  never 
lead  to  a  fatal  issue,  its  pathology  is  very  obscure. 


Hughlings  Jackson  considers  it  to  be  of  tlie  nat- 
ure of  ejiilepsy,  and  to  be  caused,  as  he  believes  to 
be  true  of  the  latter  disease,  by  a  discharging  lesion 
in  the  brain,  in  this  case,  in  the  sensory  area.  It 
must  be  acknowledged  there  is  much  in  the  mani- 
festations of  the  disease,  the  manner  of  recurrence, 
and  the  influences  which  control  it,  which  lends 
weight  to  this  view.  Of  late  years  the  most  pre- 
valent view  of  the  nature  of  this  disease  is  that  it 
is  caused  by  changes  in  the  sympathetic  nervous 
system,  and  that  the  paroxysms  are  brought  on 
by  a  spastic  or  paralytic  condition  of  the  cerebral 
blood-vessels.  When  there  is  a  spastic  condition 
the  paroxysm  is  termed  s|)astic,  or  sympathetic- 
tonic;  and  as  further  indications  of  irritation  of 
the  cervical  sympathetic,  it  is  found  that  on  the 
affected  side  the  face  and  ear  are  paler  and  colder 
than  on  the  other  side,  the  eye  is  prominent,  the 
])upil  dilated,  and  the  salivary  secretion  is  very 
viscid  and  much  increased  in  quantity.  The  par- 
oxysm, with  paretic  condition  of  the  vessels,  is 
termed  angio-paralytic,  or  neuro-paralytic.  The 
paresis  on  the  part  of  the  cervical  sympathetic  is 
further  indicated  by  heat  and  redness  of  the  face 
and  ear,  suffusion  of  the  eye,  and  contraction  of 
the  pupil  on  the  affected  side. 

I  have  had  occasion  to  examine  a  large  number 
of  cases  during  the  height  of  the  paroxysm,  and 
only  rarely,  though  the  headache  was  distinctly 
unilateral,  have  I  found  decided  manifestations  of 
irritation  or  ])aresis  of  the  cervical  sympathetic. 
Therefore,  I  cannot  but  doubt  the  correctness  of 
this  explanation  in  many  cases,  though  it  is  still 
possible  that  the  pain  may  be  due  to  varying  con- 
ditions of  the  circulation  within  the  skull,  while 
there  are  no  external  manifestations  of  changes  in 
the  synipathetic  nervous  system. 

Practically  the  important  consideration  is  that 
of  treatment.  What  can  we  do  to  ameliorate  or 
to  cure  the  disease?  We  must  consider  separate- 
ly treatment  for  the  relief  of  a  paro.xysm  and  that 
for  the  improvement  or  cure  of  the  systemic  con- 
dition which  causes  the  paroxysms. 

In  case  of  a  severe  paroxysm  all  sources  of  irri- 
tation should  be  removed.  The  patient  should 
be  at  rest  in  a  darkened,  quiet  room ;  if  anaemic, 
should  lie  down ;  if  hyperremic,  maintain  a  sitting 
position.  Firm  compression  of  the  head  or  the 
application  of  cold  sometimes  affords  consider- 
able relief.  In  the  spastic  forms  of  migraine,  with 
conti  acted  cerebral  vessels,  the  inhalation  of  nitrite 
of  amyl,  or  the  internal  administration  of  nitro- 
glycerine, or  other  remedies  which  produce  dila- 
tation of  the  bloodvessels,  will  cause  more  or  less 
complete  relief.  In  the  paralytic  forms  ergot 
often  acts  very  admirably.  Various  other  reme- 
dies are  used  whose  indications  can  not  be  so  dis- 
tinctly given.  Quinine,  in  from  five  to  fifteen  grain 
doses,  will  often  arrest  an  attack.  Many  old  suf- 
ferers with  migraine,  who  have  tried  almost  every- 
thing, find  greater  benefit  from  this  than  any  other 
drug.  Coftee,  or  its  active  ingredients,  caffeine 
and   guarana,  often    relieve   lighter    paroxysms. 


30 


THE   CANADA   MEDICAL   RECOEli. 


Chloride  of  ammonium,  chloral  and  croton  chloral 
are  of  more  or  less  service  in  most  cases.  Anstie 
believed  that  the  administration  of  twenty  grains 
of  chloral,  the  patient  at  the  same  time  keeping 
his  feet  in  hot  mustard  water,  and  inhaling  the 
steam  from  the  mustard,  was  the  ideal  treatment 
for  migraine.  Bromide  of  potash  affords  relief  in 
some  cases,  but  it  is  usually  necessary  to  give 
very  large  doses.  A  new  remedy,  antipyrine,  has 
proved  a  valuable  au.xiliary  in  our  treatment  of 
migraine  and  other  forms  of  headache.  One  or 
two  doses  of  ten  or  fifteen  grains,  given  at  the 
beginning  of  an  attack  of  sick  headache,  will  often 
act  like  a  charm  in  cutting  it  short.  A  still  newer 
remedy,  antifebrine,  is  said  to  act  equally  well. 

In  some  very  severe  attacks,  hypodermics  of 
morphia  may  be  called  for  to  procure  relief,  and 
even  these  may  afford  but  very  little  benefit. 

In  our  efforts  to  prevent  the  attacks  of  sick 
headaches,  or  lessen  their  frequency  and  severity, 
we  should  attempt  to  remove  all  the  causes  which 
have  any  influence  in  their  production.  In  some 
instances  stomach  disorders,  diseases  of  the  womb 
or  the  like,  either  directly  or  indirectly,  occasion 
their  development.  Wherever  diseases  of  this 
character  exist,  they  should,  if  possible,  be 
removed. 

Special  remedies  are  sometimes  used  with  the 
idea  of  preventing  future  attacks.  Cannabis  indica 
is  a  fiivorite  with  some  physicijns.  Its  use  for 
a  long  time  is  said  to  have  a  very  decided  effect 
in  some  cases.  I  have,  myself,  very  rarely  resor- 
ted to  any  specific  medication  in  these  cases. 
When  I  did  so  it  was  to  administer  the  bromides, 
and  only  at  such  times  when  the  headaches  ajipear- 
ed  to  occur  with  unusual  frequency  or  severity. 
Periods  of  this  kind,  of  longer  or  shorter  duration, 
are  not  rare  occurrences  to  those  suffering  with  mi- 
graine. I  have  almost  invariably  found  that  ten 
to  fifteen  grains  of  bromide  of  potash,  given  three 
times  a  day  at  such  times,  would  be  productive  of 
much  benefit. 

Probably  the  most  important  consideration  in 
cases  of  sick  headache  is  that  it  occurs  chiefly  in 
those  with  a  neurotic  taint,  where  there  is  a  his- 
tory of  headache  or  other  nervous  diseases  in  the 
family,  and  where  the  individual  is  of  a  nervous 
temperament  and  predisposed  to  nervous  disease. 
Therefore,  the  important  point  in  treatment  is  the 
toning  up  of  the  nervous  system.  Many  such 
patients  are  anemic,  debilitated  women,  and 
demand  iron  or  other  tonic  medication,  and  a 
tonic  regimen  in  every  way.  Hydrotherapy,  sea 
baths,  a  tri]5  to  the  mountains,  will  often  prove  of 
great  benefit.  Headaches  are  often  brought  on, 
or  greatly  aggravated  by  the  worry  or  excitement 
of  daily  life,  sources  of  ill  which  cannot  be  remo- 
ved ;  but  all  such  trouble  must  be  avoided  as  far  as 
possible. 

When  the  disease  has  been  of  many  years'  stand- 
ing, all  our  efforts  will  often  avail  but  little,  though 
the  disease  is  likely  to  disappear  after  the  climac- 


teric period.  It  is  in  the  young,  when  the  disease 
is  recent,  that  we  may  hope  to  accomplish  most 
good.  In  such  cases  we  must  attempt  to  cure 
the  disease  before  the  habit,  if  I  may  so  speak, 
has  been  established.  To  do  this  we  must  not 
only  try  to  cut  short  each, attack,  but  by  proper 
habits  of  life,  careful  education,  tonic  medication, 
etc.,  so  far  as  possible,  eradicate  the  neurotic  basis 
of  the  disease. —  Cincinnati  Aiedical  News. 


THE  TREATMENT  OF  RHEUMATISM. 
By  E.  S.  F.  Arnold,  M.  D. 
When  the  late  Dr.  Robert  Nelson,  for  many 
years  the  Mott  of  Canada,  went  to  California,  I 
succeeded  him  in  his  office  in  New  York.  During 
his  absence  constant  inquiries  were  made  of  me 
for  his  remedy  for  rheumatism.  On  his  return  I 
asked  him  what  this  wonderful  remedy  was.  He 
smiled,  then  simply  answered,  "  Colchicum.'' 
Seeing  that  I  was  incredulous,  he  then  told  me 
that  he  had  once  at  the  Hotel  Dieu,  in  Montreal, 
experimented  with  colchicum,  trying  all  the  offici- 
nal preparations,  sometimes  with  benefit,  but  in  the 
main  finding  all  unreliable  and  often  totally  worth- 
less. He  ultimately  tried  a  strong  alcoholic  tincture 
prepared  from  fresh  seed.  He  found  that  the 
shell  of  the  seed  contained  a  volatile  oil,  that  when 
water  was  added  to  the  tincture  it  became  opal- 
escent, like  tincture  of  myrrh,  and  by  its  use  he 
obtained  extraordinary  elTects.  He  prepared  it 
by  adding  to  one  ounce  of  the  seed  half  a  pint  of 
highest  proof  alcohol.  After  standing  a  fortnight 
and  shaking  once  or  twice  daily  it  was  fit  for  use. 
Add  five  drachms  of  this  tincture  to  half  a  pint  of 
water,  or  rather,  enough  to  make  a  half  pint,  and 
of  this  the  full  dose  is  half  an  ounce.  "  Now." 
said  he,  "  if  you  have  a  case  of  acute  or  subacute 
rheumatism,  give  this  every  four  hours,  night  and 
day,  avoiding  acids  and  giving  a  light  diet  until 
the  toxic  eftects  of  the  colchicum  are  induced,  viz., 
nausea  or  even  vomiting,  with  active  purging, 
which  occurs  generally  by  the  time  the  sixteen 
doses  are  taken,  and  the  rheumatism  will  disapjiear 
like  a  flash.  Up  to  this  period  there  will  be  ap- 
parently no  relief."  He  cautioned,  if  I  would 
secure  the  beneficial  effects,  always  to  prepare  it 
myself. 

In  cases  of  acute  and  subacute  rheumatism  I 
have  never  found  its  equal,  also  in  rheumatic  gout. 
In  simple  local  or  chronic  rheumatism,  I  do  not 
expect  anything  from  it.  When  I  was  first  appoint- 
ed Physician  to  the  Sisters  of  Charity  at  Mt.  St. 
Vincent,  on  the  Hudson,  I  was  shortly  afterward 
called  upon  to  attend  the  chaplain,  a  Canadian, 
between  fifty-five  and  sixty  years  of  age.  I  found 
him  in  a  high  fever  and  racked  with  pain 
from  head  to  foot.  "Ah,"  he  said,  "my  dear 
doctor,  I  am  in  for  a  long  siege  of  it.  I  have  had 
a  similar  attack  of  rheumatism  once  before,  and 
did  not  leave  my  bed  for  three  months".  I  told 
him  I  thought  we  could  do  better  than  that.  In 
a  few  days  he  was  entirely  free  from  pain,  and  in  a 


T'UE   CANADA   MEDICAL   RECORD. 


37 


little  over  a  week  I  found  him  strolling  in  tlie 
gnrden  in  a  drizzle,  without  experiencing  any  ill 
effects. 

Another  case  was  that  of  the   Englisli    foreman 
in  a    silk-dyeing    establishment.     'I'liis    was   built 
against  a  dam.     Water  poured    from  the  wall,  at 
the  same  time  the  atmosphere  was    so  full  of  hot 
va|)or  from  the  vats  that  a  person    unaccustomed 
to  it  could  scarcely  see  through  it.     It   was  a  bad 
jilace  for  a  rheumatic    person.     I   foimd  the  man 
had  rheimiatic  fever,  as  he  called  it,  aflecting  every 
limb.     He  told  me  he  once  had  a  similar  attack  in 
England  and  was  laid  up  for  six  weeks,    suffering 
horribly.     He  was  at  his  work    in    less    than  a 
fortnight,  and  was  never  again,  during  the    many 
years    1   stayed   in    Yonkers,    attacked.     I    have 
mentioned  this  remedy  to  many,  more  recently  to 
my  friend,  Dr.  Gouley.     He  says  he  has  found  it 
most  valuable,  and  that  he  will  never  be  without  it. 
In  the  local  and  chronic  cases  it  is  less  efficient. 
In  these  I  have  found  the  St.     Catherine  mineral 
waterof  very  great  value.  A  gentleman,  about  sixty, 
came  to  ask  me  about  Sir  Astley  Cooper's  remedy 
for  rheumatism,  which  was  iodide  of  potassium.  I 
suggested  a  trial  of  the  St.  Catherine  water  first. 
He    said    that    as  winter   approached  he  was  so 
constantly  troubled  with  rheumatism  on  exposure, 
that  it  confined  him  during  the  cold    months  en- 
tirely to  the  house.     He  commenced  a  course  of 
the  mineral  water,  with  entire   relief,  and  during 
the  last  fifteen  years  of  his  life  went  out  in  all  sea- 
sons and  in  all  weathers,  without  ever  suffering  any 
inconvenience.     He  was  never  without  the  remedy 
in  his  house,  and  he   told  me    subsequently  that 
whenever  he  felt  a  little  bilious  he  would  take  a 
teaspoonful  (concentrated)    half  an    hour  before 
dinner.     In  half  an  hour  after  this  meal  he  would 
have  one  or  two  good  movements  and  he  felt  per- 
fectly well  again.     He  very  seldom  had  occasion 
to  resort  to  it.     Another  case  was    that  of  a  mid- 
dle-aged French  gentleman,  who  had  been  a  great 
sportsman,  often  passing  whole  days  in  the  mar- 
shes.    He  was  ultimately  attacked  with  a  rheuma- 
tic neuralgia,  which  seemed    to  affect  the    tendo 
Achillis.     He    suffered  at    times  for  many    days 
with  it,  keeping  him  from  his  business,  and  endur- 
ed acute  pain.     It  seemed    determined  to  resist 
all  remedies,  both  local  and  general,  until  I  tried 
the  mineral  water.     He  found  it  horribly   nasty, 
but  experienced  so  much  benefit  from  it    that  he 
persevered,  and  a  cure  was  effected.     Of  course  I 
do  not  recommend  these  things  as  absolute  speci- 
fics, but  I  have,  nevertheless,  had  great  reason  in 
numerous   other  cases    to  think  more    highly  of 
them  than  any  other  I  know  of. — Coll.  and  Clin. 
Rec. 


of  children  who  have  themselves  introduced  them 
there.  A  ready  method  for  removing  such  sub- 
stances is  described  by  .Mr.  '1".  Osborne-Walker 
in  the  Lancet  for  Sept.  17,  1887,  where  he  states 
that  recently  a  little  boy  was  brought  under  his 
care  with  a  button  tightly  impacted  in  the  angle 
between  the  vomer  and  os  nasi  at  the  bridge  in 
the  right  nostril.  Ineffectual  attemjjts  at  extrac- 
tion had  evidently  been  made,  as  shown  by  blood 
oozing  from  the  nostril,  and  some,  coagulated, 
adherent  to  thejtbutton,  partially  concealing  its 
outlines  from  view,  and  also  by  the  button  being 
fixedly^  jammed  in.  In  such  cases,  to  prevent 
struggles  and  interruption,  the  child's  arms,  hands, 
and  legs  should  be  first  confined,  by  folding 
tightly  round  these  and  the  body  a  long,  clean 
apron,  and  then  placing  the  child  on  an  atten- 
dant's lap,  facing  a  window,  while  the  operator 
stands  behind  the  patient,  and,  bending  over  and 
depressing  with  two  fingers  of  the  left  hand  the 
apex  of  the  nose,  to  admit  as  much  light  as  possi- 
ble upon  the  object  to  be  removed,  with  the  right 
hand  very  carefully,  to  avoid  its  descent  into  the 
pharynx  or  larynx,  the  spoon  end  (with  the  conca- 
vity directed  forward)  of  an  ordinary  pocket-case 
director  should  be  introduced,  with  which  at  once 
with  a  simple  lever  movement  or  jerk  the  foreign 
body  may  be  readily  ejected. 

By  attention  to  the  following  points  the  removal 
is  instantaneously  effected.  The  close  confinement 
of  the  hands,  arms,  and  legs  by  a  shawl,  blanket, 
or  apron  ;  a  good  light ;  a  reliable  person  to  secure- 
ly hold  the  child ;  the  position  of  the  operator 
behind  the  patient ;  depressing  well  the  apex  of 
the  nose  to  obtain  a  good  view  of  the  object;  and, 
lastly,  getting  the  concave  face  of  the  spoon  of 
a  director' fairly  behind  the  body  before  making 
the  forward  lever  movement. — Tliarapenlic 
Gazette. 


A    READY     METHOD    FOR    REMOVING 
FOREIGN  BODIES    FROM    THE   ANTE- 
RIOR NARES. 
Physicians  are    often   called   to    remove   peas, 

buttons,  and  various  substances  from  the  nostrils 


PHILADELPHIA  HOSPITAL. 

Clinical    Remarks  By  Wm.   Osler,    M.    D., 

Professor  of  Clinical  Medicine  in  the  University 

of  Pennsylvania  ;  one  of  the  Attending  T'hy- 

sicians  to   the  Hospital,  etc. 

TVPHOm  FEVER,  CASES  ILLUSTRATING  RELAPSE 
AND  NERVOUS  SV.MPTOMS  ;  CIRRHOSIS  OF  LIVER, 
LATENCY,  FATAL  H.EMORRHAGE  FRO.M  RUPTURE 
UFA  DILATED  CESOPHAGEAL  VEIN. 

Two  cases  of  typhoid  fever  are  shown  to  the 
class : 

Case  I.  illustrates  an  important  ])oint  in  con- 
nection with  the  history  of  this  disease,  namely, 
relapse.  She  was  anmitted  six  weeks  ago,  and  as 
the  temperature  chart  indicates,  had  a  well- 
characterized  attack  of  typhoid  fever.  We  cannot 
distinctly  ascertain  how  long  she  had  been  ill  pre- 
vious to  admission.  When  she  was  brought  to  the 
hospital,  the  chief  symptoms  were  pulmonary. 
She  had  a  most  intense  bronchitis,  involving  espe- 
cially the  smaller  tubes.  Rales  were  heard 
throughout  the  lungs,  and  she  was  cyanosed.     We 


38 


THE   CANADA   MEDIcIl   RECORD. 


were  at  first  rather  in  doubt  wliether  we  had  to  do 
with  a  simple  pulmonary  trouble,  or  with  a  com- 
plication of  typhoid  fever.  The  spots,  however, 
soon  appeared,  and  the  disease  ran  a  characteristic 
course.  About  three  weeks  ago,  her  temperature 
became  normal,  and  remained  so  for  one  week.  It 
was  then  noticed  that  she  was  not  so  well,  and  the 
temperature  rose  to  102  °  ,  and  there  has  been 
since  an  evening  rise  to  103  '-'  or  105  °  ,  with 
marked  morning  remissions. 

You  must  carefully  distinguish  between  a  post- 
typhoid elevation  of  temperature  and  a  positive 
relapse,  and  it  is  to  this  point  I  would  especially 
call  your  attention.  Post-typhoid  elevations  of 
temperature  occur  quite  frequently,  and  may  take 
place  within  ten  days  or  two  weeks  after  the  even- 
ing temperature  has  reached  normal.  Probably, 
the  most  common  cause  is  some  indiscretion  in 
diet.  A  return  to  solid  food  is  sometimes  followed 
by  a  slight  rise.  Sometimes  mental  excitement  or 
worry  will  cause  it.  At  times,  after  allowing  the 
patient  to  see  his  friends  or  to  transact  business, 
you  will  find  that  the  temperature  will  go  up  and 
remain  above  normal  for  a  few  days.  In  one  or 
two  instances,  I  have  seen  constipation  induce  a 
rise  of  temperature.  In  these  cases  the  elevation 
of  temperature  is  usually  the  only  symptom. 
There  may  also  be  increased  frequency  of  the 
]nilse.  The  fever,  however,  is  usually  transitory, 
and  there  are  not  the  well-marked  symptoms  which 
characterize  the  relapse,  which,  when  typical,  is  a 
repetition  of  primary  disease.  The  temperature 
rises  gradually,  and  may  attain  a  maximum  as 
great  as  in  the  original  attack.  There  is  usually 
abdominal  tenderness,  often  diarrhcea,  and  fre- 
quently a  re-appearance  of  the  rose-spots.  This 
patient  has  certainly  a  relapse  which  is  running  a 
very  mild  course.  The  eruption  has  been  well 
defined,  and  some  spots  are  still  present  upon  the 
abdomen.  There  has  been  no  special  abdominal 
tenderness,  and  she  has  h.ad  no  diarrhcea.  She 
had  no  recurrence  of  the  bronchitis,  but  the  char- 
acter of  fever  and  the  distinct  eruption  are  suffi- 
cient to  establish  the  fact  that  we  are  dealing  here 
with  a  positive  relapse,  occurred  and  not  simply  with 
a  post-typhoid  elevation  of  temperature.  There  was 
another  interesting  feature  in  this  case,  namely, 
that  when  the  relapse  occurred  she  had  attacks  of 
epistaxis.  The  course  of  the  relapse  is  usually,  as  I 
have  stated,  a  repetition  of  the  original  attack,  but 
you  may  meet  with  many  variations.  As  a  rule 
it  is  milder,  the  temperature  rarely  reaching  the 
same  height,  and  the  course  of  the  disease  is  rare- 
ly so  prolonged.  The  majority  of  cases  do  well, 
and  a  fatal  termination  is  not  so  common  as  in 
the  primary  attack.  In  this  patient  the  original 
attack  was  mild,  and  the  jjrobability  is  that  she 
will  do  well. 

Case II. — Of  the  seven  or  eight  cases  of  typhoid 
fever  in  the  wards,  this,  perhaps,  has  been  the 
most  severe.  The  patient  was  admitted  to  the 
liospital  eight  days  ago.  There  is  nothing  special  in 
his  family    history,    and  his   personal    history  is 


excellent.  He  was  compelled  to  give  up  work 
sixteen  days  ago.  The  illnesss  began  with  stiff- 
ness in  the  neck  and  soreness  over  the  eyes.  He 
did  not  have  much  pain  in  the  back  or  the  legs. 
There  was  pain  in  the  stomach,  and  the  bowels 
were  constipated,  and  for*  the  relief  of  this  [nils 
were  taken,  and  the  bowels  moved  freely.  He  also 
suffered  with  epistaxis.  and  thirteen  days  ago  was 
compelled  to  go  to  bed. 

When  admitted  to  the  hospital,  the  face  was 
Hushed,  the  eyes  were  bright,  and  he  was  quite 
rational.  The  temperature  was  103.4°,  the  pulse 
a  little  over  100°,  and  dicrotic,  and  the  res- 
pirations were  not  increased  in  frequency. 
Examination  of  the  abdominal  and  thoracic  viscera 
gave  negative  results.  There  was  neither  diarrhcea 
nor  rash.  Since  admission  the  fever  has  been 
persistently  high.  He  is  now  at  the  end  of  the 
second  week  of  the  disease.  The  eruption  has 
been  quite  characteristic,  not  copious  ;  the  abdom- 
inal symptoms  have  been  slight,  as  in  most  of  the 
cases  this  autumn.  The  abdomen  is  slightly 
distended,  and  the  spleen  is  somewhat  enlarged. 
The  most  serious  symptoms  which  this  patient  has 
l)resented  have  been  those  relating  to  the  nervous 
system.  If  you  watch  him  for  a  few  minutes  you 
will  see  that  he  is  very  tremulous.  This  began 
early  in  the  case.  It  is  best  noted  about  the  face, 
and  when  the  patient  responds  to  a  question  you 
will  see  that  the  muscles  are  quivering.  When  he 
protrudes  the  tongue,  it  trembles.  The  muscles 
of  the  hands  and  arms  are  in  a  state  of  jactitation, 
— sebsultus  tendinum.  This,  as  a  rule,  indicates 
profound  involvement  of  the  nervous  system.  He 
has  had  also  pretty  active  delirium.  He  has 
attempted  to  get  out  of  bed,  and  has  had  wander- 
ing sleepless  condition  at  night.  He  has  not 
been  in  that  torpid,  heavy,  stupid  state  which  is 
seen  in  many  instances  of  typhoid  fever.  The 
mental  condition  in  the  severer  cases  of  the  disease 
is  usually  one  of  stupor  or  semi-coma,  or  it  is  one 
of  active  delirium.  Of  the  two  the  semi-comatose 
condition,  as  a  rule,  carries  a  more  favorable  prog- 
nosis.    The  active  delirium  is  more  serious. 

A  special  condition  calling  for  treatment  in  this 
case  has  been  the  persistently  high  temperature.  He 
has  been  given  antifebrin,  and  it  h.as  acted  well, 
reducing  the  temperature  two  or  three  degrees  in 
as  many  hours.  Yesterday  the  temperature  at 
8.20  a.  m.  was  104.4°.  -He  was  then  given 
eight  grains  of  antifebrin,  and  the  temperature  was 
reduced  to  100°  by  11.50  a.  m.  Three  days 
ago,  the  same  dose  of  antifebrin  reduced  the 
temperature  frem  104°  to  100°  within  three 
hours.  The  drug  seems  to  have  acted  satisfactorily 
as  regards  the  reduction  of  temperature,  but  it 
has  the  unfavorable  effect  which  most  of  these 
new  antipyretics  have,  and  which  quinine  has  not, 
namely,  that  they  produce  profuse  sweating,  which 
is  most  distressing  to  the  patient.  The  patient 
after  the  use  of  one  of  these  drugs  may  be  dren- 
ched with  sweats  as  copious  as  those  of  phthisis. 
I  have  stopped  the  antifebrin  and  have  resorted 


THE   CANADA    MEDICAL    RECORD. 


39 


to  sponging.  This  I  think  will  suffice  to  keep  the 
temperature  down.  .Anollier  symptom  which  has 
called  for  special  tieatment  in  this  case  is  cardiac 
weakness.  'I'iie  pulse  has  been  frequent  and  feeble, 
and  for  this  we  have  given  alcohol  in  repeated  and 
large  doses,  twtlve  to  fifteen  or  more  ounces  in 
the  day,  and  it  has  had  an  influence  in  quieting 
the  nervous  disturiiance  and  also  iin[)roving 
somewhat  the  vigor  of  the  heart's  action. 

CIRRHOSIS  OK     THE    LIVER. 

I  have  recently  shown  you  two  instances  of 
hemorrliage  from  the  stomach  in  middle-aged  men, 
jjossibly  due  to  cirrhosis  of  the  liver.  Since  then 
I  have  had  several  other  cases  under  observation. 
Two  of  these  cases  are  quite  interesting,  and  illus- 
trate a  point  on  which  I  wish  to  speak,  namely, 
the  latency  of  the  affection.  One-third,  possibly 
one-lK^lf,  of  all  cases  of  cirrhosis  of  the  liver, 
coming  under  observation  in  any  large  hospital,  are 
met  wuh  for  the  first  time  on  the  post-mortem 
table.  There  may  have  been  no  special  symp- 
toms, or  the  patient  has  complained  of  other 
conditions,  and  at  the  autopsy  extreme  cirrhosis 
may  be  found.  Of  this  there  have  lately  been  two 
interesting  illustrations.  A  man  was  admitted 
into  the  drunkard's  ward  with  acute  alcoholism 
and  pneumonia,  and  died  at  the  end  of  twelve 
hours.  He  was  slightly  jaundiced,  not  more  so, 
however,  than  is  frequently  seen  in  pneumonia. 
He  had  no  oedema  of^  the  feet  and  no  dropsy  of 
the  peritoneum.  At  the  post-mortem  we  found  in 
addition  to  the  lesions  of  pneumonia,  extreme 
cirrhosis  of  the  liver.  The  organ  was  very  irregu- 
lar, and  in  the  condition  of  advanced  interstitial 
hepatitis.  'Ihe  man  had  apparently  presented  no 
symptoms  of  this  affection. 

The  second  case  was  that  of  a  man  aged  44, 
sent  from  the  surgical  wards  on  account  of  sudden 
hpemorrhage  from  the  stomach.  He  vomited  three 
or  four  pints  of  blood,  and  died  within  a  kw 
hours  after  admission  to  the  medical  ward.  When 
I  saw  him  he  was  comatose,  and  the  only  thing 
detected  on  physical  examination  was  extreme 
reduction  in  the  area  of  liver  dtilness.  He  had 
apparently  had  no  symptoms  except  the  dyspepsia 
which  all  chronic  alcoholics  have.  At  the  autopsy 
we  found  the  following  interesting  condition  : 

The  body  was  fairly  well  nourished  ;  there  was  a 
small  ulcer  on  the  leg,  for  which  he  had  been  under 
treatment  in  the  surgical  ward.  There  was  no 
oedema  of  feet;  no  fluid  in  peritonemn.  Left  lobe 
of  liver  two  inches  below  ensiforni  cartilage. 
Heart  and  lungs  normal.  Stomach  did  not  con- 
tain blood  (a  point  of  interest,  as  he  was  stated  to 
to  have  vomited  the  blood)  ;  the  mucosa  was  pale ; 
no  erosions.  Veins  at  the  cardiac  end  much 
dilated.  Oesophageal  plexus  of  veins  very  promi- 
nent, and  several  large  branches  were  directly 
continuous  with  those  in  the  stomacli.  For  three- 
fourths  of  the  tube  the  subinucous  veins  were 
dilated.  On  the  posterior  wall  was  a  long  varicose 
vein  as  thick  as  a  small  quill,  and  at  one  point  this 


presented  a  greyish  white  spot,  elevated  and 
covered  with  a  thrombus.  A  small  probe  passed 
into  the  vein  came  out  through  this  spot,  which 
represented  a  laceration  in  the  vein,  and  no  doubt 
from  this  had  come  the  bleeding. 

The  liver  weighed  three  poimds  ;  was  no  hilar, 
tough,  and  on  section  showed  an  advanced  grade 
of  cirrhosis ;  portal  canals  were  much  constricted, 
and  the  iiuerlobular  connective  tissue  much 
increased.  The  diaphragmatic  plexus,  the  veins 
of  the  suR|)ensory  ligament,  those  of  the  lateral 
peritoneum,  and  particularly  those  over  the 
kidneys  were  enlarged.  The  hemorrhoidal  ves- 
sels were  not  very  much  dilated.  The  vena  azy- 
gos  was  large. 

In  both  of  tliese  cases  the  cirrhosis  was  extreme. 
The  contraction  of  the  ultimate  branches  of  the 
portal  vessels  in  the  liver  substance  was  most 
marked,  and  yet  there  were  no  symptoms  of  portal 
obstruction.  The  point  1  desire  you  to  remember 
is  this  :  that  if  in  any  case  of  cirrhosis  the  collate- 
ral circulation  is  established,  then  so  long  as  it  is 
effectively  maintained,  so  long  will  the  characteris- 
tic syinptoms  of  cirrhosis  be  absent.  There  may 
be  no  dropsy,  no  jaundice,  and  no  extreme  dys- 
pepsia. In  both  of  these  cases  the  collateral 
vessels  were  very  distinct.  It  is  chiefly  through 
the  diaphragmatic  and  oesophageal  veins,  and  the 
communication  with  the  mesenteric  and  lumbar 
veins,  and  by  hemorrhoidal  veins  that  the  colla- 
teral circulation  is  maintained.  In  both  cases, 
the  anastomoses  of  these  vessels  were  extensive 
enough  to  ]}revent  engorgement  in  the  portal 
circulation,  which  is  the  effective  factor  in  produ- 
cing dropsy.  Dilatation  of  the  oesophageal  veins 
in  cirrhosis  is  a  well  recognised  condition. 
Communication  between  the  oesophageal  and 
diaphragmatic  veins,  and  the  union  of  these  with 
the  azygos  veins  aids  materially  in  carrying  off 
from  the  stomach,  from  the  spleen,  and  even  from 
the  liver  itself,  a  large  quantity  of  blood  which 
under  other  circumstances  would  pass  through  the 
portal  circulation.  Rupture  of  an  oesophageal  varix 
is  a  rare  but  well  recognized  mode  of  death  in 
hepatic  cirrhosis. — Phil.  Med.  Ncivs'. 


INJECTIONS   OF  WARM   WATER  IN    DY- 
SENTERY. 

Dr.  R.  Tripier,  in  the  Lyon  Medicii/e,  writes  con 
cerning  the  action  of  injections  of  hot  water  in 
dysentery.  He  sometimes  gives,  in  addition,  in- 
fusion of  ipecac  internally.  When  a  patient  is  able 
to  retain  the  hot  water  (heated  to  105  °  or  115  °  ) 
a  sufficient  length  of  time,  the  jiain  is  immediately 
relieved,  the  blood  quickly  disappears  from  the 
stools,  and  even  these  soon  become  fewer.  The 
amount  of  water  injected  should  be  as  large  as  can 
be  borne;  from  :o  to  12  ounces  for  children  and 
about  a  quart  for  adults. — Journal  de  Medicin: 
et  Chirurgie  Pratiques. 


40 


THE   CANADA   MEDICAL    RECORD. 


FIBROID  TUMORS  OF  THE  UTERUS. 

By  W.  \V.  Woodham  Webb,  M.  D.,  M.  R.  C.  P.Lin  Ion 

Neiully-Sur-Scine,  France. 

The  comparatively  speedy  results  obtained  by 
the  use  of  the  pole  of  the  battery  in  the  case  of 
hemorrhagic  fibroids  is  very  striking.  When  we 
see  a  woman  who,  in  months  or  years  of  suffering, 
has  passed  through  the  stages  of  depression,  debil- 
ity and  exhaustion,  till  at  last  she  lies  down  in 
her  bed  helpless  and  in  despair,  rise  up  after  a  few 
applications,  with  her  pains  soothed,  her  bleeding 
stayed,  her  countenance  brightening,  her  appetite 
returning,  and  the  dawn  of  a  new  life  opening 
upon  her,  one  is  apt  to  think  that  medical  science 
has  justified  itself.  Yet  it  has  not  by  this  feat 
reached  the  end  of  its  powers,  it  can  res[)ond  even 
to  further  demands.  The  woman  has  still  her 
burden  upon  her.  The  surgeon  may  have  recourse 
to  his  knife  and  take  it  away.  But  at  what  risk? 
Such  a  risk  that  only  despair  will  never  him  to 
face  it,  or  make  the  patient  submit  to  it.  Those 
only  who  have  long  felt  the  crushing  responsibility 
of  cutting  operations,  and  have  had  sufficient  ex- 
perience to  gain  the  conviction  that  a  known  per- 
centage of  recoveries  is  hardly  enough  to  counter- 
balance the  pains  and  perils  of  forlorn-hope  sur- 
gery, can  fully  luxuriate  in  the  sensatio.i  of  relief 
given  by  the  prospect  of  being  able  to  control  the 
growth  of  these  tumors  and  render  them  harmless 
by  a  scathless  process.  This  is  for  the  future  to 
be  the  work  of  the  negative  pole  of  the  battery. 
And  that  is  not  all.  Before  advancing  far  with 
the  patient-taxing  proceedings  against  the  corpus 
delicti,  we  have  the  satisfaction  to  find  the  earlier 
steps  lead  to  such  a  modification  of  a  certain  class 
of  symptoms,  and  such  a  change  of  health  condi- 
tions as  to  make  the  question  of  time  of  but  secon- 
dary importance.  With  loss  of  pain  and  ease  of 
mind,  a  woman  may  wait  calmly  for  the  restoration 
of  tlie  symmetry  of  her  body. 

The  second  group  of  fibromas  is  that  in  which 
tlie  leading  troubles  are  those  of  difficult  or  suspen- 
ded menstruation.  In  some  cases  the  displace- 
ment of  the  uterus  is  so  considerable  that  no 
entrance  into  the  cavity  can  be  obtained  for  caute- 
rization, and  the  alternative  of  puncture  has  to  be 
adopted.  The  character  of  the  tumor  varies.  It  is 
sometimes  a  mere  mural  thickening,  complicated 
with  inflammatory  depositsaround.  In  other  women 
there  are  subperitoneal  accumulations  and  protube- 
rances, or  large  jjcdunculated  outgrowths.  .\c- 
comj.ianying  them  are  all  the  usual  functional 
disorders  and  nervous  irregularities,  which  take 
away  the  enjoyment  of  life  and  even  make  it  a 
Ijurden.  But  as  the  most  notable  distress  arises 
f:oni  the  periodical  pain,  the  scanty  or  unnatural 
discharge,  and  the  local  uneasmess  which  is 
always  [jiesent,  we  begin  with  attempting  to  ease 
that. 

Faradization  of  the  uterus  may  be  of  use  as  a 
palliative  remedy,  but  generallly  recourse  is  had 
^t  once  to  negative  galvano-cauterization,  of  more 


or  less  force,  and  at  intervals  more  or  less  long,  as 
the  patient  bears  the  treatment,  and  according  to 
the  change  that  takes  place.  The  periods  soon 
become  more  regular,  the  intermediate  time  is  less 
disturbed,  the  general  Itealth  improves,  and  the 
local  distress  is  not  so  urgent.  Such  an  ameliora- 
tion is  a  great  point  gained,  but  we  must  not  stop 
there.  As  more  has  to  be  done  in  regard  to  the 
riddance  of  the  tumor,  the  useful  but  slow-working 
intra-uterine  cauterizations  are  superseded  by  the 
negative  gal/ano-punctures.  As  Althaus  has  said, 
"  No  animal  tissue  whatever  can  resist  the  disin- 
tegrating effect  of  the  negative  pole ;  and  the 
force  and  rapidity  with  which  the  disintegration  is 
brought  about  are  directly  proportional  to  the 
electro  motive  force  which  is  employed,  and  to 
the  softness  and  vascularity  of  the  structures  acted 
upon."  This  action  of  the  negative  pole  is  a  dou- 
ble one.  The  negative  electrolytic  decomposition 
of  animal  substance  or  liquid  give  rise  to  an  evolu- 
tion of  bubbles  of  hydrogen,  which  mechanically 
affect  the  tissues  near  the  pole  by  insinuating 
themselves  between  the  structural  elements  and 
driving  their  fibres  asunder.  This  is  a  point  esta- 
blished by  microscopical  observation.  The 
second  effect  is  a  chemical  one — that  of  the  alka- 
lies. These,  soda,  potash,  lime,  with  the  hydro- 
gen, are  liberated  by  the  decomposition  of  the 
animal  matter,  and  go  to  the  negative  pole.  The 
metal  remains  untouched  by  them,  so  that  they  are 
all  free  to  act  upon  the  adjacent  parts  in  that  man- 
ner of  potential  caustics.  An  eschar  is  formed, 
suppuration  takes  place,  and  sometimes  a  consi- 
derable discharge  continues. 

Such  are  the  notable  effects  produced  at  the 
seat  of  puncture  by  the  negative  pole,  and  it  is 
this  only  which  in  these  cases  is  used  therapeuti- 
cally. Cauterizing  action,  which  would  be  as 
powerful  at  the  point  of  exit  of  the  current  at  the 
cutaneous  pole,  if  it  issued  as  dense  as  it  w^ent  in, 
is  not  wanted.  It  is,  therefore,  guarded  against 
by  disseminating  the  current  through  the  interven- 
tion of  the  wet  clay.  But  the  main  factor  in 
determining  a  diminution  in  the  size  of  the  tumor 
is  the  repeated  action  of  the  intense  current  of 
electricity  which  is  made  to  traverse  the  interpolar 
tissues.  Whatever  explanation  may  be  given,  the 
fact  is  that  nutrition  is  interfered  with,  the  vessels 
shrink,  the  form  alters,  the  substance  contracts, 
and  the  tumor  remains  smaller  to  an  extent  which 
renders  its  presence  of  but  little  importance.  It 
still  exists,  but  without  any  disposition  to  throw 
out  new  offshoots  orto  resume  its  former  power  of 
expansion. 

The  operator  must  be  guided  in  his  choice  of 
the  part  in  which  to  make  the  puncture  by  the 
form  and  situation  of  the  tumor,  or  by  the  condi- 
tion in  which  he  finds  the  prominent  part  of  the 
uterus.  If  it  c^n  be  done  conveniently,  the  punc- 
tures are  best  arranged  pii  and  about  the  npck  of 
the  ijterus  ;  if  thp  neck  be  obliterated,  in  a  series 
round  the  orifice;  or  where  the  displaceiflent  of  the 
organ  only  leaves   the  option  of  a  projecting  part 


Tilt':  cAiJADA  Medical  recouU. 


41 


of  the  tumor,  then  they  may  penetrate  the  tumor 
itself  througli  the  expanded  vaginal  wall.  I  have 
mentioned  the  [irccautions  necessary,  and  have 
only  to  add  that  the  length  of  puncture  used  at 
the  present  time  is  much  less  than  it  was  at  first. 
Rarely  is  it  now  found  of  advantage  to  leave 
c.\|)0sed  out  of  tlie  sheath  more  than  two  centime- 
tres of  the  trocar.  This  shallow  puncturing 
lessens  in  a  gieat  measure  the  chance  of  wounding 
vessels  or  passing  through  the  peritoneum.  Even 
when  it  so  happens  that,  on  withdrawing  the  ins- 
trument, there  is  a  flow  of  blood,  it  can  be  at  once 
restrained  by  introducing  a  speculum  and  putting 
the  parts  on  the  stretch,  or  picking  up  the  bleeding 
point  with  a  pair  of  pressure-forceps.  Generally 
the  oozing,  if  there  be  any,  is  very  trifling  and 
stops  spontaneously,  and  a  moderate  depletion  of 
this  kind  is  only  beneficial. 

The  cases,  of  which  I  give  very  condensed  notes, 
show  what  may  be  expected  from  the  treatment  by 
negative  galvano- punctures. 

Case  1. — Madame  P.,  aged  forty  six  Natural 
pregnancy  at  nineteen.  When  inirty-first  signs  of 
abdominal  tumor.  As  the  abdomen  distended  the 
health  declined.  Surgeons  consulted  declared  the 
tumor  to  be  a  uterine  fibroid,  but  declined  to  ope- 
rate. Gradually  grew  worse,  with  all  the  phenom- 
ena of  compression  ;  functions  disturbed ;  difficult 
menstruation,  and  pronounced  cachexia  ;  disabled. 
Came  to  C/init/iu  ]ime,  18S3.  Fibrous  tumor  of 
uterus  attached,  not  in  any  way  movable,  touching 
at  its  ujjper  end  the  sternum,  filling  the  belly  and 
the  pelvic  basin.  Abdominal  measurement  in 
line  of  umbilicus  1 10  centimetres.  Neck  of  uterus 
raised  up  behind-  pubes  and  inaccessible  to  the 
sound.  Puncture  inevitable.  After  three  negative 
galvano-punctures,  three  centimetres,  seventy 
milliamperes  for  eight  minutes  each,  tiie  neck  of 
the  uterus  descended,  so  that  between  July,  1883, 
and  July,  1884,  twenty-nine  galvano-cauterizations, 
negative,  intra-uterine,  were  possible,  and  a  large 
and  rapid  diminution  of  the  tumor  took  place. 
Measurement  at  one  time  showed  a  decrease  of 
sixteen  centimetres  round  the  abdomen,  but  the 
deposition  of  subcutaneous  fat  soon  brought  it  up 
to  the  point  first  noted.  The  tumor  became  pe- 
dunculated and  movable,  menstruation  regular, 
and  the  woman  was  able,  while  undergoing  treat- 
ment, to  resume  her  work  with  ease. 

From  July,  1884,  to  December,  1885,  thirty- 
eight  negative  galvano-caustic  applications,  intra- 
uterine, completed  the  treatment.  The  tumor 
went  on  lessening,  all  symptoms  of  pressure  disap- 
peared, and  the  general  health  was  as  good  as 
when  she  was  young. 

In  November,  1886,  the  tumor  was  quite  free, 
with  its  upper  border  a  hand's  breadth  below  the 
point  of  the  sternum.  Menstruation  ceased  in 
September,  1885,  and  she  gained  weight. 

June,  1887,  lives  as  a  woman  in  health,  and  if 
we  may  estimate  the  reduction  of  the  tumor  as  one- 
third,  the  set  off  against  the  remaining  bulk  of  the 
fibroid  is  the  entire  suppression  of  every  sympto- 
matic trouble. 


Case  II. — Madame  D.,  aged  fifty-nine,  mother 
of  one  child,  came  \.o  clinique  December,  1884. 
Had  been  ailing  all  her  life.  Menopause  at  fifty- 
three,  wherj  lier  health  became  worse,  with  bad 
abdominal  symptoms  caused  by  a  tumor  which 
ra])idly  fnrmcd  at  that  time.  Fotmd  to  be  a  sub- 
peritoneal uterine  fibroid,  passing  more  than  two 
inches  above  tlie  umbilicus,  fixed,  bulging  out  the 
abdomen  and  blocking  uj)  the  pelvis.  The  sound 
revealed  excessive  thinning  of  the  anterior  wall  of 
the  uterus,  so  that  all  intrauterine  interference  was 
given  up  for  fear  of  perforation. 

Between  Januaiy  and  November,  1885,  fifteen 
negative  galvano-punctures,  one  centimetre,  were 
made  with  a  current  of  from  80  to  100  milliam- 
peres, five  ininutes.  The  neck  of  the  uterus  being 
turned  up  to  the  left,  the  punctures  were  directed 
into  the  projecting  part  of  the  tumor  through  the  cen- 
tral part  of  the  posterior  vaginal  wall.  No  chloro- 
form. Some  hysterical  and  gastric  symptoms,  which 
gave  way  to  bipolar  galvanization  of  the  pneumogas- 
trics.  During  the  first  halfyear  there  was  a  rapid  re- 
gression of  the  tumor  with  corresponding  ameliora- 
tion of  the  health.  She  weighed  five  pounds  more, 
and  had  a  considerable  accinnulation  of  abdominal 
fat.  The  size  afterwards  went  on  lessening  till,  in 
December,  when  all  treatment  was  suspended,  the 
upper  part  of  the  tumor  had  become  so  movable 
tliat  it  seemed  to  be  attached  to  the  uterus  only 
by  a  peduncle,  and  could  be  pushed,  without  cau- 
sing pain,  from  one  side  of  the  abdomen  to  the 
other.  When  at  rest  the  U])per  margin  was  more 
than  two  inches  below  the  lunbilicus,  though  the 
whole  of  the  isolated  mass  could  be  raised  above 
it.  The  pelvic  section  of  the  tumor  was  also  so 
much  smaller  as  to  leave  the  uterus  disengaged, 
and  to  permit  the  vagina  to  resume  its  natural 
form.  Uterine  measurement,  which  was  at  the 
first  sitting  nine  centimetres  and  a  half,  had  short- 
ened to  six  centimetres,  and  the  thickness  of  the 
uterine  wall  was  more  uniform. 

She  remained  in  good  health  through  1886. 
Some  narrowing  of  the  cervical  canal  prevented 
any  introduction  of  the  sound,  but  caused  no 
inconvenience.  A  continued  contraction  of  the 
tuiTior  was  manifest.  At  the  present  tin:e  (June, 
1887,)  she  is  quite  well,  still  fatter,  and  has  no 
abdominal  deformity,  except  that  owing  to  the 
adipose  tissue. 

Case  III. — Madame  R,  aged  fifty-three,  good 
constitution,  no  serious  disease,  mother  of  five 
children.  Menstruation  always  natural,  till  in 
1882  she  was  seized  with  sudden  and  violent  hem- 
orrhagia.  This  lasted  three  years,  during  which 
a  painful  abdominal  tumor  gradually  reached  a 
large  size,  with  derangement  of  all  the  organic 
functions,  and  loss  of  strength  and  flesh.  Treat- 
ment with  ergot  did  no  good.  Diagnosis,  Septem- 
ber, 1885:  Interstitial  and  subperitoneal  fibroma  of 
uterus,  rising  above  the  umbilicus,  distending  the 
abdomen,  and  on  a  level  with  the  upper  rim  of  the 
pubes,  inaccessible  to  the  finger.  No  introduction 
of  sound  being  possible,  negative  galvano-punc- 
tures were  commenced. 


42 


'fHE   CANADA   MEDICAL   RECORD. 


From  the  beginning  of  September  to  the  end  of 
December,  1885,  sixteen  punctures,  one  to  five 
centimetres,  with  current  of  from  150  to  200  milli- 
amperes,  five  minutes,  through  the  vagina.  On 
October  loth,  after  the  fourth  puncture,  there  was 
total  cessation  of  hemorrhage.  Amendment  of 
liealth  began,  and  the  tumor  liad  so  much  reduced 
that  in  December,  the  neck  of  the  uterus  had  des- 
cended, and  the  sound  could  be  introduced,  show- 
ing a  measurement  of  nine  centimetres  and  a 
half.  There  was  an  unavoidable  cessation  of  treat- 
ment. It  beg.an  again  in  April,  1886,  and  bet- 
ween that  dale  and  the  end  of  July  two  more  punc- 
tures were  made,  and  the  effect  completed  by  six- 
teen intra-uterine  galvanocauteiizations.  After 
this  time  nothing  more  was  done.  Natural 
menstruation  appeared  for  the  last  time  on  August 
loth,  lasting  four  days  without  pain.  At  the  end 
of  1886  she  was  healthy,  growing  fatter,  carrying 
the  remains  of  her  tumor  without  cause  for 
complaint,  and  regularly  doing  her  work  of 
concierge.  In  June,  1887,  she  called  to  report 
lierself  quite  well.  Her  own  words  were  :  "  Je  me 
porte  aujourd'hui  aussi  bien,  en  tons  points,  qu'il 
y  a  cinq  ans,  et  sauf  la  presence  du  resle  de  ma 
tumeur,  qui  ne  m'incommode  plus  en  aucune 
mani6re,je  me  declare  en  parfaile  sante." 

Dr.  x\postoli  has  so  recently  explained  his  views 
as  to  the  ajjplication  of  this  mode  of  treatment  to 
the  many  forms  of  chronic  metritis,  by  which 
women  are  often  as  much  disabled  as  by  distinct 
tumors,  that  I  need  not  repeat  his  observations. 
I  may  only  remark  that  the  subject  is,  perhaps,  of 
even  more  importance,  seeing  that  the  condition 
is  more  common,  and  may  generally  be  regarded 
as  tlie  starting  point  of  definite  abnormal  forma- 
tions. 

But  there  is  another  matter  associated  with  this 
question  of  electrical  treatment  that  has  long 
weighed  upon  my  mind  ;  and  now,  with  this  oppor- 
tunity before  me,  I  can  not  pass  it  by  without  a 
word  that  may  specially  interest  ovariotomists.  I 
have  been  as  much  concerned  with  ovariotomy  as 
most  men,  and  always,  when  standing  beside  the 
operating  table,  have  had  the  humiliating  feeling 
which  one  must  be  conscious  of  when  grubbing  up 
weeds  in  a  neglected  garden.  We  all  know  what 
is  the  wretched  state  of  a  woman  with  a  fully 
developed  ovarian  tumor,  no  matter  of  what  kind. 
Fortunately,  scientific  skill  has  freed  tlie  delivering 
operation  of  many  of  its  terrors.  But  the  most 
brilHant  performances  of  our  operators  only  serve 
to  throw  a  shadow  of  reproach  over  the  jiatholo- 
gical  side  of  the  ovarian  question.  Hanging 
criminals  wholesale  never  was  the  means  of  ridding 
us  of  crime.  Every  good  delivery  only  made 
place  for  fresh  committals,  and  mounted  up  the 
statistics  of  social  scandal.  To  strike  at  the 
vicious  germ  of  the  evil  by  moral  training  and 
education  was  more  efficacious  in  staying  the  pest 
than  the  utmost  perfectioning  of  the  art  of  hanging. 
Why  should  we  not  see  a  similar  sanitary  reforma- 
tion among  ovariotomists  ?     Instead  of  exhausting 


their  ingenuity  in  discussing  the  qualities  of  liga- 
tures, the  merits  of  various  knots,  and  the  advanta- 
ges of  the  long  peritoneal  drop  over  the  external 
strangulation  of  the  pedicle,  just  as  the  sheriff's 
deputy  puzzles  himself  about  the  length  of  his  cord 
and  the  l^est  way  of  nooning  the  necks  of  his 
human  excrescences,  when  will  they  turn  more 
ovariological,  and  take  to  the  work  of  seeking  out 
how  to  repress  the  proliferous  tendencies  of  the 
nascent  crop  of  ovarian  cysts  ?  It  is  a  task  that 
must  be  done,  and  will  be  done  by  some  one  who 
is  duly  impressed  with  a  sense  of  professional 
responsibility.  Is  there  a  gleam  of  hope  in  what 
has  been  observed  in  the  midst  of  these  electrical 
uterine  operations  ?  Some  few  times  it  has  happened 
that  an  incipient  ovarian  tumor  has  been  recogni- 
zed. 

The  cauterizations  or  punctures  have  been 
made,  and  the  cyst  has  disappeared.  Taking  this 
as  a  fact,  does  it  not  open  out  a  line  of  experimental 
investigation  worth  following  up?  It  requires  the 
disposition,  tlie  opportunity,  and  the  devotion  of 
time.  Men  harassed  by  the  demands  of  actual 
practice  can  not  undertake  it,  but  surely  the;e 
must  be  some  who,  in  their  waiting  time,  are  on 
the  lookout  for  the  way  of  making  themselves  men 
of  repute.  They  might  profitably  give  themselves 
up  to  the  speculation  of  projecting  in  an  almost 
untouched  corner  of  preventive  medicine.  Hie 
p.tiet  iiigeniis  campus. 

The  following  is  a  summary  of  the  notes  of  one 
of  the  cases  to  which  I  have  alluded : 

Madame  G.,  aged  twenty-eight,  good  health, 
married  at  nineteen,  never  pregnant,  constant 
lucorehcea ;  regular  menstruation,  sjiort  and  scanty, 
becoming  more  abundant  after  marriage.  On 
examination,  uterus  found  nearly  natural,  vagina 
sensitive,  nothing  wrong  on  left  side,  but  on  right 
side,  in  the  situation  of  the  ovary,  a  tumor  was 
easily  distinguished,  hemispherical,  having  the  feel 
of  a  somewhat  solid  cyst,  not  very  tender  under 
pressure,  and  easily  recognized  by  its  form,  situa- 
tion, consistence,  and  want  of  sensibility  as  an 
incipient  ovarian  tumor. 

After  consultation  a  vaginal  negative  galvano- 
puncture  was  made  to  the  depth  of  one  centimetre, 
and  a  current  of  100  milliamperes  passed  for  five 
minutes.  No  chloroform  was  used,  and  the 
patient  bore  what  was  done  without  complaint. 
The  sensation  to  the  operator  was  that  of  tapping 
a  cyst  with  fluid.  No  fluid,  however,  escaped  by 
the  vagina.  The  patient  was  a  little  nervous  in  the 
evening,  and  had  some  rectal  tenesmus,  but  slept 
well,  and  went  home  at  the  end  of  twenty-four 
hours'  rest. 

On  examination  five  days  afterwards  no  tumor 
could  be  found,  and  there  was  no  tenderness.  It 
is  now  nearly  two  years  since  the  operation  was 
performed.  The  woman  has  remained  in  her 
usual  health,  is  somewhat  stouter,  and  keeps 
constantly  at  her  work.  At  the  present  time 
(June,  1887),  there  was  no  trace  of  a  cyst  on  the 
ight  side,  but  the  ovary  can  be  detected  on  lower- 


THK  CANADA   MKDICAL   RECORD. 


43 


ring  the  uterus.  On  the  left  side  a  small  tumor 
about  the  size  of  a  chestnut,  with  all  the  characters 
of  an  ovarian  cyst,  has  made  its  appearance.  A 
little  projection  on  the  rigiit  vaginal  wall  marks 
the  spot  where  the  puncture  was  made. 

Finally,  and  as  the  result  of  eight  month?, 
incessant  observation,  and  of  my  own  exjierience 
in  the  troatmcat  of  cases  in  conjunction  with  Dr. 
.•\postoli,  1  can  unliesitatingly  assure  those  who  are 
interested  in  the  question,  operators  or  operatees, 
that  the  conclusions  at  whicii  I  arrived  at  an  early 
])eriod  of  my  investigations  as  to  the  value  of  the 
therapeutic  influence  of  electricity  in  cases  of 
uterine  fibroids,  used  after  the  manner  I  have 
described,  witli  a  view  to  introduce  it  to  the  notice 
of  English  surgeons,  are  more  than  confirmed  by 
my  longer  acquaintance  with  the  subject.  It  is 
also  worth  mentioning  that  they  have  met  with  the 
assent  of  all,  including  such  authorities  as  Sir 
Spencer  Wells,  Keith,  and  Dr.  Playfair,  who  have 
been  induced  by  what  I  have  written  to  visit  the 
c/iniijue,  and  e.\aniine  the  evidence  for  themselves. 
Some,  indeed,  have  at  once  resolved  to  adopt  the 
practice,  and  others,  who  are  not  disposed  to 
undertake  a  task  which  requires  so  much  quiet 
perseverance  and  familiarity  with  technical  details, 
have  confided  their  patients  to  our  care.  These 
cases  I  shall  hereafter  publish,  when  time  has 
proved  that  the  benefits  received  are  as  permanent 
as  those  recorded  of  his  own  jiatients  by  Dr.  Apos- 
toli. 


CHRONIC  CON.STIPATION.* 

By  GiiORGE  J.  Cook,  M.  D., 

Formerly  Professor  of   Anatomy  in  Kentucky    School  of 
Medicine;  Consulting    .Surgeon    for   Dise.ises   of  the 
Rectum  to  the    Indianapolis  City  Hospital    and  Dis- 
pensary ;  Member  of  the  American  Medical 
Association,  etc. 

The  part  directly  involved  in  chronic  constipation 
is  the  large  intestine.  The  contents  pass  through 
the  small  intestine  in  three  hours,  and  through  the 
large  bowel  in  twelve  hours.  (Landois.)  The 
contents  are  liquid  in  form  as  they  are  poured 
through  the  ileo-csecal  opening — in  the  colon,  they 
are  exposed  to  the  ojien  mouths  of  Luberkuhn's 
follicles,  which  take  up  the  digested  portion  that 
has  escaped  the  absorbents  above.  The  longer 
the  contents  are  exposed  to  the  absorbents  along 
the  colon,  the  more  of  the  watery  portion  will  ht 
extracted,  and  the  more  solid  will  be  the  mass  of 
excrement.  The  secretion  from  the  large  intestine 
is  mostly  mucus,  in  quantity  sufficient  to  lubricate 
its  walls.  There  is  not  sufficient  watery  secretion 
from  this  part  to  modify  the  consistence  of  the 
fiaeces.  The  consistence  of  the  excremental  mass 
which  passes  from  the  rectum  depends  on  the 
length  of  time  required  for  the  contents  to  pass 
from  the  csecum  to  the  anus,  and  the  activity  of 
the  absorbents.     The  consistence  of  fsces  should 


5f:Read  to  the  Mississippi  Valley  Medical  Association,  at 
Crab  Orchard,  Kentucky,  July  14,  1887. 


be  mushy,  or  at  most  only  sufficiently  hard  to  be 
moulded  in  form. 

If  the  contents  pass  through  the  large  intestine 
in  twelve  hours,  and  the  resulting  excremental 
mass  is  very  hard,  the  contents  have  remained 
too  long  in  this  part,  whereas,  if  they  siiould  be 
thirty-six  or  forty  eight  hours  in  passing,  and  the 
fascL's  is  of  normal  consistence,  they  have  remained 
in  the  large  intestine  the  proper  length  of  time. 
The  proper  time  for  the  contents  to  remain  in  the 
large  intestine  is  modified  to  an  extent  by  the 
action  of  the  small  intestine.  If  the  peristalsis 
is  very  active  in  the  small  bowel,  and  will  carry 
the  contents  through  rapidly,  the  quantity  passing 
through  the  ileo-csecal  opening  will  be  correspond 
ingly  large,  giving  the  colon  more  work  to  do 
and  it  will  lequire  more  time  to  do  it. 

If  the  peristalsis  is  sluggish  in  thestnall  intestine, 
allowing  the  contents  to  be  exposed  to  the  active 
absorbents  of  this  part  a  long  time,  the  quantity 
passing  into  the  colon  will  be  smaller,  and  the 
less  time  it  si  o  ild  remain  there.  In  a  like  manner, 
the  activity  of  absorption  in  both  the  large  and 
small  bowel  will  modify  the  time  necessary  for 
the  contents  to  remain  in  the  former.  Thus  the 
proper  peristalsis  of  the  large  bowel  is  modified 
by  the  activity  of  the  peristalsis  in  the  small,  and 
absorption  in  both  small  and  large  intestine. 

Chronic  constipation  may  be  defined  as  that 
condition  in  which  the  contents  remain  too  long 
in  the  large  intestine.  There  are  two  forms  of 
chronic  constipation,  viz.  :  Obstruction  and 
atonic.  In  the  former  there  is  an  obstruction  to 
the  free  passage  at  some  point  along  the  large 
intestine,  while  in  the  latter  the  passage  is  free, 
but  for  want  of  proper  tone  in  the  muscular  struc- 
ture of  the  bowel,  the  contents  are  not  carried 
along  in  the  proper  time.  In  enumerating  the 
causes  of  the  first  form,  we  will  begin  on  the 
external  sphincter  muscle.  This  little  muscle,  of 
wonderful  power  and  endurance,  performs  an  im- 
portant function  at  the  lower  end  of  the  alimentary 
canal.  When  natural,  it  will  counteract  and  relax 
at  the  pleasure  of  the  individual,  but  if  irrritated, 
it  may  pass  beyond  control,  and  refuse  to  relax  at 
the  proper  time  to  allow  the  fecal  mass  to  pass, 
and  form  an  obstriiction  which  the  expulsive  force 
is  not  able  to  entirely  overcome,  and  the  result  is 
an  incomplete  defacation. 

This  irritation  of  tlie  sphincter  may  be  caused  by 
inflammation  or  ulceration  involving  the  margin 
of  the  anus,  or  the  raucous  membrane  of  the  lower 
part  of  the  rectum.  The  repeated  voluntary  con- 
traction of  this  muscle  to  prevent  defecation  at 
the  proper  time,  an  act  indulged  in  by  so  many  per- 
sons, and  the  pressure  above  of  the  retained  mass 
bring  will  about  an  irritable  and  hypertrophied 
condition  of  the  muscle.  Contraction  at  the  upper 
end  of  the  rectum  is  a  cause  of  constipation,  fre- 
quently present,  but  seldom  recognized,  and  usually 
the  result  of  chronic  inflammation  in  that  part  of 
tl.e  gut.  The  contraction  prevents  the  free  passage 
of  the  contents  from  the  sigmoid  flexure  into  the 
rectum, 


44 


THE   CANADA    MEDiOAL   RECOUD. 


Organic  stricture  may  occur  at  any  point  in  the 
rectum  as  a  result  of  ulceration,  or  of  syphilitic 
or  malignant  deposit.  A  Very  frequent  cause  of 
obstruction  in  females  in  displacement  of  the 
uterus,  in  which  this  organ  presses  down  or  back 
against  the  rectum,  sufficient  to  interfere  with  the 
jiassage  of  fneces.  Large  hasmorrhoidal  tumors 
may  so  obstruct  the  anal  opening  as  to  greatly 
interfere  with  the  passage  of  faeces.  Among  the 
rarer  causes  of  obstruction  are  strictures  along  the 
colon,  from  contraction  in  the  calibre  of  the  gut, 
or  from  fibrous  band  across  the  outside,  compres- 
sing it. 

Atonic  constipation  may  result  from  a  number 
of  causes.  The  most  frequent' one,  however,  is 
the  violation  of  nature's  laws  in  regard  to  the 
evacuation  of  the  large  intestine.  When  the  sen- 
sory nerves  of  the  rectum  indicate  that  the  faecal 
mass  is  passing  from  tiie  sigmoid  flexure,  and  is 
ready  for  expulsion,  and  the  time  or  circumstances 
are  not  convenient,  the  voluntary  sphincter  is 
closed,  and  farther  progress  prevented.  An  occa- 
sional occurrence  like  this  may  do  no  harm,  but 
when  it  is  frequently  repeated,  large  quantities 
are  made  to  accumulate  in  the  colon  and  rectum, 
the  muscles  are  stretched,  the  sensitve  nerves 
blunted,  and  atony  is  established.  Some  persons 
seem  to  have  a  weak  muscular  development  in 
the  intestine,  just  as  some  may  have  a  weak  organ- 
ization of  the  voluntary  muscles.  Such  persons 
may  have  constipation  almost  from  birth.  Centric 
causes,  interfering  with  the  generation  of  nerve 
force,  may  bring  about  atony  of  the  intestinal 
canal. 

Both  forms  of  constipation  may  exist  at  the 
same  time,  and  bear  the  relation  to  each  other 
of  cause  and  effect.  When  there  is  an  obstruction, 
the  blocking  back  of  the  fasces  in  the  colon  and 
rectum  may  so  stretch  the  muscles  as  to  weaken 
them  ;  and  if  from  atony  a  hard  mass  is  allowed 
to  remain  for  a  length  of  time  at  one  point,  it 
may  cause  inflammation  and  ulceration,  which 
will  result  in  organic  stricture,  or  if  this  mass  is 
lodged  in  the  rectum  it  may  cause  spasm  of  the 
sphincters. 

Insufficient  intestinal  secretion  is  usually  given 
by  authors  as  a  cause  of  chronic  constipation. 
1  do  not  undertand  how  this  can  be  a  cause,  nor 
how  they  determined  that  such  a  condition  exists. 

As  before  stated,  the  contents  pass  into  the 
colon  in  a  liquid  form,  and  the  watery  secretion 
from  the  large  intestine  is  not  sufficient  to  prac- 
tically effect  the  consistence  of  the  fasces.  'I'he 
passage  of  dry,  hard  stools  is  not  evidence  of 
lack  of  secretion  anywhere.  When  there  is  a 
lack  of  secretion  from  the  liver,  there  may  be  inac- 
tivity of  the  colon  because  of  the  absence  of  tiiis 
natural  stimulant.  At  times,  when  the  person  is 
indulging  largely  in  meats  and  concentrated  foods, 
from  which  there  is  little  excrement,  there  may 
be  torpor  of  the  bowels,  because  the  bulk  of 
fjeces  is  less  than  usual,  and  not  sufficient  to 
e.xcite  the  colon,    but  when  the   person    returns 


to  their  usual  mixed  diet,  the  bowels  will  act  with 
regularity.  Chronic  constipation  is  more  prevalent 
among  females  than  males.  This  is  especially 
true  under  the  age  of  twenty.  One  of  the  greatest 
neglects  in  the  home  education  of  young  girls  is 
in  regard  to  the  function  of  the  large  bowel,  and 
its  relation  to  perfect  health.  To  fully  ajipreciate 
this,  it  is  important  to  understand  the  relation  of 
the  colon  and  rectum  to  the  ovaries  and  uterus. 

The  left  ovarian  vein  passes  behind  the  sigmoid 
flexure,  close  to  the  descending  colon,  and  empties 
into  the  left  renal.  The  right  one  is  shorter, 
passes  close  to  the  ctecum,  and  empties  into  the 
vena  cava.  These  only  occasionally  have  valves. 
The  uterine  veins  empty  into  the  internal  iliac. 
If  the  large  bowel  is  constantly  filled,  the  effect 
on  the  circulation  through  these  veins  is  easily 
understood.  The  distended  sigmoid  flexure  and 
descending  colon  will  interfere  with  the  return  of 
blood  from  the  left  ovary,  and  a  full  csecum  will 
press  the  right  ovarian  vein  ;  a  full  rectum  will 
press  against  the  internal  iliac  and  uterine  veins, 
and  interfere  with  the  return  of  blood  from  this 
organ. 

The  result  of  such  a  condition  as  this  in  the 
generative  organs  of  the  female,  especially  between 
the  ages  of  twelve  and  twenty,  needs  no  descrip- 
tion. I  believe  if  more  attention  was  paid  to  the 
proper  performance  of  the  function  of  the  lower 
bowel  in  early  female  life,  the  gynecologists  would 
have  less  to  do.  In  the  construction  of  a  house, 
much  attention  will  be  given  to  sanitary  plumbing, 
etc.,  to  insure  against  the  dangers  of  gas  returning 
from  the  sewer  to  affect  the  health  of  the  occu- 
pants, while,  at  the  same  time,  many  of  these 
persons  may  be  carrying  veritable  privies  around 
within  their  own  bodies.  We  can  observe  daily 
the  vicious  influence  of  the  poisons  from  the  fer- 
menting and  decomposing  mass  in  the  colon, 
manifested  by  the  impaired  digestion,  faulty  assi- 
milation, foul  tongue,  muddy  complexion,  and  de- 
pressed nervous  energies. 

If  we  expect  to  cure  chronic  constipation,  we 
have  first  to  know  the  cause,  and  to  know  this  a 
thorough  examination  is  necessary,  and  only  when 
this  is  done  can  we  proceed  intelligently.  If  an 
obstruction  is  found,  proper  measures  must  be 
used  for  its  removal.  After  this,  the  colon  must 
be  cleared  of  any  accumulations  which  may  be 
lodged  in  the  saccules.  The  proper  method  to 
cleanse  the  colon  is  by  injections  of  hot  water, 
which  must  be  thrown  as  high  as  the  ileo-caeca 
valve.  Purgations  should  never  be  depended  upon 
for  this  purpose,  for  it  is  often  impossible  to  dis- 
lodge hard  masses  with  them,  and  in  the  attempt 
we  may  do  harm  to  the  gut ;  but  with  water  we 
are  certain  of  thorough  cleansing,  and  no  harm 
can  result.  \Vhen  the  obstruction  is  removed,  and 
the  colon  cleared,  it  is  then  in  a  condition  to 
resume  its  normal  function.  But  if  the  bowel  has 
been  greatly  distended,  it  may  need  some  assis- 
tance to  regain  its  proper  tone  and  strength,  and 
appropriate  tonics  for  this  purpose  will  have  to  be 


THE   CANADA    MEDICAL    RECORD. 


4-, 


given.  If  an  examination  reveals  no  obstruction, 
ihen  there  must  be  a  want  of  tone  or  power  in  the 
large  bowel  to  carry  the  contents  along  in  the 
proper  lime.  In  the  commencement  of  these  cases 
also,  we  mtist  first  see  that  the  colon  is  cleared  of 
any  frecal  accumulations,  and  let  me  repeat,  do  not 
depend  on  purgatives  for  this  purpose.  Purga- 
tives, as  taken,  are  the  bane  of  the  human  family. 
After  cleansing  we  must  use  means  to  strengthen 
the  muscles  of  the  large  intestine,  and  enable  it  to 
properly  perform  its  function,  and  while  this  is  being 
done,  care  must  be  taken  to  correct  any  habits  of 
the  indi\idual  which  may  predispose  to  constipa- 
tion. 

The  principles  of  treatment  which  we  would 
ap])ly  to  a  weakened  voluntary  group  of  muscles 
are  proper  for  a  like  condition  of  the  muscular 
coat  of  the  large  intestine.  To  promote  circula- 
tion and  excite  muscular  contraction,  and  also 
assist  directly  in  propelling  the  contents  of  the 
bowel,  we  can  use  massage  ;  at  the  same  time  we 
can  add  another  stimulant,  by  ajiplying  electricity. 
We  have  medicines  which  act  directly  on  the  motor 
centre  of  the  muscular  coat  of  the  intestine,  this 
motor  centre  being  the  plexus  mesentericus  of 
Auerbach,  located  between  the  two  layers  of  mus- 
cular fibres  in  the  wall  of  the  bowel,  (Lindois.) 
Aloes  is  a  type  of  these  medicines.  Nicotine  also 
acts  directly  on  this  centre,  and  promotes  peris- 
talsis, hence  the  pleasure  m  an  after  dinner  cigar. 
Other  medicines  act  indirectly  through  the  cerebro- 
spinal nerves.  Strychnia,  for  instance.  The  im- 
pressions are  carried  to  the  plexus  mesentericus 
through  the  cerebo-spinal  nerves,  which  stimulate 
this  centre,  and  contraction  of  the  muscular  coat 
is  the  result. 

In  this  same  indirect  way,  we  can  promote  per- 
istalsis through  volition.  Our  aim  in  stimulating 
the  muscular  coat  of  the  bowel  should  be  to  bring 
about  natural  contraction,  and  not  spasmodic 
action. 

The  natural  contraction  of  the  bowel  is  indicated 
by  the  term  peristalsis — contracting  in  successive 
circles.  In  this  the  contraction  is  gentle,  and 
passes  in  successive  means  along  the  bowel,  pro- 
jielling  the  contents  without  irritation  to  any  part. 
To  promote  this  action  we  must  be  careful  not  to 
give  medicines  in  too  large  doses.  If  the  dose  is 
too  large,  it  will  cause  spasm,  which  will  retard 
the  jjassage  of  the  contents,  and  by  this  hyper- 
stimulation  increase  the  paresis.  So,  in  giving 
colon  tonics,  we  must  begin  with  small  doses  and 
slowly  increase  until  we  get  the  desired  result. 
While  we  are  thus  toning  up  the  bowel,  we  must 
keep  it  clear  of  any  fffical  accumulations.  For 
this  purpose  salines  are  our  best  remedies,  but 
care  must  also  be  taken  with  these  not  to  give  too 
large  doses,  ov  you  will  do  harm.  A  goblet  of 
water,  with  thirty  to  sixty  grains  of  sulphate  of  soda 
in  it,  taken  on  rising  in  the  morning,  will  be  car- 
ried rapidly  along  the  alimentary  canal,  and  not 
overstimulate  either  the  muscular  or  glandular 
systern  of  the  intestiiie.  bijt  will  evacuate  the  large 


intestine.     The  qtiantity  of  soda  in  the  water  ren- 
ders it  more  alkaline  than  the  blood,  and  prevents 
absorption,  and    at  the  same  time  is  not  so  alka- 
line as  to  cause  any  ajipreciable   flow  from  the 
blood  into  the  bowel  ;  and  this  qtiantity  of  water 
taken  on  an  empty  stomach  is  of  sufficient  bulk  to 
promote  ])eristalsis,  and  it  is  carried  rapidly  to  the 
large  intestine,  where  it  liquifies    the  faeces,    and 
causes  a  free  evacuation.     Salines  may  be  taken 
in  this  way  for  a  length  of  time  without  harm.  They 
do  not  tone  up  the    bowel,    nor  do  they  in   small 
doses  weaken  it,  except  as  we  weaken  any  muscle 
by  relieving  it  of  work.     When  the  contents  are 
made   fluid,  only  slight  jjeristalsis  is  necessary  to 
evacuate  them.     When  the  large  intestine  is  in- 
flamed    or      ulcerated    at   any  part,  we   should 
give  salines  alone  when  necessary   to  evacuate   it 
with  medicines.     The  atony  in  chronic  constipa- 
tion may  not  affect  the  entire  large  bowel,  but  may 
be  confined  to  the  rectum  and  sigmoid  flexure,  or 
to  the  latter  and  descending  colon,  and  great  good 
may  be    done  by    stimulating  injections.     Some- 
times we  seem  to  get  better  results  by  giving  the 
medicines    by    rectum    instead    of  through     the 
stomach.     In  selecting  medicines  to  relieve  chronic 
constipation,  we  should  be  careful  not   to  punish 
the  liver  and  small  intestine  for  the  sins  of  the 
rectum  and  colon.  Unless  we  are  certain  that  there 
is  not  sufficient  secretion  from  the  liver,  we  should 
not  add  a  chologogue  to  the  pill  ;  and  if  we  think 
the  contents  pass  from  the    stomach  to  the  colon 
in  three  hours,   we  should  not  stimulate  the  sma'i 
intestine. 

If  atony  is  due  to  centric  disease  of  the  nervous 
system,  the  remedies  must  be  directed  there,  but 
at  the  same  time  care  must  be  observed  to  keep 
the  colon  and  rectiun  clear.  I  will  not  attempt  to 
give  formulas,  nor  speak  of  the  medicines  proper 
to  give  in  different  cases  of  chronic  constipation. 
This  can  be  determined  only  by  studying  each 
case  by  itself,  and  knowing  the  physiological  action 
of  inedicines. 


THE  ABUSES  OF  MILK  DIET  IN  THER- 
APEUTICS.* 

By  Roberts  Bartholow,  M.D.,  LL.D., 

Professor  of  Materia  Meilica,  Tlierapeulics  and  Hygiene  in 

the  Jefferson  Medical  College. 

The  therapeutic  employment  of  milk,  not  only  has 
been  popularized,  and  the  lay  public  made  familiar 
with  its  various  adaptations,  bitt  in  the  wake  of  the 
general  appreciation  has  followed  the  usual  exag- 
gerations, and  hence  it  is  prescribed  with  little  re- 
gard to  the  conditions  properly  requiring  it.  Under 
these  circumstances  it  seems  desirable  to  indicate 
the  limitations  of  this  therapeutical  food,  and  to 
show  wherein  it  may  be  hurtful  ratlier  than  bene- 
ficial. 

In  certain  disorders  of  the  digestive  functions, 
milk  causes  a  sense  of  discomfort,  decided  uneasi- 
ness,   oppression — sometimes  even  pain,  and    it 

•Journal  of  Reconstrqctives,  July,  1SS7 


46 


THE   CANADA  MEDICAL   KECORD. 


prolongs  the  morbid  condition.  The  cases  of 
this  kind  may  be  grouped  into  two  classes  ;  those 
in  whom  the  casein  is  the  offending  material ;  those 
who  cannot  properly  digest  the  cream  or  butter. 
We  find  examples  of  the  first  class  among  children, 
but  they  are  by  no  means  uncommon  in  adults. 
They  are  detected  the  more  readily  in  early  life,  be- 
cause the  curds  are  rejected  by  vomiting,  or  appear 
undigested  in  the  stools.  Adults  unable  to  digest 
casein,  or  who  digest  it  slowly  or  painfully,  have 
epigastric  distress,  heaviness  and  oppression  for 
several  hours  after  meals,  stupor  and  disinclination 
for  exertion  coming  on  after  an  hour  or  two,  and 
continuing  until  the  offending  material  has  pa'^sed 
well  down  the  iniestines. 

An  excellent  substitute  for  the  milk  when  the 
casein  disagrees  is  barley  water  with  cream.  The 
barley  water  should  be  carefully  strained  and  have 
the  density  of  good  skimmed  milk,  and  one-sixth 
or  one-fourth  cream  added,  so  that  the  mixture  has 
the  consistency  of  rich  milk. 

The  class  of  subjects  to  whom  milk  is  unadap- 
ted  are  the  cases  of  duodenal,  hepatic  and  pancre- 
atic diseases,  because  of  the  deficiency  in  the 
secretions  necessary  to  the  process  of  emulsioii- 
izing  fats,  and  pre|)aring  them  for  entrance  into  the 
lymph  vessels.  Fats  decomposing  form  very  irri- 
tating fat  acids,,  and  the  change  in  the  reaction  of 
the  intestinal  juices  is  the  cause  of  various 
secondary  troubles  in  the  biliary  function  and 
elsewhere.  To  fit  milk  for  use  under  such  cir- 
cumstances, it  must  be  skimmed,  and  about  the 
time  the  stomach  digestion  is  completed,  aids  to 
the  intestinal  digestion  should  be  administered. 
Such  aids  are  a  soda  alkali  and,  it  may  be,  some 
pancreative  solution  to  effect  complete  digestion  of 
the  fatty  constituents. 

The  mere  bulk  of  the  milk  is  an  objection  to  its 
use  in  certain  diseases.  In  dilatation  of  the  stom- 
ach, the  space  occupied  by  the  necessary  quan- 
tity perpetuates  the  disease.  The  reflex  effects 
of  distention  of  the  stomach  in  cases  of  weak  heart 
and  iu  angina  pectoris,  may  not  only  cause  dis- 
tressing symptoms,  but  may  even  prove  fatal. 
It  cannot  be  too  strongly  stated  that  milk  is  a 
highly  objectional  aliment  in  heart  disease,  when- 
ever the  nrotor  apparatus  of  the  organ  is  diseased, 
and  whenever  its  movements  are  readily  influenced 
by  morbid  states  of  the  stomach  through  the 
reflex  channels. 

In  no  malady,  as  I  conceive,  is  milk  inore  abu  ed 
than  in  acute  rheuinatism.  It  is  very  often  then 
the  chief — sometimes  the  only — aliment  employed 
during  the  whole  course  of  this  disease.  Besides 
the  objection  inherent  in  its  mere  bulk,  certain 
theoretical  considerations  of  its  nature  should 
have  considerable  weight  in  deciding  the  question 
of  use.  The  very  obvious  objection  that  milk 
furnishes  lactic  acid  as  a  produ  :t  of  its  fermenta- 
tion should  not  be  ignored.  All  the  world 
knows  the  intimate  relation  between  lactic  acid 
and  the  rheumatic  poison.  By  the  introduction 
of  lactic  acid,  a  form  of  endocarditis,  not   distin- 


guishable form  the  rheumatic,  is  set  up,  and  of 
those  diabetics  treated  by  lactic  acid,  a  consider- 
able proportion  suffered  from  attacks  of  rheumatic 
fever  (acute  rheumatism).  It  is  difficult,  of 
course,  to  determine  this  poiut  with  certainty, 
but  I  have  reason  to  believe  that  patients 
with  rheumatic  fever  do  not  get  well  so  quickly, 
and  are  much  more  apt  to  have  relapses,  when 
they  consume  much  milk  during  the  course  of 
this  disease.  Surely,  sufficient  reasons  exist  for 
undertaking  a  thorough  investigation  of  the  ques- 
tion. My  own  practice,  in  the  cases  in  which  I 
am  consulted,  is  to  advise  against  the  use  of  milk 
as  an  element  in  acute  rheumatism. 

In  typhoid  fever,  milk  is  one  food  now  given 
irrespective  of  the  character  of  the  cases.  Of  late 
this  almost  universal  practice  has  come  to  be 
challenged.  It  has  been  depended  on,  without 
investigating  the  state  of  the  digestive  functions, 
and  quite  unmindful  of  the  effect  it  may  have  on 
heat  production.  It  is  often  given  in  too  great 
quantity  at  a  time,  or  so  frequently  that  the 
stomach  has  not  disposed  of  one  quota  before 
another  is  thrust  upon  it.  Unless  the  gastric 
juice  has  preserved  to  a  considerable  extent  its 
power  of  converting  the  albuminoids  into  peptones 
— which  we  have  no  right  to  expect — the  casein 
resists  its  action ;  hence  it  follows  that  material 
of  digestion  should  be  administered  soon  after  the 
milk  is  taken,  and  to  prescribe  without  reference 
to  the  ability  of  the  stomach  to  dispose  of  it  is  to 
insure  increased  fever  and  delirium,  and  more 
frequent  stools.  Besides  supplying  the  means  for 
proper  digestion  of  the  milk,  attention  should 
be  given  to  its  administration  at  such  intervals 
that  every  portion  given  may  be  disposed  of 
before  another  is  permitted  to  enter  the  stomach. 
It  is  a  trite  observation,  which  is  not  therefore  less 
true,  that  it  is  more  important  to  the  nutrition  if 
some  food  be  well  digested  rather  than  a  large 
amount  be  merely  swallowed. 

Notwithstanding,  since  Donkin's  first  reports, 
milk  has  entered  largely  into  the  dietary  of  diabe- 
tics, its  utility  has  recently  come  to  be  seriously 
questioned.  If  conversion  of  milk  sugar  into 
grape  sugar  does  not  take  place,  there  can  be  no 
doubt  of  the  value  of  milk  in  this  disease,  since  it 
possesses  so  great  a  number  of  alimentary  consti- 
tuents. If,  as  is  now  asserted,  this  conversion  does 
take  place,  the  free  administration  of  milk  in 
diabetes  must  be  regarded  as  an  abuse. —  Coll. 
Clin.  Record. 


BOR.\CIC  ACID  IN  THE  TREATMENT 
OF  LEUCORRHEA. 

For  months  past,  I  have  made  frequent  use  of 
boracic  acid  in  the  treatment  of  leucorrhea  in  a 
manner  hitherto  unmentioned,  at  leist  so  far  as  has 
cotne  under  my  notice,  and  with  surprising  suc- 
cess ;  in  every  case  where  I  applied  it,  prompt 
and  permanent  improvement  resulted. 

Having  had  some  excellent  results  from  the 
boracic  acid  packing  in  chronic  suppurative  otitis, 


THE  CANADA  MKDICAL  RECORD. 


47 


I  determined  to  resort  to  its  U5e  in  a  similar  way 
in  a  case  of  leucorrhea,  whicli  Ii;id  for  several 
months  resisted  a  most  perserviiif^  use  of  the 
regular  orthodox  remedies — /.  e..,  nitrate  of  silver, 
tincture  of  iodine,  fluid  hydrastis  and  bismuth, 
hot  water  irrigations,  etc.  The  experiment  was 
eminently  successful,  and  the  patient  returned 
home  within  a  fortnight  well  and  happj,  and  has 
so  remained  ever  since — many  months — during 
which  time  I  have  had  occasion  to  resort  to  the 
remedy  frequently, and  with  uniformly  good  results. 

My  manner  of  using  it  is  as  follows  :  Having 
first  irrigated  the  vagina  at  as  high  a  temjierature 
as  can  well  be  borne  by  the  patient,  a  cylindrical 
speculum  is  introduced,  and  the  vaginal  walls  very 
carefully  dried,  first  with  a  soft  sponge  and  then 
with  absorbent  cotton.  This  done,  boracic  acid  in 
crystals  is  poured  into  the  mouth  of  the  speculum, 
and  pushed  up  against  the  uterus  and  vault  of  the 
vagina  with  a  clean  cork  caught  in  a  uterine 
sponge  carrier,  sufficient  acid  being  used  to  sur- 
roimd  and  bury  the  intravaginal  portion  of  cervix, 
filling  the  upper  part  of  vagina.  A  tampon  of  ab- 
s.rbent  cotton  is  thtn  fiimly  pressed  against  the 
packing,  and  held  in  situ  until  the  folds  of  the 
vaginal  walls  close  over  it  as  the  sjjeculum  is  with 
drawn. 

This  should  be  allowed  to  remain  three  or  four 
days,  or  even  longer,  as  after  this  time  there  still 
remain  some  undissolved  particles  of  the  acid  ;  nor 
will  the  tampon  seem  at  all  offensive.  Theosiiom 
vaginse,  if  examined  in  twenty-four  hours,  instead 
of  being  besmeared  with  the  leucorrheal  secretion 
or  discharge,  presents  a  clean  appearance,  and 
bathed  in  a  watery  fluid  which  begins  to  appear 
several  hours  after  the  packing  has  been  placed ; 
and,  in  my  cases,  this  was  the  only  discharge  no- 
ticed afterward. 

However,  a  second,  or  even  a  third,  repetition 
may  be  necessary  ;  but  in  none  of  my  cases,  num- 
bering nearly  a  score,  have  I  found  more  than  a 
second  packing  called  for,  and  in  many  one  suffi- 
ced ;  anil  in  no  instances  has  it  occasioned  pain, 
not  even  inconvenience.  I  do  not  claim  for  this 
agent  and  method  infallibility,  nor  should  consti- 
tutional dyscrasias  be  ignored,  and  this  local  treat- 
ment be  depended  on  unaided  to  effect  a  cure  ; 
but  here,  as  in  the  treatment  of  leucorrhea  by  other 
remedies,  a  proper  association  of  all  means  hav- 
ing a  curative  influence  upon  the  disease,  consti- 
tutes the  rational  therapeutics.  My  individual  ex- 
perience with  this  remedy  in  the  treatment  of 
leucorrhea,  through  limited  to  too  few  cases  to 
establish  its  universal  efficacy,  if  such  a  wide  range 
of  power  can  be  clamed  for  any  medicine  at  any 
time,  none  the  less  proves  it  as  one  of  the  agents 
which,  when  properly  employed,  promises  much  in 
the  treatment  of  the  aimoying  and,  sometimes, 
intractable  conditions  constituting  the  pathology  of 
leucorrhea,  particularly  when  the  change  is  in  the 
vaginal  glands  or  mucous  membrane,  or  from  in- 
tracervical  inflammation.  Nor  will  harm  likely 
result  from  its  use,  though  it  fail   in  maintaining 


the  i^lace  my  experience  would  give  it. — Schwartz, 
in  St.  Louis  Coiir.  of  Mai, 


CAUSE  AND  CURE  OF  A  CKRTAIN  FORM 

OFB.VCKACHE. 

By  Sir  James  Sawvkr,  M.  D.,  I".  R  C.  P., 

Phjscian  to  the  Queen's  Hospital,  Binninglinin. 

F:arly  in  the  year  i8Si,  in  a  note  which  was 
published  in  a  weekly  professional  journal.  Tasked 
the  attention  of  my  brethern  to  a  form  of  back- 
ache which  had  not,  so  far  as  I  know,  been  des- 
cribed before.  I  desire  now  to  refer  to  this  subject 
again,  and  to  record  that  my  further  experience  in 
jjractice  has  confirmed  my  previous  remarks  upon 
the  point  in  question. 

Subjective  symptoms  are  always  important 
diagnostic  signs,  and  they  are  often  clear  thera- 
peutic indications.  Among  such  sensations,  back- 
ache is  frequently  a  leading  symptom,  and  also 
one  which  is  pressingly  dwelt  upon  by  patients. 
Of  backache  there  are  divers  forms.  Dr.  George 
Johnson,  in  an  able  clinical  lecture,  and  Mr. 
U'illiam  Squire,  in  a  practical  memorandum,  have 
drawn  the  attention  of  the  profession  to  many  of 
these.  But  they  have  not  mentioned  a  variety  of 
backache  in  which  the  cause  of  the  pain  is  trace- 
able to  the  condition  of  the  large  bowel.  I  find  that 
some  patients  complain  of  a  pain,  aching,  dull  and 
heavy  in  character,  and  extending  "  right  across 
the  back."  When  asked  to  point  out  its  position 
they  indicate  this  by  cariying  a  hand  behind  the 
trunk  and  drawing  the  extended  thumb  straight 
across  the  back,  in  a  transverse  line,  about  half- 
way between  the  inferior  angles  of  the  scapulae 
and  the  renal  region.  This  pain  I  venture  to  attri- 
bute to  a  loaded  colon ;  I  conclude  I  have  correct- 
ly found  its  proximate  cause  in  fscal  accumula- 
tion in  the  large  intestine.  I  have  found  it  to 
disaj)pear  after  the  exhibition  of  an  efficient  ca- 
thartic. This  form  of  backache  is  a  concomitant  of 
habitual  constipation,  and  is  especially  significant 
of  the  alvine  sluggishness  of  sedentary  persons. 
In  such  a  condition  as  I  have  stated  elsewhere,  I 
find  aloes,  given  in  combination  with  iron,  to  yield 
the  best  results.  We  owe  the  valuable  suggestion  of 
combining  iron  with  aloes  when  aloes  is  given  for 
laxative  purposes,  to  the  late  Sir  Robert  Christinson. 
He  showed  that  the  cathartic  property  of  aloes  is 
much  increased  by  its  combination  with  sulphate 
of  iron.  Dr.  Neligan,  Dr.  Kent  Spender  and  Dr. 
David  Bell  have  confirmed  this  experience.  I  prefer 
socotrine  aloes,  and  I  give  of  it  one,  two  or  three 
grains  in  a  pill,  combined  with  a  quarter  of  a  grain 
of  sulphate  of  iron,  and  one  grain  of  extract  of  hy- 
oscyamus.  This  pill  should  be  taken  eveiy  night. 
We  must  aim  at  producing  a  full  alvine  evacua- 
tion after  breakfast.  AMien  a  saline  catliartic  is 
indicated,  I  usually  employ  the  old-fashioned 
Rochelle  salt.  This  •'  goes  "  well  with  tea,  coffee  or 
cocoa.  One  or  two  tablesioonfuls  may  be  taken 
at  breakfast,  dissolved  in  a  large  cnifjl  of  one  of 
these   beverages. — La'Het. 


48 


THE   CANADA    MKDiCAL   rxKCOnO. 


TREATMENT  OF  PSOAS  ABSCESS. 

This  much  disputed  question  was  brought  up 
recently  at  the  meeting  of  American  Orthopedic 
Association  and  elicited  views  differing  most  widely 
from  one  another.  Dr.  H.  Hodgen  of  St.  Louis, 
inclined  to  the  belief  that  the  proper  method  of 
dealing  with  them  was  by  early  aspiration. 

The  treatment,  although  not  new,  had  not  he 
thought,  received  tlie  attention  it  merited.  The 
three  methods  of  treating  such  abscesses  were  : 

The  expectant,  the  operative  with  drainage,  and 
aspiration  as  soon  as  the  diagnosis  of  vertibral 
disease  could  be  made  and  the  presence  of  pus 
detected.  The  objections  to  allowing  the  abcess 
to  take  care  of  itself  were  that  there  was  destruc- 
tion of  tissue,  that  there  was  interference  with 
function,  and  that  there  was  inconveience  if  not 
]iain  to  the  patient.  The  uncertainty  as  to  where 
the  abscess  would  burrow  was  also  an  objction  to 
the  expectant  plan  ;  it  might  burrow  under  Pouijart's 
ligament,  oi  point  in  the  gluteal  region  and  do  no 
harm,  yet  it  might  enter  the  bladder  or  the  intens- 
tine.  In  one  of  his  cases  he  believed  it  had  opened 
into  the  hip  joint  of  the  same  side  with  the  abscess. 
In  each  of  his  five  cases  the  result  after  from  two 
to  five  aspirations  had  been  good.  No  evidence 
was  left  of  their  ever  having  been  psoas  abscess. 
He  would  not  aspirate  more  than  four,  five  or  seven 
times  ;  after  that  he  would  put  on  the  plaster-of 
Paris  jacket  and  let  the  abscess  alone. —  Weekly 
Medical  Review. 

The  Canada  Medical  Record. 

A  Monthly  Journal  of  Medicine  and  Surgery- 

EDITORS  : 

FRANCIS    SV.  CAMPBELL,   M.A..  M.D.,  L.K.C.P.  LOND, 

Eilitor  ami  Pioprietor. 
R.  A.  KENNEDY,  M.A.,  M.D.,  Managing  Editor. 
ASSISTANT  EDITOR: 
GEORGE  E,  ARMSTRONG,  CM.,  M.D. 

EDBSCDIPTION    TWO    DOLLARS    PER    ANNDM. 

All  comntuvicafions  and  Kxchangrs  viufit  be  addressed  to 
tli£  Ed'tor.s.  fJratt'ei-35(j,  Post   O/fice^  Montreal . 

MONTREAL,  NOVEMBER,  18.S7. 

NEW  HOSPITAL  IN  TORONTO. 
The  Toronto  daily  papers  state  that  a  new 
Hospital  will  shortly  be  erected  in  that  city. 
The  Hon.  John  Macdonald  has  inaugurated  the 
scheme  by  heading  the  subscription  list  with  a 
donation  of  $40,000.  It  is  expected  that  the  sum 
of  Si. so, 000  will  be  required,  and  the  University  of 
Toronto  will  give  th.e  required  ground. 


OBITUARY. 

DR.   FRANCIS   J.    NELSON. 

Nfws  has  just  reached  iis  of  the  death   of  Dr. 


Francis  J.  Nelson,  late  of"  Montreal,  in   Canon 

City,    Colorado,    August    28th,  from    pulmonary 
hoemorrhage. 

The  late  Dr.  Nelson  was  born  in  this  city,  Nov. 
25th,  1S6!  ;  He  came  of  a  family  well  known  in 
Medicine,  he  being  its  tenth  jjliysician.  He  was 
third  son  of  the  late  Dr.  Horace  Nelson  of  this 
city,  and  a  grand-son  of  the  late  Dr.  Wolfred 
Nelson,  a  former  Mayor  of  Montreal. 

With  his  brothers,  Drs.  Wolfred  and  George  W. 
Nelson,  he  matriculated  in  the  Medical  Faculty 
of  Bishop's  College,  in  this  City.  Study  and  our 
severe  winters  told  on  his  delicate  constitution  ; 
under  medical  advice  he  left  Canada,  and  pro- 
ceeded to  Atalanta,  Georgia,  where  he  gradu- 
ated, in  the  Southern  Medical  College  in  the 
spring  of  1884.  Later  he  settled  in  the  Ojai 
Valley,  in  Southern  California,  and  had  established  . 
a  fair  practice,  when  the  hereditary  enemy  of  J 
his  house,  consumption,  marked  him  out.  He  re- 
ported some  improvement  in  Colorado,  but  a 
sudden  hcemorrhage  closed  his  career,  while  yet 
in  the  bud. 

Dr.  G.  O.  Beaudry,  Professor  of  Physiology  at  the 
Montreal  School  of  Medicine  and  Surgery  (Vic- 
toria College),  died  on  the  26th  of  November, 
of  Typhoid  fever,  after  an  illness  of  three  weeks. 
Dr.  Beaudry  will  be  much  missed  by  his  confreres, 
especially  by  those  of  his  school,  for  he  was  an 
active  worker  in  their  interest. 


PERSONAL. 

Dr.  Codd,  Surgeon  of  the  Mounted  Infantry 
School  at  Winnipeg,  has  been  appointed  President 
of  the  Military  Medical  Board  for  the  investigating 
of  claims,  arising  from  wounds  received  and  sick- 
ness contracted  while  on  service  during  the  late 
Northwest  Rebellion. 

Dr.  Rollo  Campbell  (M.  D.,  Bishop's,  1SS7) 
sailed  for  Europe  by  the  Allan  Mail  SS.  Parisian, 
on  the  loth  Nov.  He  is  at  present  working  at  the 
London  Hospital. 

Dr.  Duiican  (M.  D.,  McGill,  1885)  has  been 
appointed  Surgeon  of  C.  Battery  Canadian  Artil- 
lery recently  organized,  and  \vhich  is  stationed  at 
Victoria,  British  Cohunbia. 

Dr.  Sutherland,  of  Winnipeg,  has  been  appointed 
Resident  Physician  to  the  Manitoba  Penitentiary, 
at  Stony  Mountain. 

Dr.  Kerr,   of  Winnipeg,  proposes  leaving  fya 
city,  t9  settle  in  Washiiigton,  U.  S, 


THE  CANADA  MEDICAL  RECORD. 


Vol.  XVI. 


MONTREAL,    DECEMBER,    1887. 


No.  ?>. 


ORIGINAL  COMMUNICATIONS. 
Cliiiiciil    Lecture.      On    Pityriasis 

Versicolor 49 

Tlienipeutic    Cliiipiiigs     from    tlie 

London  (Kuglaiid)  nospiliil....     50 
PEOGRESS  OF  SCIENCE. 
Recent  Advances  in  the  Treatment 

of  Piilmonarj  Consumption 51 

On  Diabetes 5V 

Antipvriu  in  Rheumatism;  its  Value 

and  Mode  of  Action 61 


Local  Treatment  of  Diphtheria C4 

Infantile    Marasmus • 66 

The  Dyspnea  of  Asthma  and    its 

Treatment 68 

Tile  Terrors  of  Childhood G8 

The  Treatment  of  Rheumatism 69 

Small  Doses 69 

Tlie  Treatment  of  Golds 70 

Compound   Wine  of   Creasote    for 

Pulmonary  Disorders 70 


The  Use  of  Indigo  as  an  Eramcna- 
gogue 71 

Puncture  and  Injection  of  Ether 
and  Iodoform  in  Purulent  Abs- 
cess of  Buttocks 71 

On  Nasal  Vertigo 72 

EDITORIAL. 

Personals 72 

The  London   Illustrated  News 72 

Rkview 72 


0i'i^inid  BommimkwfjimiL 


CLINICAL  LECTURE. 

On  Pityriasis  Versicolor. 

Delivered  at   the   Montreal  General  Hospital,  Oct.    iith, 

1SS7. 

By  F.  Wayland  Campbell,  M.D.,  L.R.C.P.  London, 

Professor  of  the  Practice  of  Medicine  in  the  Medical 

Faculty  of  the  University  of  Bishop's  College. 

This  disease  is  characterised  by  yello\vish-brown 
spots  of  variable  size,  slightly,  if  at  all,  raised  above 
the  surface  and  scattered  over  the  chest,  abdomen, 
upper  extremities  and  back,  and  slightly  desqua- 
mating in  the  center.  We  sometimes  meet  \vith  cases 
where  the  patches  are  very  large,  scarcely  broken 
by  a  patch  of  healthy  skin.     Fortunately  the  dis- 
ease rarely  attacks  the  face.     It  is  seldom,  if  ever^ 
met  with  in  very  young  children,  is  most  cominon 
in  adults,  and  very  rare  in  advanced  life.    It  is  met 
with  among  those  who  perspire  freely.     The  dis- 
ease is  due  to  a  fungus,  which  seeins  to  require  a 
dry  location  for  the  performance  of  its  work.    The 
reason  why  the  disease  does  not  appear  on  the  face 
and  hands  is  the  fact  that  these  parts   have  soap 
and  water  freely  applied  to  them,    and  thus  the 
uppermost  epedermic  layers  in  which   the  fungus 
has  its  seat  are  worked  off.     In  men  it  is   some- 
times met  with  in  the  genitals,  that  is  on  these  por- 
tions of  the   thigh,  on  which  the  serolum    rests. 
Here  the  skin  often  acquires  a  brownish   red  or 
copper  color.     In  females  it  is  coinmon  on  the  pu- 
bic region  and  on  the  Labia  majora.  The  spreading 
of  the  spots  is  often  slow,  though  I  have  seen  it 
attain   considerable  dimensions  in   a  very   short 
time.     In  the  fall  and  winter  the  disease  is  most 


generally  met  with,  on  account  of  less  bathing  and 
warmer  clothing.  The  fungus  of  this  disease  is 
called  Microsporon  "Furfur."  Pityriasis  Versicolar 
may  be  confounded  with  macular  syphilide,  and 
pigment  remnants  of  other  eruptions.  Its  decided 
brown  color,  slight  desquatnation  and  easy  remov- 
al of  the  upper  layer  with  the  finger  nails,  will 
readily  prevent  an  error  in  diagnosis. 

Treatment. — The  great  object  should  be  to 
cast  off  the  upper  layers  of  the  skin  in  which  the 
"microsporon  "  has  its  seat,  and  for  this  purpose, 
I  know  nothing  superior  to  a  lotion  of  3  s  to  3  j  of 
Hyposulphite  of  Soda  to  an  Oj  of  water.  This 
lotion  should  be  freely  applied  to  the  spots  by 
means  of  a  fine  sponge,  several  times  daily.  Yes- 
terday, I  had  at  the  out-door  clinic,  a  woman, 
who  on  the  3rd  of  this  month  presented  herself  to 
me,  with  well  marked  Pityriasis  Versicolar, 
principally  on  the  chest  and  shoulders,  and  for 
whom  I  prescribed  this  lotion  ;  its  effects  was  every- 
thing that  could  be  desired,  and  on  her  return  yes- 
terday she  was  practically  cured.  The  case  before 
you  now  you  see  for  the  first  time  to-day.  I  shall 
adopt  the  same  treatment  and  in  a  week  I  hope 
to  be  able  to  show  her  to  you  perfectly  cured. 
Frictions  by  green  soap— with  a  copious  bath 
daily,  will  at  times  be  found  useful.  Ointrneiit  of 
chrysarobin  ten  to  20  per  cent.,  pyrogallic  acidj 
five  to  ten  per  cent.,  salicylic  acid  of  like  strength 
and  thymol  of  five  per  cent,  are  all  u^efu'r  but 
my  experience  is  decidedly  in  favor  of  the  lotion 
qf  the  Hyposulphite  of  Soda. 

LUPUS. 

The  morbid  process  consists  in  thg  fact  tjiat  thp 
skin  is  penetrated  by  a  specific  virus  at  « 


resent 


50 


THE   CANADA   MEDICAL   RECORD. 


unknown, but  believed  by  many  to  be  identified  with 
the  bacilla  of  tuberculosis.  This  virus  excites  in- 
flammatory action  and  thus  gives  rise  to  small 
patches  of  inflammation  generally  situated  along 
the  course  of  the  vessel.  On  the  other  hand,  it  is 
looked  upon  as  being  the  cutaneous  manifestation 
of  a  strumous  diathesis.  There  are  several  varie- 
ties of  this  disease,  but  the  variety  that  attacks 
the  nose,  as  a  rule,  may  be  lupus  maculosus  and 
e.xfoliativus,  which  latter  is  the  form  we  have  in 
the  case  before  us.  There  is  first  an  infiltration 
on  the  ala  or  the  dorsum  of  the  nose.  With  the 
absorption  of  the  infiltration  there  is  shrinking, 
mutilation  and  diminution  of  the  nose.  Before 
this  occurs,  however,  there  is  a  small  yellowish 
red  papule,  which  appears  near  the  ala,  and  these 
very  often  coalesce  till  they  assume  a  prominent 
and  elevated  patch  or  else  the  volume  of  the  nose 
is  increased.  This  organ  is  now  brownish  red  in 
color,  irregular,  with  knobby  elevations,  the  sur- 
face rough,  with  small  ulcers  covered  with  thick 
crusts.  These  ulcers  continue  to  eat  their  way 
behind  these  crusts,  and  when  at  last  they  are  re- 
moved the  destruction  of  the  nose  has  been  all 
but  complete.  Lupus  is  much  more  common  in 
females,  than  in  males.  The  prognosis  is  gener- 
ally favorable,  though  the  disease  is,  in  every 
case,  in  danger  of  recurring. 

Treatment. — Has  two  objects  :  ist.  Tu  arrest 
the  development  and  progress  of  the  pathogenetic 
virus.  2nd.  To  destroy  the  morbid  products  already 
deposited.  To  accomplish  the  first  object,  it  is 
necessary  to  destioy  locally  the  virus,  and  give 
medicine  internally.  Iodoform  is  highly  recom- 
mended, Pot.  lod.  is  an  old  but  useful  remedy.  It 
must  be  taken  for  a  lengthened  period.  Cod  liver 
oil,  with  or  without  the  addition  of  pure  iodine  or 
creosote,  arsenic,  iron,  quinine,  also  general 
diatetic  treatment.  To  remove  the  virus,  we  must 
destroy  the  morbid  products  already  produced. 
For  this  puspose  caustics  are  the  best.  Do  not 
use  Caustic  potash  or  Vienna  paste.  A  combination 
known  as  Cosme's  paste,  modified  by  Hebra — 
composed  of  white  arsenic,  artificial  Cinnabar,  and 
fat  is  highly  recommended,  because  it  does  not 
destroy  healthy  skin.  Nitrate  of  silver  is  ne.xt  to 
useless,  for  the  action  of  the  silver  does  not  extend 
beyond  the  part  treated.  Pyrogallic  acid  is 
perhaps  the  best  local  application.  It  destroys  all 
Lupus  tissue,  and  spares  the  healthy  skin.  More- 
over its  cicatrices  are  slight — soft  and  smooth. 
It   is  best  applied  in  the   form    ofa  lo  per  cent. 


ointment  applied  spread. on  linen.  It  should  be 
tied  firmly  to  the  diseased  part,  and  changed 
night  and  morning  for  three  or  four  days.  By 
this  time  a  black  depos\J  lies  upon  the  surface. 
Tiie  pain  during  this  application  is  slight,  it  does 
not  begin  usually  till  the  third  day,  and  continues 
only  when  the  ulcerated  surface  is  uncovered.  As 
an  after  dressing  carbolic  acid  or  thymol  or  iodo- 
form, either  powder  or  a  lo  per  cent,  ointment 
or  an  ointment  of  v  gr.  of  Biniodide  of  Mercury  to 
the  ounce  of  lard.  On  the  other  hand  if  the  dis- 
eased part  is  small,  it  is  suggested  to  bring  the 
surgeon's  knife  into  play  and  excise  the  part. 
Dr.  George  H.  Fox,  the  well-known  Dermatologist 
of  New  York,  says  :  "  much  destruction  of  tissue  ard 
consequent  disfiguration  might  have  been  spared 
in  hundreds  of  cases  by  a  timely  use  of  the  knife, '' 
whether  the  part  be  removed  by  the  knife  or  by 
cauterization — the  exposed  surface  will  not  as  a 
rule  heal  up  under  three  weeks. 


THERAPEUTIC    CLIPPINGS    FROM  THE 
LONDON  (ENGLAND)  HOSPITAL. 

{Specially   reported  for  the  Can.\da  Medic.\l 
Record,  by  Dr.  Rollo  Campbell.) 

Dr.  James  Anderson  frequently  prescribes  the 
following  combination  in  the  Dysmemorrhcea  of 
Amaemia. 

Mist.  Ferri  Co.,  (Griffith's  Mixture)   3  ss. 

Decoct.  Aloes  Co.,  3  ss  M. 

Signe  Ter  in  die. 


Chorea  is  at  present  very  prevalent  in  London 
and  the  plan  of  treatment,  which  is  followed  in  the 
London  Hospital  is  rest,  good  food  and  Liq.  Ar- 
senicalis,  either  alone  or,if  the  patient  be  anemic, 
in  combination  with  some  preparation  of  Iron 
(e.  g.  Ferri  et  Ammonia  Citrate.)  If  the  chorea 
movements  are  very  severe  and  prevent  sleep, 
Potass.  Bromid.  is  prescribed  with  the  Arsenic. 


Dr.  Stephen  Mackenzie  is  at  present  testing  the 
therapeutic  powers  of  Antipyrin,  .Antifebrine,  Salol 
and  Salicylate  of  Soda,  in  the  treatment  of  Acute 
Articular  Rheumatism. 


In  a  case  of  Eczema  Impetigo  Dr.  Mackenzie 
directed  the  following  plan  of  treatment  ;  first 
soften  the  scabs  with  some  oily  application,  then 
wash  it  (oil)  off  with  tepid  water  and  lastly  apply 


THE   CANADA   MEDICAL   RECORD. 


51 


Unguentum  Zinci  Oleatis.      (Zinc.  Oxid.  grs.  xjcx. 
Oleic  Acid.  3  ss.  Vaseline  ad.  5  '■) 


In  I'edii  ulosis  Capilis,  Dr.  .Stephen  Mackenzie 
uses  the  following  test  to  dislingm'sh  the  ova  found 
on  the  hairs,  from  the  small  scales  found  on  the 
hairs  in  Seborrhcea  Eczema  and  Pityriasis.  If  it 
be  an  ovum,  this  being  attached  to  the  hair  by  an 
albuminous  sub.stance  or  colLar  will  allow  of  its 
being  slipped  up  and  down  the  hair  without  falling 
off;  if  it  only  be  a  dried  scale  found  in  Seborrhcea 
it  will  at  once  fall  off  on  attempting  to  move  it. 


Mr.  Mansell-IMoullin,  surgeon  to  the  London 
Hospital,  says  that  as  a  general  rule  ulcers  situated 
on  the  lower  extremity  (leg)  above  its  middle  are 
syphilitic  in  origin. 


The  following  is  a  good  rule,  laid  down  by  Paget 
for  applying  passive  movement  to  stiff  joints,  "if 
the  affected  joint  is  at  any  one  time  of  the  day, 
colder  than  the  opposite  (healthy)  one,  then  you 
can  use  passive  motion,  and  the  more  frequently 
the  better. 


In  a  case  of  Lichen  planus,  with  smooth  flat 
lapped,  shining  papules,  accompanied  by  pigmen- 
tation and  itching.  Dr.  Mackenzie  advised  the  use 
of  Liq.  Carbonis  Detergens,  Carbolic  Acid,  or  the 
Unguentum  Zinci  Oxidi. 


There  is  at  present  in  the  London  Hospital  a 
man  suffering  from  that  very  rare  skin  affection 
known  as  Hyroa.  He  is  being  treated  at  present 
by  daily  hot  baths,  in  which  he  remains  for  several 
hours,  after  which  the  affected  parts  are  smeared 
and  kept  covered  by  some  oleagenous  preparation. 
He  was  formerly  on  the  Arsenical  treatment  and 
improved  for  a  short  time,  and  when  Arsenic  failed 
Iodide  of  Potassium  appeared  to  exert  a  beneficial 
effect,  but  this  remedy  has  lost  its  power,  and 
warm  baths  are  now  alone  used. 


The  following  recipe,  from  the  Pharmacopoeia 
of  the  London  Hospital,  is  of  occasional  service 
5 .  Gallic  Acid.  grs.  x. 

Diluted  Sulphuric  Acid.     M.  x. 

Tincture  of  Opium.  M.  v. 

Distilled  Water.  ;  i.    Mix. 

For  one  dose. 


The  following  is  a  very  useful  astringent  mixture 
for  use  in  Intestinal  Hemorrhages,  etc. 
IJ.  Acid  Sulph.  Aromat.  M.  xv. 

Spts.  Chloroformi.  M,  xx. 

Tinct.  Camph.  Cornp.  3  i. 

Decoct.  Hoematoxyli  ad.      3  i,  M  for  a  dose 


"  Mistura  Bismuthi  Compositor." 
Ij .  Bismuth  Subnit. 

Magnes.  Carb.  aa.  grs.  xv. 

Pulv.  Tragacanth  Co.       grs.  x. 

Tinct.  Calumb.  m.  x. 

Acqua Chloroformi  ad.     i'l.  M.  For  a  dose. 

sPm^ie^  of  Sckme. 


RECENT    ADVANCES    IN    THE    TREAT- 
MENT OF  PULMONARY  CONSUxMPTION.* 

By  Solomon  SoKis  Cohen,  A.M.,  M.  D., 

Lately  Chief  of  the  Medical  Clinic,  Jefferson  Medical 
College  Hospital,     Philadel|^'liia. 

Whether  our  efforts  be  directed  toward  cure — 
that  is,  toward  putting  our  patients  is  a  condition 
that  permits  them  to  recover ;  or  whether  we  aim 
at  the  prevention,  which  is  better  than  cure ; 
excluding  from  consideration  measures  purely 
palliative,  the  objective  therapeutic  point  may  be 
summed  up  in  one  word — Nutrition.  Of  those 
methods  intended  to  promote  nutrition,  first  in 
importance  comes  the  subject  of  superalimenta- 
tion ;  to  which  the  prominent  attention  it  deserves 
was  directed  by  Debove's  communications  upon 
forced  feeding,  or  gavage,  in  1881  and  1882. 

Debove  being  convinced  that  many  consump- 
tive patients,  despite  loss  of  appetite,  maintained 
comparatively  good  powers  of  digestion  and  assi- 
milation, determined  to  resort  to  mechanical  feed- 
ing. He  therefore  passed  into  the  stomach, 
through  the  mouth,  a  flexible  rubber  tube  connect- 
ed with  a  funnel  (such  a  tube  as  had  been  employ- 
ed for  lavage — washing  the  stomach — and  the 
method  of  introducing  which  will  be  described  in 
the  latter  connection) ;  and  by  this  means 
introduced  much  larger  quantities  of  food  than  the 
patients  would  voluntarily  swallow.  The  taste  of 
the  aliment  thus  administered  becomes  a  matter 
of  no  consequence,  and  we  are,  therefore,  able  to 
select  that  which  will  give  the  most  nutriment  in 
the  smallest  bulk.  Meat  powders  were  adopted 
as  the  basis  of  Debove's  nutritive  mixtures  ;  but 
milk,  eggs,  soups,  and  farinaceous  powders  may 
be  used,  either  separately  or  in  conjunction 
therewith.  When  necessary,  pepsin,  pancreatin, 
hydrochloric  acid,  etc,  may  be  added,  or  pepton- 
ized aliments  be  employed.     A  mixture  that  was 


Read    before     the    Medical    Society  of  the    State    gf 
Pennsylvania,  June  30,  1887. 


52 


THE    CANADA   MEDICAL    RECORD. 


used  with  advantage  by  Dr.  Stern,  of  Philadelphia, 
and  myself,  in  the  cases  of  two  patients  treated  at 
the  Philadelphia  Polyclinic,  consists  of  a  quart  of 
milk,  two  tablespoonfuls  of  beef  powder,  three 
eggs,  fifteen  grains  of  scale  pepsin,  and  thirty 
drops  of  dilute  hydrochloric  acid,  warmed,  and 
administered  twice  a  day;  the  patient  eating  what 
he  wished  in  the  interval.  In  hospital  service 
forced  feeding  is  practised  three  times  daily,  but 
in  private  piractice,  we  must  be  content  with 
what  is  possible. 

Meat  powders  may  be  purchased   in  the  shops, 
or  can  be  prej^ared  at    home   by  cutting  boiled 
meat     into  little    pieces,    drying   thoroughly    by 
means    of  a  wa*er  bath,  and  grinding  in  a   coffee 
mill.     Powder  so  prepared  is  said    by  Dujardin- 
Beaumetz  to  answer  its  purpose  very    well.     The 
farinaceous  powders  used  in  France  are    prepared 
from  cooked  lentils,  malted  lentils,  and  maize.     I 
have  no  personal  experience  with  them,  but  they 
are   said  to   be   highly  nutritious.     About  seven 
ounces  of  the  alimentary  powder,  whether  meat  or 
farina,  or  both,  are  mixed  with  a  quart  of  milk  or 
water,  the  milk  being  added  slowly  to  form  a  paste, 
which    afterward   dissolves    readily    in  the  addi- 
tional liquid.      AVhen    the  long  tube  of  Debove 
cannot  be  [lassed,  or  when  patients  will  not  allow 
it  to  be  passed,  it  often  suffices  simply  to   pass 
the    entrance  of  the   oesophagus  with  a   shorter 
tube,  as  recommended  by  Stoerk  ;  or  to  make  use 
of  the  special  apparatus  of  Dujardin-Beauirietz  or 
Bryson  Delavan,  which  consists  of  a  glass  jar  with 
two  tubes ;   one  of  which,  above  the  level  of  the 
fluid,  communicates  with   a  hand-bulb  for  supply- 
ing compressed  air,  the  other,  below  the  level  of 
fluid,    communicating    with  a    short  cesoj)hageal 
sound   of  small  calibre  ;  an  ordinary  rubber  cathe- 
ter will    answer   at  a  pinch.     When  the  bulb    is 
compressed,  fluid  food  is  driven  over.       Efforts 
of  swallowing    on  the    part  of    the    patient   will 
facilitate  the  process. 

From  the  reports  made  by    reliable    observers 
in  France  and  elsewhere,  as  well  as    from  a  few 
cases  under  my  personal  observation,    I  feel    no 
hesitancy  in  aftirming  that    remarkable  gains    in 
weight  may  be  obtained  from  forced  feeding,  and 
that  very  often  there  will  be  concomitant  recession 
in  febrile  and  other  phthisical  ))henomena.     Im- 
provement in  physical  condition  of  the  lungs  has 
been  reported,    but    I  have  never  succeeded    in 
keeping    a    patient    under    the    treatment    long 
enough  to  verify    this   by    personal   observation. 
American  patients    in  private  or  dispensary  prac- 
tice are  not  as  tractable  are  foreign  ones,  in  these 
matters,  and  I  have  no  o]3portunity  of  conducting 
the  treatment  of  phthisis  in  hospital  wards.     To 
secure  the  benefits  of  superalimentation    with   the 
great    run    of   patients,    I   have  had   to    employ 
alimentary  mixtures  similar  to  those  of  the  gavage 
process,  by   natural  methods.     The  dietary  advi- 
sed is  a  largely   nitrogenous  one,  of  which    beef, 
raw  or  rare,   broiled  or  roast,  forms  the  principal 
item  ;  there    being   added   sulticient   milk,    eggs, 


fish,  lamb,  mutton,  leguminous  vegetables,  and 
greens  ;  fruits  in  season,  large  quantities  of  butter, 
with  small  quantities  of  bread,  pjotatoes,  and  star- 
chy foods  in  general.  Alcohol  is  employed  as  a 
food  when  it  is  necessary  tg  obtain  force  with  the 
least  expenditure  of  digestive  energy. 

Fried  foods  of  all  kinds,  pastry  and  other  indi- 
gestible matters,  are  of  course  prohibited.  Patients 
are  advised  not  to  allow  more  than  three  hours  to 
pass  without  taking  food,  e.xcept  during  sleep  ;  to 
drink  a  glassful  of  cream  or  milk,  or  cream  punch, 
milk  punch,  or  egg  nog,  just  before  going  to  bed, 
and  to    have  milk   at  hand  to   drink    in  case  of 
waking  during  the  night  or  early   morning.     Not 
more  than  three  set  meals  daily  are  advised,  but 
in  the    intervals   milk,  with   or    without   alcohol, 
chicken    soup,  bouillon,   rich   broths,  are  adminis- 
tered ;  as  a  vehicle  usually,  for  the  beef-peptonoids 
of  a  well  known   firm  of  American  manufacturing 
chemists.     Of    this  preparation  it  is    endeavored 
to  give  not    less  than  two  ounces  daily,  and  the 
amount    may    be    increased     as     circumstances 
require.     Various  preparations  of  meat  juice  pur- 
chased in  the  shops,  or  prepared  at  home,  may  be 
used  in  the  same  manner,  according  to  indications. 
The  aim  of  the  treatment    is  to    supply    enough 
nutriment   not  alone  to  counter-balance    current 
waste,  but  to  make  up  previous    excess  of  waste 
over  repair,  and  the  details  must  be  elaborated  in 
each  case  with    regard   to  individual    condition. 
Cod  liver  oil,  we  well  know,  is  an  advantageous 
addition  to  the  dietary  in  some  cases,  but  not  so 
many  as    we   have  supposed.     At   least  it  is  not 
indipensable.     Oleaginous  inunctions  are  often  of 
considerable  benefit. 

When  overfeeding  by  natural  methods  fails,  or 
when  the  patient  is  unwilling  or  unable  to  swallow 
the  necessary  quantity  and  quality  of  food,  resort 
should  be  had  without  hesitation  to  the  oesopha- 
geal tube  and  forced  feeding. 

But  having  supplied  the  proper  kind  and  amount 
of  aliment,  we  must  place  our  patient  in  a  condi- 
tion to  digest  and  assimilate  it.  It  is  true,  as 
already  suggested,  that  we  may  make  use  in  cer- 
tain measure  of  predigested  foods,  and  that  we 
may  assist  digestion  in  other  instances  by  the 
administration  of  the  digestive  ferments  ;  but  our 
endeavors  must  not  cease  there. 

The  problem  before  us  naturally  divides  itself 
into  three  parts  :  First,  the  preparation  of  the 
digestive  tract,  to  elaborate  and  to  absorb  the  chy- 
lous fluids — primary  assimilation.  Second,  the 
]3romotion  of  the  complex  process  of  the  breaking 
down  and  displacement  of  imperfect  tissues  and 
effete  products,  and  replaceivient  by  new  and 
vigorous  tissues,  with  evolution  of  forces  required 
in  the  economy  ;  /.  ^.,  metabolism — secondary 
assimilation;  and  third,  the  promotion  of  the 
excretion  of  waste  products. 

The  first  desideratum  is  endeavored  to  be  secured 
by  methods  which  cleanse,  disinfect,  and  stimu- 
late the  digestive  canal ;  varied  in  detail  according 
to  circimistances,     WHicn  we  have  reason  to  sud. 


THE  CANADA  MEDICAL  RECORD. 


6^ 


pose,  for  example,  that  a  sluggish  gastric  catarrh 
interferes  witii  digestion,  washing  out  the  stomach 
may  be  practised  with  good  effect.  'I'he  ])roce- 
diire  is  quite  simple.  A  stomach-tuhe  of  similar 
material  to  Fiench  catheter  tubing,  about  28 
inches  long,  and  from  j(  inch  to  7-16  of  an  inch  in 
diameter,  is  attached,  by  a  short  section  of  glass 
tubing,  to  a  soft  rubber  tube  about  one  yard  long, 
in  the  extremity  of  which  is  inserted  a  hard  rubber 
funnel  of  about  six-ounce  capacity.  The  stomach- 
tubes  having  been  dipped  into  warm  water  or  warm 
milk,  is  introduced  into  the  oesophagus  and  pro- 
pelled by  successive  pushes,  or  swallowed  by  the 
patient;  and  the  funnel  being  sufficiently  elevated, 
from  a  pint  to  a  quart  or  more  of  warm  water 
(100  °  F.),  in  which  is  dissolved  a  drachm  or  two 
of  borax,  table  salt,  or  baking  soda  is  slowly  pour- 
ed into  the  funnel.  As  the  last  of  the  fluid  is 
passing  out  of  the  funnel,  the  latter  is  rapidly 
inverted  over  a  receptacle  on  the  floor,  and  the 
contents  of  the  stomach  are  thus  siphoned  out. 
The  manceuvre  is  repeated  until  the  returned 
water  is  clear.  This  process,  called  lavage,  which, 
as  already  stated,  suggested  gavage,  and  is  practised 
in  truich  the  same  manner,  leaves  the  gastric 
m  ucous  membrane  in  excellent  condition  for  di- 
gestion and  absorption.  It  may  be  immediately 
followed  by  gavage,  as  recommended  by  Dujardin- 
Beaumtz.  The  drinking  of  half  a  pint  to  a  pint 
of  hot  water,  half  an  hour  to  an  hour  before  meal 
time,  will  sometimes  accomplish  much  the  same 
purpose,  and  is,  of  course,  less  troublesome. 

When  a  condition  of  septic  fermentation  is  be- 
lieved to  interfere  with  digestion,  a  suitable  anti- 
septic agent,  such  as  carbon-disulphide  water  or 
solution  of  hydrogen  dioxide,  may  be  introduced 
into  the  lavage  solution,  and  a  portion  allowed  to 
remain  a  few  minutes  in  the  stomach  ;  or  creasote, 
carbolic  acid,  iodoform,  the  solutions  mentioned, 
or  other  agents  may  be  administered  in  the  ordin- 
ary way.  When  the  intestinal  canal  is  believed 
to  be  the  seat  of  the  trouble,  we  may  attempt  to 
wash  it,  indirectly  by  lavage,  or  by  potations  of 
hot  water,  or  to  medicate  it  with  creasote,  bismuth, 
sulphocarbolates,  mercurials,  iodoform,  sulphides, 
naphthalin,  or  other  appropriate  drugs.  I  have 
reason  to  believe  from  the  effect  produced  upon 
some  cases  of  phthisis  attended  with  diarrhcea, 
that  the  injection  per  rectum,  of  hydrogen  sulphide, 
directly  or  indirectly  arrests  septic  fermentations, 
in  the  small  intestine. 

To  aid  digestion,  stimulate  digestive  secretion, 
and  promote  absorption,  in  addition  to  the  mea- 
sures already  referred  to,  preparations  of  malt, 
Hoffmann's  anodyne,  bitter  tonics,  nux  vomica, 
arsenic,  preferably  Fowler's  solution,  iron,  nitro- 
hydrochloric,  nitric  and  phosphoric  acids,  trini- 
trin,  and  other  appropriate  medication  may  be 
employed  when  indicated. 

Nutriment  being  administered,  digested,  and  ab- 
sorbed into  the  blood,  must  be  converted  into 
vital  forces,  and  into  tissue.  Exercise  and  res- 
piration  are    the   natural    means   to   effect    this. 


"  Respiration, "  said  .\rbuthnot,    "is   the  second 
digestion." 

When  the  patient  is  able  to  carry  out  the  in- 
structions, and  when  there  is  a  sufticiency  of  un- 
impared  lung  tissue,  respiratory  gymnastics,  and 
voluntary  forced  respiration  may  suffice.  Ordin- 
arily, however,  these  measures  will  not  be  sufficient 
and  must  be  replaced  or  supplemented  by  a  method 
which  affords  mechanical  assistance  to  resi)iration 
independent  of  voluntary  exertion.  This  method 
offers  itself  in  the  inhalation  of  compressed 
air,  a  subject  which  will  always  be  associated  with 
the  name  of  its  great  promotor,  Waldenburg.  The 
air  is  inspired  under  an  excess  pressure,  gradually 
increased  frorn  1-80-1-60  up  to  1-40  or  1-30  of  an 
atmosphere.  Expiration  is  ordinarily  made  into 
the  atmosphere  ;  sometimes  into  rarefied  air.  The 
inhalations  are  administered  once  or  twice  daily. 
At  each  period,  ten  or  fifteen,  twenty-five  or  thirty, 
up  to  one  hundred  or  more  respiratory  acts  are 
completed  in  five  to  fifteen  minutes,  and  the  pro- 
cess is  repeated  after  an  interval  of  about  ten 
minutes. 

The  value  of  this  procedure  as  an  aid  to  nutri- 
tion, formed  the  theme  of  a  paper  I  read  before 
the  Pennsylvania  State  Medical  Society  last  sum- 
mer, and  needs  not  now  to  be  elaborated.  Let 
me,  however,  briefly  recapitulate  the  principal 
points.  The  inhalation  of  compressed  air,  dilating 
the  air-cells  as  it  does,  by  gentle  and  equable  pres- 
sure, aids  nutrition  by  securing  the  proper  exposure 
of  venous  blood  to  the  atmosphere,  facilitating  the 
disengagement  of  carbon  dioxide  and  the  taking 
up  of  o.xygen  to  be  carried  by  the  haemoglobin 
to  the  tissues,  and  assist  in  force-production  and 
tissue-building.  The  mechanism  by  which  this 
is  accomplished  is  complex.  The  air  passages  are 
cleansed  from  decomposing  products  of  secretion 
and  desquamation,  and  the  alveoli  are  reopened  in 
unused,  blocked,  and  partially  consolidated  areas 
of  pulmonary  tissue,  thus  securing  efficient  pul- 
monary ventilation.  Increase  of  partial  pressure 
favors  dissociation  of  carbon  dioxide  and  associa- 
tion of  oxygen  in  the  pulmonary  capillaries.  Direct 
pressure  and  pressure  differentiation  tend  to  pro- 
mote the  relief  of  congestion  in  the  lungs,  the 
absorption  of  inflammatory  congeries  of  new  cells, 
and  the  stimulation  of  both  intra-pulmonary  and 
peripheral  circulation.  Increase  of  blood  pressure, 
further,  stimulates  the  production  of  lymph.  Thus 
is  secured  not  alone  the  exposure  by  increased 
volume  and  rapidity  of  pulmonary  circulation,  of  a 
greater  number  of  corpuscular  oxygen  carriers  to 
the  increased  volume  and  weight  of  inspired  ox)'- 
gen,  under  the  conditions  most  favorable  to  oxi- 
dation of  haemoglobin,  but  also  the  penetration  of 
the  corpuscles  with  their  vitalizing  burden  in  the 
nutrient  lymph-stream, further  into  the  tissues.  This 
latter  effect  may  theoretically  be  hightened  by 
a  measure  advocated  by  Prof  Bartholow  in  simple 
anaemia,  with  sluggish  peripheral  circulation  ;  name- 
ly dilatation  of  the  terminal  vessels  by  means  of 
trinitrin  (nitroglycerin).     I  have  as  yet  no  avail- 


54 


THE   CANADA   MEDICAL   SECOUD. 


able  experience  with  nitrogljcerine  in  phthisis. 

One  circumstance,  which  had  long  militated 
against  the  popularization  among  the  profession 
of  pneumatic  treatment,  was  the  cost  and  cum- 
bersome clumsiness  of  the  necessary  apparatus. 
In  1883,  with  the  assistance  of  Charles  Richardson, 
of  the  house  of  Queen  &  Co.,  Philadelphia,  I 
succeeded  in  largely  obviating  these  objections  by 
means  of  an  apparatus,  which  can  not  only  be  em- 
ployed in  the  physician's  office,  but  may  be  en- 
trusted to  the  management  of  the  patient  or  his 
friends  at  home,  and  is  comparatively  inexpensive. 
It  is  fully  as  efficient  as  the  a])paratus  of  Waldenburg, 
upon  which  it  is  modelled,  and,  like  its  original,  is 
superior  to  a  certain  widely  advertised  and  extra- 
vagantly costly  patented  instrument,  devised  in 
1885.  It  consists  simply  of  a  small  gasometer 
and  a  foot-bellows.  The  inner  cylinder  is  weight- 
ed at  the  bottom,  in  order  to  throw  the  centre  of 
gravity  as  low  as  possible,  and  preserve  its  steadi- 
ness without  pulley  or  flanges.  Air  is  pumped  in 
by  means  of  the  foot-bellows,  the  supply  valve  of 
the  latter  being  connected  with  a  rubber  tube  of 
large  aperture,  which  is  j)laced  out  of  the  window, 
to  secure  pure,  fresh  air.  Without  additional 
weighting  the  inner  cylinder  gives  the  pressure  of  t- 
70  of  an  atmosphere.  By  placing  additional  weights 
on  top,  the  pressure  may  be  increased  to  any 
desired  amount  up  to  one-fortieth  of  an  atmosphere. 
The  supply  of  air  is  continuous,  and  the  patient 
may  inhale  directly  from  the  apparatus,  or  the 
stream  of  inspired  air  may  be  made  to  pass  through 
a  Wolff  bottle  containing  terebene  or  other  vola- 
tile medicament. 

The  mouth  and  nose  are  covered  with  a  mask  to 
exclude  atmospheric  air,  and  the  ingress  and  egress 
of  respired  air  are  regulated  by  a  stopcock.  For 
detailed  information  as  to  the  use  of  compressed 
and  rarefied  air,  time  requires  me  to  refer  to  my 
previous  communications,  or  to  the  text-books  on 
inhalation. 

To  the  administration  of  compressed  air  inhala- 
tions, twice  a  day,  is  to  be  added,  when  possible) 
due  exercise  in  the  open  air  ;  and  when  this  is  not 
advisable  or  possible,  passive  exercise  by  massage, 
frictions,  and  similar  measures.  Three  hours  after 
meals,  during  the  culmination  of  digestion  and  the 
activity  of  absorption  is  the  preferable  time  for 
open-air  exercise.  In  the  presence  of  active  febrile 
processes,  both  active  and  passive  exercise  are  to 
be  moderated  or  even  interdicted.  Compressed- 
air  inhalations,  however,  need  not  be  abandoned. 
Inhalations  of  nitrogen  have  been  recommended 
to  abate  fever.     I  have  not  tried  the  measure. 

Digestion,  absorption,  assimilation,  metabolism 
being  assisted,  it  remains  to  promote  the  excretion 
of  waste,  in  order  to  rid  the  system  of  the  now  well- 
recognized  danger  of  auto-intoxication  by  leuco- 
maines,  ptomaines,  etc.,  and  to  make  room  for 
reconstructive  materials.  Stimulation  of  the  em- 
unctories  by  diuretics,  cholagogues,  cathartics,  even 
diaphoretics  are  here  indicated  ;  but  drugs  should 
be  avoided  as  far  as  possible^  and  when  absolutely 


indicated, only  the  mildest  renedies  are  to  be  chosen, 
these  being  promptly  discontinued  when  the  desir- 
ed effect  has  been  produced. 

Our  general  tonic  medication,  exercise,  forced 
respiration,  etc.,  will,  of  course,  assist  directly,  and 
indirectly,  as  emunctorial  stimulants.  The  daily 
sponge  bath,  which,  to  the  well,  is  a  matter  of  com- 
fort and  cleanliness,  becomes  to  the  consumptive 
a  measure  of  therapeusis.  The  drinking  of  water, 
perferably  hot,  is  again  applicable  as  the  best  of  diu- 
retics and  a  potent  diaphoretic.  Lemon  juice  and 
sugar  may  be  added  to  render  it  more  palatable,  the 
former  indeed,  increasing  its  value  as  a  diuretic. 
Nitro-hydrocoloric  acid  is  among  the  best  hepatic 
stimulants  in  this  connection.  An  enema  is  ordi- 
narily the  best  method  for  emptying  the  bowels.  To 
overcome  intestinal  torpor  the  same  measures  em- 
ployed under  other  circumstances,  nux  vomica,  bel- 
ladonna, faradism,  etc.,  may  be  resorted  to. 
Among  the  preferable  cholagogue  cathartics, 
are  podophyllin  and  rhubarb. 

The  indications  thus  far  considered  may  be  ful- 
filled in  the  generality  of  cases  by  the  following 
routine: 

1.  An  abundant  and  proper  diet,  as  already  dis- 
cussed ;  gavage,  if  necessary. 

2.  The  drinking  of  hot  water,  or  hot  lemonade  ; 
lavage,if  necessary. 

3.  Moderate  open-air  exercise;  respiratory  gym- 
nastics ;  daily  inhalations  of  compressed  air. 

4.  The  administration  of  some  such  pill  as  this, 
three  or  four  times  a  day  :  Iodoform,  i  to  2  grains, 
creasote  one-half  minim  to  one  minim  ;  to  which 
may  sometimes  be  added  :  reduced  iron,  i  grain, 
or  arsenious  acid,  i-6oth  to  T-20th  grain,  the  pill 
being  made  up  with  glucose,  crude  petroleum,  or 
extract  of  licorice,  with  the  addition,  if  indicated,  of 
some  bitter  extract,  such  as  gentian,  cinchona,  or 
nux  vomica,  and  dispensed  in  capsule.  Among 
other  useful  prescriptions  may  be  cited,  when  iron 
is  indicated  :  Compound  syrup  of  phosphate  of 
iron  (Parrish);  tincture  of  chloride  of  iron,  dilu  e 
phosphoric  acid,  and  Churchill's  syrup  of  hypo- 
phosphities  (J.  Solis  Cohen);  the  officinal  syrup  of 
hypophosphities  and  iron,  etc.  Iron  seems  to  be 
better  borne  by  the  stomach,  and  to  be  more  rea- 
dily appropriated  by  the  red  blood-globules  when 
inhalation  of  compressed  air  is  practised.  I  have 
noticed  this  even  in  non-phthisical  anamia.  Car- 
diac weakness,  excessive  febrile  action,  and  other 
conditions  may  call  for  appropriate  medication. 

Although  the  ordinary  administration  of  drugs 
is  beyond  the  limits  proposed  to  be  discussed  in 
this  paper,  it  may  be  interpolated,  while  upon  the 
subject  of  internal  medication,  that  great  improve- 
ment is,  in  many  cases,  apparently  due  to  the  use 
of  iodoform,  both  singly  and  in  combination,  in 
doses  ranging  from  one  to  five  grains  three  times 
daily.  Gains  in  weight  are  often  very  gratifying, 
when  sufficient  food  is  furnished.  Thus  I  recall  a 
patient  under  my  care  in  the  medical  clinic  of  Jeff- 
erson College  Hospital,  who,  although  far  gone  in 
the  disease,  and  doubtless,  beyond  the  possibility 


THE   CANADA   MEDICAT,   RECoRD. 


55 


of  permanent  restoration,  gained  eleven  ]iounds 
in  one  niontii  while  taking  a  pill  of  iodoform,  two 
grnins,  three  times  a  day,  and  drinking  from  one 
to  two  quarts  of  milk  daily  with  the  addition  of 
beef  pe[)tonoids. 

Crude  petrolenm,  like  creasote  and  tar  pro- 
ducts in  general, seems  to  have  a  favorable  influence 
upon  cough  and  expectorations.  The  good  effects 
of  iron  and  arsenic  in  ani^niia  and  malnutrition 
generally  are  well  known.  'I'heir  action  in  jjhthi- 
sis  needs  no  other  explanation.  It  is  due  prima- 
rily, I  believe,  to  direct  influence  u])on  digestion ; 
secondarily,  to  general  stimulation  of  constructive 
metamorphosis. 

'I'husfar  we  have  considered,  in  the  main,  meas- 
ures directed  to  the  general  system.  To  the  in- 
halation of  compressed  air,  a  measure  designed  in 
part  mechanically  to  counteract  local  pathological 
conditions,  and  to  the  administration  of  iodoform 
and  creasote,  drugs  devoted  in  part  to  the  restric- 
tion of  morbid  histological  action,  we  may  add 
some  of  the  newer  devices   immediately  directed 

I  against  the  local  morbid  processes,  in  part  or  in 
■whole. 
First  in  this  division  of  our  theme,  is  the  subject 
of  medicinal  inhalations.  This  might  well  be 
made  the  subject  of  an  elaborate  paper.  Time 
permits  but  a  hasty  indication  of  its  value.  The  gen- 
eral profession  lias  been  unaccountably  slow  to 
realize  the  advantage  of  a  method  which  permits 
of  direct  medication  of  the  respiratory  tract  in 
greater  or  less  extent.  This  hesitation  may  have 
been  produced  by  the  extravagant  claims  of  some 
unbalanced  observers.  I  will  try  to  avoid  that 
error,  but  I  cannot  help  speaking  with  enthusiasm. 
There  are  certain  volatile  medicaments  long  known 
to  exert  favorable  influence  upon  pulmonary  dis- 
eases, although  the  method  by  which  they  operate 
is  a  matter  of  dispute.  From  a  purely  empirical 
standpoint,  then,  I  will  enumerate,  in  the  order 
of  merit,  those  that  appear  to  me  to  be  the  most 
generally  useful.  These  are,  creasote,  ethyl  iodide, 
terebene,  spirits  turpentine,  tincture  benzoine, 
spirits  thymol,  and  spirits  choloroform.  Euca- 
lytol  is  often  useful,  but,  in  the  main,  has  disap- 
pointed me.  Whatever  the  reason  may  be  that 
the  atmosphere  of  pine  woods  benefits  those  suffer- 
ing with  chest  troubles,  is  the  reason  that  terebin- 
thinate  inhalations  at  home  have  sometimes  an 
almost  equally  good  effect ;  especially  so,  it  seems 
if  combined  with  oxygen.  Ethyl  iodide,  besides 
some  specific  effect  of  its  own,  offers  a  ready  means 
of  local  and  general  iodization  without  disturbing 
the  stomach  ;  to  preserve  it,  it  should  be  mixed 
with  alcohol,  and  dispensed  in  a  dark  bottle. 

In  chronic  processes,  creasote,  terebene,  and 
ethyl  iodide  are  employed  for  general  good  effect. 
To  control  subacute  epiphenomene,  terebene  and 
ethyl  iodide  are  most  frequently  resorted  to.  Ben- 
zoine is  preferable  for  acute  catarrhal  processes. 
Thymol  is  sometimes  substituted  for  creasote  wlen 
the  Oder  is  a  source  of  complaint.  Choloroform  finds 
indications  as  a  sedative  to  troublesome  cough  and 


as  a  mitigant  of  the  sharpness  of  some  specimens  of 
terebene.  Burrough  and  Welcome's  terebene  is 
to  be  preferred  for  internal  use,  but  the  commer- 
cial terebene  (Merck's)  seems  better  for  inhalation, 
and  very  often  requires  the  admixture  of  chloroform 
or  spirits  of  choloroform.  These  agents  may  be  in- 
haled from  a  wide-mouthed  vial,  but  preferably 
from  the  sponge  attached  to  the  little  perforated 
zinc  respirator,  devised  by  Dr.  Burney  Yeo,  of  Lon- 
don, which  may  be  worn  almost  continousiy,  with 
very  little  inconvenience,  thus  keeping  up  a  desir- 
able effect.  Many  patients  wear  the  respirator 
during  sleep,  and  are  perfectly  comfortable.  Fifteen 
or  twenty  drops  of  a  mixture  consisting, for  example, 
of  equal  parts  of  creasote,  terebene  or  ethyl  iodide, 
and  spirits  of  chloroform  or  alcohol,  inay  be 
dropped  on  the  sponge,  and  renewed  two  or  three 
times  a  day.  One  of  the  volatile  substances  enu- 
merated may  be  floated  on  the  surface  of  water  in  a 
Wolff  bottle,  connected  with  the  compressed-air 
apparatus,  or  with  a  reservoir  of  oxygen.  Tere- 
bene is  the  one  usually  chosen  for  this  purpose. 
Vaprous  sprays  of  various  antiseptic,  stimulant, 
or  sedative  solutions  may  be  administered  by 
means  of  the  Oliver  or  globe  atomizer,  or  one  of 
the  many  contrivances  depending  upon  the  same 
princi])le— a  combination,  that  is,  rif  the  Bergsson 
and  Sales-Giron  methods  of  nebulization,  giving  a 
very  fine  mist  which  apparently  penetrates  the  air- 
passages  for  some  distance.  Messrs.  Godman  and 
Shurtleff  have,  at  the  suggestion  of  Dr.  J.  Solis- 
Cohen  and  myself  arranged  a  neat  combination  of 
the  Oliver  atomizer  with  the  stopcock  of  a  com- 
pressed-air apparatus.  Should  this  device  stand 
the  test  of  experience,  I  will  describe  it  in  a  future 
paper.  Hydrogen  dioxide  suggests  itself  as  a  valu- 
able drug  for  use  in  this  manner. 

Acting  upon  a  recommendation  of  Prof.  Bartho- 
low's,  I  am  making  some  observations  on  the 
inhalation  of  sulphurous  acid  gas,  an  old  remedy,  by 
a  new  method.  It  has  been  found  that  carbon 
dioxide  and  sulphur  dioxide,  both  extremely  rebel- 
lious gases  when  attempt  is  made  to  liquify  them 
separately,  may,  by  a  comparatively  slight  pressure 
be  together  brought  into  a  liquid  form  and  confined 
in  an  ordinary  mineral  water  siphon  bottle.  On 
releasing  the  pressure,  they  immediately  return 
to  the  gaseous  state,  and  the  air  of  an  apartment 
may  thus  be  readily  charged  with  any  desired 
quantity.  The  diffusion  and  probably  the  mix- 
ture with  carbonic  acid  robs  the  sulphurous  acid, 
to  some  extent,  of  the  suffocating  properties  it 
exhibits  when  inhaled  undiluted.  The  dose  is  to 
be  regulated  in  each  case  by  the  individual  capa- 
city to  breathe  the  sulphurous  atmosphere — which 
varies  greatly — and  the  patient  is  to  pass  as  much 
time  as  may  be  practicable  in  the  medicated 
apartment. 

Sufficient  time  has  not  elapsed  since  I  have  been 
able  to  obtain  the  liquid  referred  to,  to  venture  a 
positive  expression  of  opinion  from  my  individual 
experience.  I  believe  that  it  will  prove  to  be  a 
valuable  addition  to  our  resources.     This  leads, 


56 


THE  CANADA  MEDICAL   RECORD. 


naturally,  to  the  subject  of  [jaseous  injections  of 
carbonic  acid  and  hydrogen  sulphide.  At  the 
time  that  I  had  announced  the  sub-titles  of  this 
paper,  the  Bergeon  method  of  treating  phthisis 
was  a  novelty  in  this  country  ;  but  as  the  members 
of  this  Society  are  now  beyond  doubt  thoroughly 
familiar  with  it,  instead  of  describing  the  process 
in  full,  I  shall  simply  give  a  tew  practical  points, 
the  result  of  personal  experience  :  First,  as  to  the 
method  of  preparing  and  using  the  gases  ;  and, 
secondly,  as  to  what  may  and  what  may  not  be 
expected  of  it. 

The  intelligent  physician  will  "  prove  all  things 
and  hold  fast  to  that  which  is  good,  "  even  though 
imperfect  experience  may  decry  as  utterly  useless 
that  for  which  unbalanced  enthusiasm  had  claimed 
too  much.  He  will  not  hold  scientific  investigators 
responsible  for  the  vagaries  of  irresponsible  news- 
paper reporters,  nor  reject  that  which  palliates, 
because  it  does  not  infallibly  cure.  In  the  first 
place,  we  must  remember  that  the  effect  of  the 
Bergeon  injections  is  produced  by  the  elimination 
of  the  hydrogen  sulphide  (or  other  active  agent) 
through  the  air  tract.  Unless  we  obtain  evidence 
of  this  elimination  by  recognition  of  the  odor  in  the 
expired  air,  or  the  blackening  of  test  paper  of 
plumbic  acetate  (in  case  H  2  S  be  employed)  by 
the  breath,  we  are  not  secuirng  the  proper  effects, 
and  cannot  expect  improvement.  Failing  to 
secure  this  evidence  in  many  cases,  witli  most  of  the 
natural  waters  used.  I  have  been  well  satisfied  by 
the  use  of  the  solution  recommended  by  Yeo  after 
Bardet,  which  is  prepared  by  adding  to  eight 
ounces  of  water  three  drachms  each  of  the  follow- 
ing solutions  : 

No.  I. — Sodium  sulphide  (c.  p.)  3  ss. 

Distilled  water  f  3  vj. — M. 

No.  2. — Tartaric  acid  f  j  ^  U 

Salicylic  acid  3  ss. 

Distilled  water  fSvj. — M. 

Secondly,  to  avoid  colic  and  griping  pains  we 
must  be  sure  no  air  remains  in  bag,  bottles,  tubes, 
or  any  part  of  the  apparatus,  and  must  warm  the 
injected  gases. 

Thirdly,  twenty  minutes  to  half  an  hour  must 
be  consumed  in  the  process.  From  four  to  six 
quarts  of  carbon  dioxide  should  be  used  at  each 
injection,  after  the  first  few  to  established  tolerance. 
The  patient  should  remain  recumbent  for  half  an 
hour  after  the  cessation  of  the  injection. 

Fourthly,  the  best  times  for  injections  are  just 
before  breakfast,  and  just  before  going  to  bed — 
/.  e.,  three  hours  after  supper. 

Fithly,  patience  and  perseverance  are  necessary, 
both,  on  the  part  of  patient  and  physician. 

Sixthly,  tartaric  acid  is  more  easily  carried  and 
more  neatly  handled  than  sulphuric  acid,  and  will 
disengage  carbonic  acid  from  sodium  bicarbonate 
as  quickly.  About  two  parts  by  measure  of  tar- 
taric acid  to  three  of  sodium  bicarbonate  is  a  good 
working  rule. 

This  method  of   treatment  is  not  designed  to 


destroy  the  bacillus  tuberculosis,  but  to  remedy 
those  local  conditions,  mainly  suppurative,  which 
permit  this  microbe  to  find  a  suitable  habitat  in 
the  lungs.  A  significant  fact  lately  reported,  and, 
if  verified,  of  vast  scientific  importance  in  correct- 
ing current  errors  as  to  etiolggy,  is  that  the  sputum 
of  patients  thus  treated,  fails  to  produce  tubercu- 
losis in  animals. 

The  effects  of  the  treatment,  as  I  have  seen  them 
in  many,  but  not  in  all  cases,  are  more  or  less 
rapid  reduction  of  temperature,  diminution  of 
cough,  improvement  in  the  character  of  expector- 
ated matters,  promotion  of  sleep,  increase  of 
appetite,  cessation  of  night-sweats.  These  pallia- 
tive results,  great  in  themselves,  are  still  greater  in 
the  removal  of  obstacles  to  nutrition.  The  physical 
signs  attributable  to  collateral  catarrh  and  suppura- 
tive processes  subside.  1  have  seen  no  cure,  but 
then  there  has  not  been  time  either  to  permit 
recovery  or  to  test  its  reality.  I  have  not  noticed 
any  marked  recession  in  physical  signs  in  the  lung 
due  to  the  tuberculous  process  itself;  but  in  two 
cases,  patients  of  Dr.  J.  Solis-Cohen's,  I  have  seen 
cicatrization  of  laryngeal  ulcerations  apparently, 
tuberculous,  with  subsidence  of  pyriform  tumefac- 
tions. This  is  a  rare  occurrence,  even  with 
assiduous  local  treatment,  and  in  these  instances 
local  treatment  was  not  instituted.  In  no  case, 
however,  have  we  abandoned  superalimentation, 
or  refrained  from  medication  when  it  seemed  to  be 
indicated.  I  regard  the  Bergeon  process  as  a 
good  adjuvant  to  other  treatment ;  but  until  I  have 
larger  and  longer  experience  therewith,  I  should 
hesitate  to  place  sole  dependence  upon  it.  To 
e^ablish  its  proper  value  we  must  employ  it  in  all 
cases,  and  find  out  in  what  group  it  seems  to  be 
most  useful.  I  should  say  from  my  own  expe- 
rience, and  from  what  I  learn  from  my  friends  in 
Philadelphia,  that  the  cases  in  which  it  appears  to 
be  most  efficacious  are  neither  those  where  the  lung 
is  hopelessly  broken  down,  and  it  is  powerless  ; 
nor  those  in  which  softening  has  not  begun,  and 
it  is  unnecessary  ;  but  those  in  which  septictemic 
processes,  due  to  pulmonary  suppuration,  are  a 
source  of  danger  and  a  cause  of  depression  ;  yet 
in  which  there  is  still  a  hope  of  prolonging  life  if 
the  suppurative  process  can  be  controlled.  When 
this  has  been  accomplished,  I  should  then  feel 
disposed  to  resort  to  inhalations  of  compressed 
air.  The  latter  are,  indeed,  the  one  great  depen- 
dence in  cases  of  early  phthisis,  and  were  I 
compelled  to  choose  between  compressed-air 
inhalations  and  all  the  drugs  of  the  pharmacopceia 
I  should  unhesitatingly  prefer  the  former.  I  know 
that  I  have  seen  consumption  cured  by  its  mear.s. 
I  have  seen  cases,  in  the  practice  of  my  brother, 
that  have  remained  well  for  ten  years,  and  know 
of  some  still  living  that  have  survived  the  predict- 
ed time  of  death  even  longer ;  and  I  am  happy  to 
say  in  conclusion  that  the  patients  of  my  own, 
whose  cases  I  reported  to  this  Society  last  year, 
are  still  alive,  and  to  all  appearances  perfectly 
well.     The  treatment  adopted  in  these  cases  and 


Till',    CANADA    MEDICAL   RECORD. 


57 


earned  out  at  home— obviating  the  expensive  and 
often  futile  quest  after  a  health-restorin;^  climate- 
was  superalimentation,  compressed  air,  ethyl  iodide 
and  terehene  inhalations,  iodoform,  creasote, 
andiron  mternally  ;  measures  directed  not  against 
a  microbe,  which  is  the  evidence  of  disease,  but 
against  the  malnutrition,  whi  h  is  its  cause.— 
/'////.  AJcd.  News. 


ON  DIABETES* 

By  F.  W.   Paw,  M.  D.,F.R.S., 

Senior   I'liysiciaii  to  Uuy's  Hospital,   London. 

Diabetes  has  always  been  regarded  as  an  incur- 
able disease,  and  although  it  has  elicited  much 
■<tudy,  there  are  still  many  points  open  for  inves- 
tig  ition.  The  nature  of  the  affection  may  be  sta- 
ted in  very  precise  terms.  It  is  simply  a  faulty  as- 
similation or  a  faulty  disposal  of  certain  elements 
ot  our  food.  If  we  look  to  the  food  of  man,  we  find 
that  the  chief  elements  of  it  are  nitrogenous  mat- 
ter, tatty  matter,  and  carbohydrates,  that  is  to  say, 
the  large  group  consisting  of  starcli,  cane  sugar^ 
iirape  sugar,  dextrine,  etc.,  behave  in  the  system, 
the  one  exactly  the  same  as  the  other,  so  tliat  it 
would  be  better  to  employ  this  general  term. 

In  diabetes  there  is  no  difterence  in  the  beha- 
vior of  the  carbohydrates  ;  starch  behaves  the  same 
as  cane  sugar,  the  same  as  dextrine.  It  is  this 
group  of  principles  in  connection  with  which  there 
is  a  faulty  disposal  or  a  faulty  assimilative  action. 
The  disease  consists  essentially  of  that.  A  heal- 
thy person,  for  example,  takes  one  or  another  ol 
the  carbohydrates,  and  it  is  lost  sight  of  in  the 
system  ;  we  know  nothing  more  with  regard  to  it, 
and  we  assume  that  the  processes  of  life  are  such 
as  to  lead  to  the  transformation  of  this  carbohy- 
drate in  such  a  manner  that  it  shall  be  susceptible 
of  utilization  in  the  system.  That  is  the  case  «ith 
the  carbohydrates.  That  is  the  condition  of  health  ; 
but  what  is  the  condition  of  diabetes  ?  In  diabe- 
tes, one  of  these  carbohydrates  may  be  taken,  and 
m  proportion  as  the  carbohydrate  is  taken  so  is 
sugar  eliminated  in  the  urine.  ^Ve  may  therefore 
say,  and  it  is  merely  the  expression  of  a  fact,  that 
m  the  diabetic  there  is  a  want  of  assimilative 
power,  there  is  a  want  of  the  power  to  dispose  of 
what  carbohydrates  may  be  taken  into  the  system 
as  food.  Thus  far,  I  think,  we  have  to  deal  with 
facts. 

In  diabetes  the  sugar  reaches  the  general  circu- 
lation m  a  manner  that  it  should  not  do.  In  a 
state  of  health,  analysis  shows  that  only  a  trace  of 
sugar  exists  in  the  contents  of  the  general  circula- 
tion— in  the  small  proportion  of  0.6,  0.7,  0.8  per 
thousand,  so  that  when  a  carbohydrate  is  taken  as 
food,  it  is  stopped  before  it  reaches  the  general 
circulation.  Not  so  with  diabetes.  Here  sugar 
exists  to  a  large  extent  iii  the  general  circulation. 


*A  communication  to  the  Section  of  General  Medicine, 
of  the  Inteniational  Medical  Congress.  Stenographically 
Ffported  for  T/ieAMjcal  AVffj,  and  revised  by  the  author. 


In  proi)ortion  to  the  severity  of  the  case  will  be 
the  quantity  of  sugar  contained  in  the  general  cii- 
tulation.  The  carbohydrate  which  is  taken  as 
food  does  not  stop  before  reaching  the  general 
circulation,  but  in  ])roportion  as  it  is  taken,  so 
does  sugar  a])pear  in  the  urine.  The  sugar 
apiieais  in  the  urine  in  proportion  as  it  exists  in 
the  blood,  and,  therefore,  the  Urine  may  be  said 
to  be  the  index  of  the  diabetes. 

The  amount  of  sugar  in  the  urine  stands  ii: 
direct  relation  to  the  amount  of  sugar  in  the  blood. 
You  cannot  possibly  keep  sugar  in  the  circulation  , 
it  will  not  remain  there,  but  it  will  m.ake  its  appear- 
ance in  the  renal  secretion.  Now  I  have  at  pre- 
sent only  gix'en  expression  to  facts  that  may  be 
observed. 

_  But  why  does  sugar  thus  get  into  the  general 
circulation  in  diabetes?  That  is  the  important 
point.  I  think  it  is  generally  admitted  that  the 
liver  constitutes  the  assimilative  organ  for  the 
carbohydrates.  The  liver  it  is  that  stops  the 
sugar,  or  the  carbohydrate  in  its  passage  to  the 
general  circulation.  The  sugar  is  so  changed  by 
the  liver  that  it  is  not  permitted  to  arrive  in  the 
general  circulation.  Sugar  in  the  organism  is 
transformed  into  glycogen,  and  leads  on  to  the 
production  of  fat.  Its  office  may  be  demonstrated 
in  the  lower  animals.  If  you  want  to  fatten  an 
animal  quickly,  feed  it  on  an  abundance  of  sugar. 
This,  I  think,  demonstrates  the  use  of  sugar  in 
the  production  of  fat.  The  liver,  then,  I  think,  is 
a  steatogenic  organ,  transforming  the  sugar  into 
glycogen,  and  afterward  into  fat. 

It  seems  to  me  in  health  that  this  is  what 
occurs  ;  that  the  carbohydrate  absorbed  from  the 
intestine  is  stopped  by  the  liver,  converted  into 
glycogen  and  then  into  fat,  instead  of  being  jjas- 
sed  through  the  organ  and  appearing  in  the  gene- 
ral circulation.  If,  however,  it  passes  Ihrougli 
the  organ,  we  have  diabetes.  But  what  is  at  the 
bottom  of  this  faulty  process  ?  It  seems  to  be  a 
wrong  condition,  apparently  arising  from  a  faulty 
condition  of  the  venous  blood.  The  liver  is 
differently  placed  from  other  organs,  in  its  large 
supply  of  venous  blood  and  its  proportionatelv 
small  sui)ply  of  arterial  blood  ;  and  tlie  blood 
which  reaches  it  should  be  in  a  good  venous  con- 
dition. If  it  be  not  in  a  good  venous  condition, 
we  have  the  chemistry  of  the  liver  immediately 
altered,  and  sugar  appears  in  the  urine. 

This  alteration  of  the  portal  blood  may  be  pro- 
duced in  a  number  of  ways,  it  may  be  produced 
by  disease  or  by  experiment,  in  the  first  place,  by 
the  injection  of  defibrinized  arterial  blood  into 
the  portal  circulation.  In  a  very  short  time  after 
arterial  blood  from  which  the  fibrin  has  been  re- 
moved has  been  introduced  into  a  vein  of  tht 
portal  system,  we  find  sugar  in  the  urine.  The 
blood  may  be  renderec(  sacchariqe  by  over- 
oxidizing  the  systemic  b,laad.  Experjjoents — not 
only  my  own,  but  tho^se  of  others— hr(Ve  dein?,n- 
strated  this,  that  the  carryi()g  on  of  respij:ai.io.4Ti  in 
the  iQwer  animals  more,  actively  than '  {^gy.mgt'^  ih? 


58 


THE   CANADA    MEDICAL   RECORD. 


heart's  action  continuing,  will  lead  to  the  produc- 
tion of  saccharine  urine.  If  oxyjien  exist  in  the 
portal  blood  to  an  extent  to  which  it  ought  not  to 
exist,  you  will  have  saccharine  urine. 

How  does  this  apply  to  diabetes  ?  If  you 
get  a  vaso-motor  paralysis  of  the  arteries 
of  the  body  you  will  have  that  condition. 
If,  as  may  be  witnessed,  vve  have  a  vaso- 
motor paralysis  of  the  vessels  of  one  side  of 
the  head  and  neck,  we  find  that  the  veins  of  the 
region  become  distended,  not  with  venous  blood, 
but  with  semi  arterial  blood.  As  a  result  of  such 
the  blood  will  arrive  at  the  liver  without  being 
fully  de-arlerialized,  in  other  \vords,  in  an  imper- 
fectly '.enous  condition.  If  the  arteries  of  the 
abdominal  organs  of  the  chylojtoietic  viscera 
become  enlarged  so  that  the  blood  in  them  does 
not  become  perfectly  de-arterialized,  you  will  find 
the  chemical  action  of  the  liver  becoming 
changed  so  as  to  permit  the  carbohydrates  to 
pass  through  it  and  get  into  the  system,  and  so 
charge  the  general  circulation  with  sugar.  The 
worst  forms  of  diabetes  I  have  met  with  are  those 
in  which  there  is  a  dilated  condition  of  the  vessels 
of  the  mouth.  For  the  producti<jn  of  diabetes,  it 
is  only  necessaiy,  I  consider,  for  us  to  have  a 
dilated  condition  of  the  vessels  of  the  chylopoietic 
viscera.  But  the  worst  cases  of  the  disease,  as  I 
have  just  said,  are  those  in  which  this  dilated 
condiiion  of  the  vessels,  due  to  vaso  motor  |.)ara- 
lysis,  lias  extended  from  the  chylopoietic  viscera 
and  visibly  involved  the  mouth.  In  these  cases 
we  have  the  [desence  of  an  exceedingly  red 
tongue. 

Again,  ])uncture  of  the  floor  of  the  fourth  ven- 
tricle, that  celebrated  experiment  of  Bernard, 
leads  to  the  presence  of  sugar  in  the  urine.  Now 
what  did  Bernard  himself  observe  in  connection 
with  the  animals  thus  experimented  upon?  A 
dilated  condiiion  of  the  vessels  of  the  chylopoietic 
viscera. 

One  of  the  first  points  to  attend  to  in  a  case  of 
diabetes  is  to  test  for  sugar.  Sometimes  discordant 
opinions  are  expressed  with  reference  to  cases; 
one  physician,  for  instance,  will  say  that  the 
patient  is  suffering  from  diabetes,  while  another 
physician  will  say  that  he  is  not  suffering  from  the 
disease.  Sonielimes  that  depends  upon  the  test 
made,  at  other  times  it  dejjends  upon  its  being  a 
mild  case  of  the  disease,  which  presents  varying 
conditions  under  the  influence  of  food.  If  the 
patient  has  partaken  freely  of  carbohydrates,  sugar 
exists  in  iiis  urine,  and,  if  examined  then,  it  is  to 
be  detected.  Then  he  goes  to  another  physician 
after  he  has  not  partaken  so  largely  of  the  carbo- 
hydrates, or  perhaps  after  a  fast,  and  there  is  no 
sugar  present. 

We  want  a  test  that  will  give  us  a  decided  and 
reliable  indication.  I  believe  that  the  most  reli- 
able test  for  sugar  in  tlie  urine  is  the  copper  test. 
What  is  ordinarily  used  is  known  as  Fehling's 
solution.  But  there  is  this  objection  to  Fehling's 
solution,  namely,  that    it  is  apt  to  get    bad    after 


being  kept,  because,  if  kept  for  a  long  time,  it  will 
throw  down  a  precipitate  ;and,  again,  the  stopper 
of  the  bottle,  unless  used  often,  is  apt  to  become 
fixed,  and  when  you  want  to  use  it  you  cannot  get 
it  out.  Some  time  ago  I  came  to  the  conclusion 
that  it  would  be  well  ifweeould  get  the  Fehling's 
reagents  prepared  ready  for  use  in  a  solid  form.  I 
found,  however,  that  when  thus  prepared  the 
agents  rapidly  deliquesced  and  decomposed. 
Here,  however,  is  a  pellet  which  I  have  had  pre- 
pared in  w'hich  the  difficulty  has  been  overcome. 
It  is  com]30sed  of  the  copper  sulphate,  Rochelle 
salt,  and  caustic  potash.  It  must  be  made  in  a 
certain  way  with  the  materials  in  an  anhydrous 
state.  The  sulphate  of  copper  is  to  be  placed  in 
the  die  first,  then  some  Rochelle  salt,  next  the 
potash,  and  finally  some  more  Rochelle  salt  to 
complete  the  mass.  If  now  w-e  dissolve  one  of 
these  ])ellets  in  a  little  water,  we  have  first  produ- 
ded  the  greenish  color  of  the  copper,  but,  later,  as 
the  potash  is  reached,  it  becomes  blue,  as  is  cha- 
racteristic of  Fehling's  solution.  If  these  pellets 
are  kept  in  well-stop]3ered  bottles  they  will  keep 
for  any  length  of  time.  And  there  is  this  advantage 
about  the  pellet,  that  if  it  does  become  bad  from 
the  absorption  of  moisture,  it  becomes  so  bad 
that  it  cannot  be  used,  and  therefore  there  is  no 
danger  of  its  leading  to  error.  It  will,  if  exposed 
to  the  atmos])here,  become  altered,  but  it  then 
turns  black,  so  that  the  change  is  readily  recogni- 
zed, and  it  cannot  be  used.  If  I  now  add  to  this 
solution  a  little  liquid  containing  sugar,  and  boil 
the  mixture,  the  oxide  of  copper  becomes  reduced 
to  the  slate  of  suboxide,  just  as  tit  the  ordinary 
testing  witli  Fehling's  solution.  These  pellets  are 
now  considerably  used  in  England, 

I  do  not  think  that  a  case  of  diabetes  can  be 
satisfactorily  managed  unless  a  quantitative  analy- 
sis of  the  urine  is  made,  and  the  amount  of  sugar 
contained  in  it  is  determined.  I  do  not  consider 
that  a  person  can  get'along  satisfactorily  without 
knowing  the  amount  of  sugar  that  is  being  elimi- 
nated by  the  kidneys  any  more  than  he  can  get 
al(3ng  in  a  case  of  thoracic  disease  without  know- 
ing, by  the  aid  of  the  stethoscope,  exactly  the 
amount  of  disease  existing  there.  In  my  own 
practice,  I  desire  that  two  speciinens  be  brought 
to  me,  one  passed  in  the  evening  and  the  other 
upon  rising  in  the  morning.  By  an  examination 
of  this  kind  you  can  discover  errors  of  diet  in 
your  patient  that  would  otherwise  escape  you. 
You  do  not  need  to  ask  the  patient  at  all  what  he 
lias  been  eating,  you  can  tell  him.  Errors 
of  diet  can  be  detected  at  once.  You  can  not 
only  detect  that  the  patient  is  not  following  your 
instructions,  but  you  can  tell  at  what  meal  the 
error  has  been  committed.  Under  ordinary 
circumstances,  if  the  person  is  passing  sugar  (of 
course,  if  he  is  not  passing  sugar  you  cannot  tell 
anything  about  it)  you  may  find  in  the  night  urine 
a  considerable  quantity  of  sugar,  and  in  the  mor- 
ning urine  none  at  all.  The  sugar  in  the  night 
urine   has    been  derived  from  the  carbohydrates 


tut:   CANADA    MEDICAL   KECORD. 


oO 


taken  during  the  day.  The  morning  urine  has 
iicen  derived  from  tlie  blood  dmingtlie  night,  and 
therefore  in  the  interval  ofdigesliun,  and  thus  may 
contain  no  sugar. 

The  urine  of  food  may  be  quite  different  from 
the  urine  of  fiisling. 

I  remember  once  a  patient  whom  I  had  treated 
for  some  time,  coming  to  me  witli  a  bottle  of  niglit 
urine  containing  an  unexpectedly  large  amount 
of  sugar.  1  coukl  not  account  for  this  sudden  in- 
crease of  the  amount  of  sugar  in  it.  I  got  him  to 
enumerate  the  articles  of  lood  he  had  taken  tlie 
evening  before.  Among  the  articles'enumeiated 
he  named  blanc  mange,  but  he  had  tVequently 
taken  that  before  without  injury.  1  told  him  to 
inquire,  and  that  in  all  probability  he  would  find 
that  it  had  not  been  made  in  the  usual  manner ; 
and  u]]on  doing  so,  he  learned  that  it  had  been 
made  with  corn  fiour  (corn-starch)  instead  of  in 
the  manner  that  had  formerly  been  done,  viz., 
with  isinglass  and  cream.  In  another  instance,  I 
was  al.ilc  to  tell  a  patient  that  she  had  taken  her 
breakfast  in  bed.  I  found  in  this  case  that  the 
night  urine  contained  no  sugar,  while  the  morning 
urine  was  loaded  with  it.  She  had  arisen  late,  and 
the  only  way  of  accounting  for  these  conditions 
observed  was  on  the  supposition  that  she  had 
eaten  liefore  arising,  and  this  1  foiuid  w.as  actually 
the  case. 

Now  we  want  some  means  of  easily  and  precisely 
determining  the  amount  of  sugar  contained  in 
the  urine.  This  can  be  done  as  follows  :  As  we 
know  and  have  just  seen,  in  testing  in  the  ordinary 
manner  with  the  copper  solution,  the  suboxide  of 
copper  is  ]jrecipitated.  In  the  method  that  I  shall 
show  you,  instead  of  this,  tlie  solution  remains 
clear,  and  becomes  coloriess,  and  the  sugar  is 
estimated  from  the  amuunt  of  liquid  being  exam- 
ined, that  is  required  to  decolorize  a  given  quantity 
of  the  Solution.  The  solutionis  made  with  the 
sulphate  of  copper,  Rochelle  salt,  caustic  potash, 
and  water  of  ammonia.  Into  a  given  quantity  of 
this  the  liquid  containing  sugar  is  dropped.  It 
is  best  in  testing  urine  to  dilute  it  with  twenty  or 
thirty  parts  of  water  in  order  to  make  the  test 
more  delicate.  The  diluted  urine  is  placed 
in  a  graduated  curette,  from  which  it  is  dropped 
into  the  ammoniated  copper  solution  after  the 
latter  has  been  heated  to  the  boiling  point,  letting 
it  flow  drop  by  drop  until  the  color  has  just  entire- 
ly disappeared.  Tlie  dropping  of  the  licjuid  into 
the  test  solution  is  guided  by  means  of  a  screw 
adjustment  affixed  to  the  tube,  which  can  be  set 
so  as  to  permit  the  escape  of  forty,  lifty,  eighty,  or 
one  hundred  drops  per  minute.  The  beauty  of 
the  test  is  that  the  e.xact  terminal  point  of  the 
reduction  can  with  the  greatest  surety  be  deter- 
mined, for  there  is  no  precipitate  to  obscure  the 
view  of^the  reduction.  You  observe  now  in 
the  apparatus  before  me  that  as  the  saccharine 
liquid  drops  into  the  boiling  test  solution  the  color 
is  gradually  disappearing  and  the  liquid  remains 
perfectly  clear. 


Sometimes,    albumen  is  found  in  addition    to 

sugar  in  the  urine  of  the  diabetic.  Not  infrequent- 
ly yon  will  find  that  when  the  patient  first  comes 
mider  your  observation  he  has  a  considerable 
(juantity  of  albumen  in  his  urine,  and  that  after  he 
has  been  under  treatment  for  the  disease  for  a 
wiiile  the  albumen  disapi)ears.  This  will  permit 
me  to  bring  to  your  notice  a  convenient  test  for 
albumen.  This  consists  of  citric  acid  and  the 
ferrocyanide  of  sodium,  the  ferrocyanideof  sodiimi 
being  used  because  it  makes  a  looser  pellet 
than  the  ferrocyanide  of  potassium,  and  therefore 
more  quickly  dissolves.  There  is  this  advantage 
about  it,  that  as  a  clinical  test  you  require  nothing 
more.  If  albumen  is  present,  you  are  sure  to  get 
a  precipitate  ;  and  if  you  get  a  precipitate,  you 
are  sure  that  albumen  is  present.  It  is  also  a  test 
of  an  exceedingly  delicate  nature.  It  is  a  test 
that  requires  nothing  to  check  and  nothing  to 
corroborate.  You  can  carry  it  with  you  in  your 
pocket  like  a  jiencil-case  or  pocket-knife.  No 
matter  whether  I  need  it  or  not,  I  always  have  my 
albumea  test  in  my  pocket  with  me.  I  have  here, 
as  you  see,  a  very  compact  tube  containing  all 
that  is  required.  I  will  show  you  the  method  of 
using  the  test  with  this  liquid,  which  contains 
albumen.  The  citric  acid  pellet  must  be  used  first. 
It  very  s|)eedily  dissolves.  Sometimes  citric  acid 
will  bring  down  a  precipitate  of  uric  acid,  or  it  may 
be  of  oleo-resinous  matter ;  but,  as  it  is  not  the 
citric  acid  which  is  the  teat,  we  do  not  rely  upon 
j  that.  If  the  citric  acid  brings  down  a  precipitate 
of  uric  acid,  a  dilution  of  the  urine  will  redissolve 
it.  On  the  addition  now  of  the  other  pellet, 
consisting  of  ferrocyanide  of  sodium,  you  have  a 
definite  and  reliable  precipitate  of  albumen  pro- 
duced. This  test  has  now  been  out  several  years, 
and,  so  far  as  is  known  uj)  to  the  present  time, 
nothing  under  the  circumstances  will  occasion  a 
precipitate  with  the  pellet  of  ferrocyanide  of 
sodium  besides  albumen,  sa  that  it  is  a  test  upon 
which  you  may  rely  alone. 

I  will  speak  now  of  considerations  bearing 
more  particularly  upon  the  disease  itself  There 
are  different  grades  of  intensity  probably  as 
marked  in  diabetes  as  in  any  dise.ise  we  have  to 
deal  with.  Let  us  start  with  a  healthy  person. 
Even  a  healthy  person  has  not  an  unlimited  power 
of  assimilating  the  carbohydrates,  but  the  first 
step  toward  disease  is  where  the  assimilative  power 
is  below  the  normal.  This  kind  of  person  will 
not,  under  ordinary  circumstances,  pass  sugar  in 
his  urine.  If,  however,  he  partake  freely  of 
preserves,  or  other  articles  of  food  containing 
large  quantities  of  sugar,  he  will  pass  saccharine 
urine.  Then  you  come  to  persons  who,  when 
partaking  moderately  of  food  containing  carbohy- 
drates, will  pass  sugar.  They  may  take  carbohy- 
drates to  a  certain  extent  without  showing  evidence 
of  abnormality,  but  as  soon  as  the  limit  is  passed 
sugar  will  appear. 

Age  influences  largely  this  complaint.  Severe 
cases  are  in  young  subjects,  mild  cases  are  in  old 


60 


THE   CAJ^ADA   MEDICAL  RECORD. 


subjects,  and  the  more  advanced  the  age  the 
better  tlie  prognosis.  I  know  of  no  disease  in 
young  subjects  that  is  more  grave.  The  ordinary 
length  of  hfe  in  young  subjects  afflicted  with 
diabetes  may  be  said  to  be  about  two  years.  In 
middle-aged  or  elderly  persons  the  prosjiects, 
happily,  are  of  a  different  nature.  If  they  follow 
proper  management  they  can  keep  the  disease 
under.  The  unsatisfactory  cases  are  in  the  young, 
the  satisfactory  cases  in  the  elderly. 

The  age  at  which  the  disease  is  most  comnion 
ranges  between  forty  and  sixty  years.  Preparatory 
to  the  meeting  of  tlie  British  Medical  Association, 
a  few  years  ago,  I  went  through  my  case  book  and 
tabulated  1360  cases,  and  1  found  that  the  cases 
occurring  between  forty  and  sixty  years  of  age 
made  up  fifty-six  per  cent,  of  the  whole. 

Sometimes  the  disease  commences  in  mild  form, 
and  may  run  along  for  several  years  before  it  is 
recognized.  You  may  say.  What  authority  have 
you  for  making  such  an  assetrion  ?  How  do  you 
know  that  the  disease  has  run  for  some  time  with- 
out having  been  recognized?  There  is  this  way 
of  knowing  it :  saccharine  urine  leaves  white  spots 
on  articles  of  clothing,  and  in  micturition  the 
trousers  are  apt  to  get  splashed.  The  "  boots"  at 
jiotels  are  able  to  recognize  diabetic  guests.  They 
find  the  spots  on  the  legs  of  their  trousers  very 
difficult  to  brush  out.  1  have  had  patients  come 
to  me  who  were  able,  when  asked,  to  hunt  up  old 
trousers  on  which  these  spots  were  found,  and 
could  remember  the  annoyance  occasioned  by 
them  for  a  long  time  before.  Such  are  the 
grounds  for  being  able  to  say  that  the  disease 
may  have  existed  for  some  time  without  having 
been  recognized. 

It  runs  in  families  to  a  considerable  degree.  1 
do  not  say  that  it  is  hereditarj'  in  the  same  way  as 
gout  and  phthisis  are,  but  it  runs  in  some  families 
in  a  striking  manner.  I  was  asked  to  see  a 
patient  suffering  from  diabetes,  who  belonged  to  a 
family  of  five,  the  eldest  of  whom  was  not  more 
than  eighteen  or  nineteen.  The  mother  had  died 
of  diabetes  and  the  grandmother  had  died  also  of 
the  disease.  One  of  the  children  was  brought  to 
me,  as  I  have  said,  and  sugar  existed  in  the  urine. 
1  desired  to  have  a  specimen  from  each  of  the 
remaining  children.  In  four  of  the  five  the  urine 
was  saccharine. 

There  is  one  point  with  reference  to  the  disease 
to  which  I  would  like  to  call  your  especial  atten- 
tion, and  ask  you  to  give  it  the  benefit  of  your 
own  observation.  It  is  only  somewhat  recently 
that  my  own  attention  has  been  fixed  upon  the 
matter,  and  the  number  of  cases  I  find  to  be 
affected  in  the  manner  I  am  going  to  mention  is 
striking.  The  remark  does  not  apply  to  young 
subjects,  but  to  persons  beyond  the  middle  period 
of  life.  1  used  to  come  across  persons  who  com- 
plained of  pain  in  the  legs,  put  down  as  cases  of 
gout  or  rheumatism ;  and  I  took  it  as  simply 
coincidental  to  the  diabetes,  without  anything 
important  in  it.     But  I  so  frequently  met  with  it 


that  my  attention  became  aroused,  and  now  I  find 
many  subjects  of  diabetes  beyond  the  middle 
period  of  life  thus  affected.  There  is  also  more  or 
less  ataxia.  It  is  not  exactly  the  pure  form  of 
ataxia  that  it  is  seen  in  locomotor  ataxia,  because 
I  have  noticed  that  these  persons  can  stand,  main- 
taining their  balance  fairly  well  with  their  eyes 
shut.  Yet  they  walk  with  some  difticulty.  They 
cannot  properly  maintain  their  balance.  They 
feel  often  comi)elled  in  walking  to  pull  themselves 
together  and  make  an  effort  to  walk  steadier,  lest 
liersons  behind  them  may  think  they  have  been 
taking  too  much.  This  is  what  has  occurred  to 
me  over  and  over  again  to  hear. 

Then,  again,  with  this,  there  are  usually  asso- 
ciated some  anesthesia,  and  hypera^sthesia,  and 
various  forms  of  paresthesia.  Persons  feel  as 
though  they  were  walking  on  pebbles.  The  flesh 
is  tender,  so  that  when  the  leg  is  grasped  it  gives 
pain.  This  comes  oftener  in  the  legs  than  in  the 
upper  extremity  ;  sometimes,  however,  it  affects 
the  upper  also.  Then  there  is  an  aching  of  the 
bones.  The  patient  complains  of  it  especially  at 
night,  in  bed.  The  condition  appears  to  be  due 
to  peripheral  neuritis. 

Treatment. — In  young  subjects,  all  we  can  do 
is  to  endeavor  to  stay  the  disease  for  a  time.  You 
cannot  possibly  cure  it.  At  an  early  stage  of  the 
disease  in  the  young  subject,  you  diet  the  patient — 
the  sugar  is  removed,  and  the  patient  thinks  he 
is  cured.  Sometimes  you  are  called  upon  to  treat 
a  patient  who  has  been  brought  to  an  extreme 
state  of  emaciation  and  weakness,  by  a  sudden 
and  severe  invasion  of  the  disease.  Placed  under 
proper  treatment,  the  change  appears  like  a  resus- 
citation. He  goes  on  getting  better,  his  hopes 
are  raised,  and  he  thinks  he  is  well.  Unfortunately 
this  is  not  the  case.  It  is  a  progressive  disease. 
It  is  a  disease  which  seems  to  progress  in  the 
same  way  as  progressive  muscular  atrophy  or 
locomotor  ataxia,  but  its  advance  is  uneven.  As 
it  advances,  the  diet  and  other  methods  of  treat- 
ment which  succeeded  in  removing  the  sugar  at 
first  no  longer  do  so ;  the  patient  now  loses  ground 
and  becomes  weaker  and  weaker.  You  are  able 
at  first  to  keep  down  the  symptoms  and  the  exces- 
sive flow  of  urine  ;  but  soon  you  lose  your  power 
to  keep  them  down,  and  finally  something  occurs 
to  throw  your  patient  off  his  balance,  and  to  lead 
up  to  diabetic  coma,  which  is  the  ordinary  mode 
of  death  in  these  cases. 

It  would  be  a  hard  and  oppressive  life  to  devote 
one's  self  only  to  the  treatment  of  diabetes  occur- 
ring in  subjects.  But  the  successes  obtained  in 
treating  the  disease  in  patients  of  a  more  advanced 
age  compensate  m  a  measure  at  least  for  the 
failure  in  young  persons. 

We  first  avoid  feeding  the  disease,  and  whilst 
doing  this  endeavor  to  convert  the  wrong  action 
of  assimilation  into  a  right  one.  I  lay  the  greatest 
stress  on  diet.  I  do  not  think  that  we  can  get 
along  in  the  management  of  these  cases  without 
strict  attention  to  diet.     There  must,  then,  be  the 


THE  CAS*ADA    MEbtCAL   KKCOUt*. 


61 


proper  articles  of  food  provided.  It  is  easy  enough 
for  the  ixitioiU  to  avoid  taking  some  articles  of 
food, as  sweets, pastry,  puddings,  j)Otatoes,etc.,biit  it 
not  so  easy  in  tiie  case  of  bread.  What  he  may 
take  may  be  summed  up  as  consisting  of  any  kind 
of  meat,  fisli,  poultry  and  game,  with  eggs,  butter, 
cheese,  the  various  forms  of  green  vegetable  food, 
and  a  [irepared  substitute  for  bread.  Milk  should 
only  be  taken  to  a  limited  extent.  Some  author- 
ities have  reconniiended  the  free  use  of  mi  k.  But 
milk  contains  sugar,  and  milk-sugar  behaves  in  the 
system  exactly  as  any  other  form  of  sugar.  I 
have  found  that  where  milk  has  been  taken  in 
large  quantity,  the  sugar  has  been  kept  up  in  the 
urine  ;  whilst  when  the  quantity  of  milk  was  re- 
duced, the  state  of  the  urine  improved.  Certainly 
it  is  a  hardship  for  a  patient  to  abstain  from  bread, 
and  you  want  to  make  it  as  easy  as  possible  for 
him,  by  substituting  something  else  of  a  palatable 
nature  for  the  article  prepared  from  wheaten 
llmir.  I  do  not  think  bran,  which  is  often  used, 
is  a  good  substitute,  because  it  contains  from  40 
t )  50  ijer  cent,  of  carbohydrates  and  very  little 
else  that  can  be  digested  and  applied.  Gluten  is 
better,  but  it  contains  a  considerable  amount  of 
starch.  If  the  gluten  is  good,  it  contains  only  from 
30  to  33  per  cent;  but  I  have  found  some  specimens 
containuig  70  to  80  per  cent.  Perhaps  there  is  no  ar- 
ticle of  food  better  suited  to  the  diabetic  than  the 
almond.  There  is  nothing  which  seems  to  supply 
him  better  with  what  is  wanted.  The  almond, 
rich  as  it  is  in  nitrogenous  material,  rich  as  it  is  in 
oily  material,  is  just  the  article  of  food  to  meet 
his  requirements,  and  palatable  products,  as  a  sub- 
stitute for  bread,  may  be  prepared  from  it. 

Medicinal  Treatment. — .^s  far  as  my  experience 
goes,  nothing  contributes  so  much  to  arrest  the 
disease  as  opium,  morphia,  and  codeia.  It  is 
difficult,  of  course,  to  say,  when  you  are  treating 
a  case  with  one  of  these  remedies  in  conjunction 
with  diet,  whether  the  good  result  you  get  is  not 
solely  the  dieting.  But  my  own  experience  is  to 
the  effect  that  my  practice,  ever  since  I  have  been 
giving  these,  has  been  much  more  satisfactory 
than  it  was  before  I  gave  them.  Clearly  these 
agents  appear  to  exert  some  power  in  controlling 
the  disease.  It  is  my  custom  when  I  get  a  patient 
of  forty-five  to  fifty  years  of  age  to  put  him  at  once 
on  small  doses  of  opium,  morphia,  or  codeia,  and 
gradually  increase.  The  sugar  in  the  urine  dimi- 
nishes and  usually  disappears.  After  a  wliile  I 
permit  the  patient  to  take  a  little  bread — say,  two 
oimces  a  day.  If  he  takes  this  without  a  return 
of  sugar  I  let  him  gradually  increase  the  quantity 
until  he  takes  four  or  six  ounces  per  day.  Then 
I  say  to  him  you  had  better  let  well  alone  and 
stop  at  this,  knowing  how  readily  harm  may  be 
done  by  going  beyond  what  can  be  taken  without 
occasioning  the  passage  of  sugar.  As  long  as 
sugar  does  not  exist  in  the  urine  there  is  nothing 
to  interfere  with  a  healthy  state  being  maintained. 
The  patient  is,  to  all  intents  and  purposes,  in  a 
natural  condition  as  regards  his  general  state.     It 


is  only  with  the  voidance  of  sugar  that  we  get  the 
sym|)toms  of  the  disease  and  imtoward  results. — 
Meit.  Ah~ii.'s. 


ANTIl'YRIN     I.\     RHEUMATI.SM;    ITS 
VALUE  AND  MODE  OF  ACTION. 

Hy  N.  S.  Davis,  Jr.,  A.  M.,  M.  D., 

PROFESSOR  OF  PRINCIPLES  AND  PRACTICE  OF  MEDICINE 
IN  THE  CHICAGO   MEDICAL  COLLEGE. 

Read  beft^re  the  Section  of  Practice  of  .Medicine,  Mateiia 
Mcdica  and  Physiology,  at  the  Thirty-Eiyht  Annual  Meet- 
ing of  the  Ameiican  Meihcal   Associ,ation,  June  8,  1887. 

During  the  last  few  months  numerous  write; s 
in  Germany  and  France  have  described  the  good 
effects  of  antipyrin  in  acute  rheumatism.  It  has 
been  said  of  it  that  it  relieves  the  pain,  and  allay:, 
the  fever  as  quickly  as  does  the  salicylate  of  soda, 
and  that  under  its  influence  the  cutaneous  redness 
over  the  affected  joints,  and  their  swelling,  gra- 
dually but  soon  disappears. 

All  of  these  statements  I  can  confirm  by  my  ex- 
perience during  the  last  four  months  in  some 
twenty  cases. 

I  have  used  antipyrin  in  acute  cases,  also  in 
those  that  were  subacute  and  in  the  acute  exacer- 
bations of  those  that  were  chronic.  I  noticed 
early  that  the  greatest  and  most  rapid  improvement 
was  obtained  in  cases  in  which  there  was  a  rise  of 
temperature  above  the  normal. 

The  first  case  in  which  1  used  antipyrin  was 
one  of  chronic  rheumatism  in  which  there  was,  at 
the  time,  an  acute  exacerbation.  The  patient's 
stomach  was  so  irritable  that  very  little  was 
retained  by  it.  Enough  of  salicylic  acid  or  of  the 
salicylates  could  not  be  given  to  produce  an 
impression  on  the  disease.  I  therefore  tried  as  an 
experiment  a  single  dose  of  antipyrin,  of  twenty 
grains,  at  bed  time.  Soon  after  taking  the 
medicine  the  pains,  which  were  uniformly  much 
more  severe  at  night  than  during  the  day,  were 
eased.  The  patient  breaking  into  a  profuse  pers- 
piration, fc-U  asleep  and  passed  the  first  restful 
night  for  some  weeks.  After  a  few  days  under 
this  treatment  her  fever  disappeared,  and  she  was 
almost  free  from  pain.  When  the  fever  was 
wholly  wanting  it  was  noticed  that  the  antipyrin 
ceased  to  ease  the  pain  that  remained,  and  did  not 
relieve  the  chronic  stiffness  and  swelling  of  the 
joints.  As  often,  however,  as  the  temperature 
rose  the  antipyrin  acted  well.  I  have  met  with 
similar  results  in  the  treatment  of  three  other 
cases  of  chronic  rheumatism.  No  relief  to  the 
pain,  swelling  and  other  symptoms  of  inflammation 
was  obtained  in  a  case  of  gonorrhceal  riieumatism, 
in  which  one  ankle,  one  knee  and  the  joints  of  the 
fingers  were  much  swollen  and  exceedingly  pain- 
ful. There  was  in  this  case  at  the  time  no 
fever. 

As  an  illustration  of  the  action  of  antipyrin  in 
acute  cases,  I  will  cite  the  history  of  a  young  man 
recently  dismissed  from  Mercy  Hospital,  appa- 
rently cured.     He  had  been   sick  with  a    sharply 


62 


THE   CANADA   MEDICAL   RECORD. 


acute  and  quite  severe  attack  of  rheumatism  for 
ten  days,  when  he  entered  the  hos])ital.  During 
that  time  most  of  the  large  joints  had  been  in  turn 
affected.  When  first  seen  by  me  his  temperature 
103°  ;  iiis  pulse  quick,  bounding,  full,  but  com- 
pressible; his  skin  moist,  with  moderate  perspira- 
tion ;  his  countenance  indicated  pain  and  distress. 
At  the  time  the  pain  was  almost  wholly 
limited  to  the  left  knee  and  right  shoulder  and 
elbow.  All  these  joints  were  considerably  swol- 
len, and  tiie  skin  over  the  knee  was  very  slightly 
reddened.  There  were  no  evidences  of  endo- 
or  pericarditis.  Appetite  was  completely  wanting 
but  thirst  was  much  increased.  The  bowels  were 
constipated.  The  urine  was  somewhat  scant  and 
highly  colored.  .Sleep  of  more  than  momentary 
duration  had  been  impossible  for  many  days.  Jn 
a  word,  the  patient  at  the  moment  presented  the 
symptoms  characteristic  of  a  typical  case  of  acute 
rheumatism.  As  it  was  one  of  the  earliest  cases 
of  acute  rheumatism  that  I  treated  wholly  with 
antipyrin,  I  ordered  at  first  the  administration  of  a 
powder  containing  twenty  grains  of  the  drug  only 
night  and  morning.  The  following  afternoon  lie 
reported  that  soon  after  taking  the  medicine 
he  slept,  and  for  three  or  four  hours  was 
free  from  pain,  but  as  the  influence  of  the 
drug  wore  off  the  pain  returned.  His  tem- 
perature had  then  lowered,  but  was  still  consider- 
ably above  normal.  I  now  ordered  the  antipyrin 
powders  given  three  times  daily  instead  of  twice. 
Two  days  later  the  patient  looked  much  better, 
and  described  himself  as  almost  free  from  pain  ; 
the  cutaneous  redness  over  the  knee  was  gone, 
and  all  the  joints  were  less  swollen,  but  still  stiff 
and  .somewhat  painful  on  attempted  motion.  The 
temperature  for  the  most  part  during  the  preced- 
ing twenty-four  hours  w-as  normal  ;  twice  it  rose 
slightly.  'I'he  frequency  of  the  administration  of 
the  antipyrin  was  left  to  the  judgment  of  the  house 
physician  ;  the  directions  being  to  administer  the 
drug  whenever  the  temperature  rose  or  an  access 
of  pain  occurred.  Following  this  plan,  he  receiv- 
ed during  the  next  two  days  two  powders  daily. 
He  was  entirely  comfortable  so  long  as  quick  and 
violent  movements  were  not  attempted.  For 
eighteen  hours  there  had  been  no  abnormal  tem- 
perature. The  swelling  of  the  joints  was  much 
less,  and  freedom  of  motion  much  greater.  The 
case  progressed  steadily  in  a  favorable  manner, 
and  all  stiffness  and  pain  disappeared  chuing  the 
next  week.  The  antipyrin  was  continued  for 
several  days  after  all  fever  was  gone.  No  other 
medicine  was  administered  after  its  discontinuance, 
the  patient  simply  being  guarded  against  adverse 
atmospheric  influences. 

In  the  other  acute  cases  in  which  I  have  tried 
antipyrin,  I  have  been  most  pleased  with  the  readi- 
ness with  which  it  relieved  jiain  and  lessened  fever. 
In  some  instances  the  improvement  was  more 
40  marked  and  more  rapid  than  in  the  case  I  have 
just  sketched;  in  others  it  was  somewhat  slower, 
but  always  decided.  I  feel  confident  that,  so  far  as 


a  limited  number  of  cases  will  permit  one  to  deter- 
mine, antipyrin  can  be  said  to  be  as  efficacious  as 
the  salicylates.  Being  at  first  impressed  with  the 
thought  that  the  relief  obtained  in  rheumatism  was 
due  to  the  antipyretic  effects  of  the  drug,  I  sub- 
stituted for  it  salicylic  acid'as  soon  as  the  temper- 
ature became  normal ;  as,  however,  experience 
showed  that  the  efficacy  of  antipyrin  did  not  de- 
jjend  upon  this  property,  I  continued  its  use,  as 
improvement  took  place,  in  lessened  doses  and 
less  frequently,  until  a  cure  was  established. 

In  the  hospital  c.i.ses  most  recently  treated 
the  drug  has  been  used  in  fifteen  grain  doses, 
administered  at  the  height  of  the  disease  every 
four  hours,  diminishing  the  frequency  of  its  repe- 
tition as  improvement  occurred.  It  has  seemed 
to  me  that  I  obtained  more  satisfactory  results  in 
my  private  patients  to  whom  I  gave  it  in  larger, 
twenty  grain,  doses,  four  times  daily,  when  the 
disease  was  at  its  height,  and  to  whom,  during 
the  period  of  improvement,  it  was  given  in  smaller 
doses,  but  not  at  first  less  frequently.  From  si.\.ty 
to  ninety  grains  (four  to  six  grams)  daily  are 
recommended  usually  by  those  who  have  employed 
antipyrin  in  rheumatism. 

The  advantage  of  antipyrin  over  the  salicylates 
consists  chiefly  in  its  less  nauseating  properties,  its 
less  liability  to  provoke  vomiting,  headache,  and 
noises  in  the  ears.  Not  unfrequently  a  patient  is 
found  who  can  not  take  the  salicylates  in  efficient 
doses.  While  trying  antipyrin,  both  in  rheumatism 
and  in  other  febrile  diseases,  I  have  found  only  one 
or  two  persons  who  rejected  it;  and  a  few  others 
whose  stomachs  were  irritable,  who  complained, 
of  slight  nausea  immediately  after  taking  it.  These 
eflects  are,  however,  much  less  frequently  pro- 
duced by  it  than  by  the  salicylates.  It  can  also 
be  given  efficiently,  when  necessary,  by  the  rec- 
tum or  subcutaneously. 

The  only  ill  effect  that  is  likely  to  result  from 
the  use  of  antipyrin  is  the  so  called  "antipyrin 
rash."  This  is  seen  only  in  a  very  small  proper 
tion  of  the  cases  treated  with  it.  Two  or  three 
cases  of  fatal  collapse  have  been  reported  occur- 
ring in  typhoid  patients,  after  taking  antipyrin.  At 
the  most,  however,  this  is  an  exceedingly  rare 
accident,  and  it  is  questionable  even  if,  in  the 
cases  referred  to,  the  accident  was  due  to  the 
antipyrin.  Ringing  in  the  ears  has  been  reported 
as  occurring,  but  so  seldom  that  it  need  not  be 
looked  for  when  the  usual  doses  are  used. 

Others  have  found,  very  rarely,  a  case  of  acute 
rheumatism  in  which  no  relief  could  be  obtained 
from  the  antipyrin  treatment.  The  same  can  be 
said,  however,  of  the  usual  salicylate  treatment. 

The  use  of  the  drug  does  not  appear  to  influ- 
ence the  frequency  of  the  occurrence  of  heart 
complications,  and  their  existence  is  not  a  contra 
indication  to  its  employment. 

It  is  impossible,  from  what  we  yet  know  of  the  na- 
ture of  rheumatism  and  of  the  physiological  action 
of  antipyrin  to  explain  thoroughly  its  therapeutic 
.action.     'I'he   perspiration    which    very  uniformly 


THE   CANADA    MEDICAL    RECORD. 


63 


follow  its  adniinistmtion,  and  in  rheumatism  seems 
to  accompany  the  diminution  of  pain,  is  probably 
due  to  relaxation  of  tlie  cutaneous  vessels,  such  as 
has  been  observed  by  Beyer  (i)  and  others,  and 
which  naturally  would  feed  and  stimulate  the  cu- 
t.uieous  glands.  It  has  been  shown  that  the 
|)eripheral  vessels  dilate  under  the  influence  of 
antipyrin,  the  arteries  dilating  when  large  doses 
are  administered.  \\'hetlier  this  change  of  calibre 
is  due  to  vaso  motor  influence  or  not  is  undecided, 
some  claiming  that  the  change  is  brought  al  out 
by  the  direct  action  of  the  drug  upon  the  vessels, 
since  similar  changes  take  ])lace  in  isolated  organs, 
(2)  others  claiming  the  reverse  to  be  true.  (3) 

Antipyrin,  when  mixed  with  blood,  does  not 
cause  a  change  of  color  or  liestruction  of  the 
corpuscles,  as  does  kairin,  thallin,  resorcin,  (4)  and 
probably  antifebrin. 

Possibly  its  antipyretic  properties  are  to  be 
explained  by  the  vascular  changes  which  it  pro- 
duces, since  they  would  contribute  to  increase  the 
radiation  of  bodily  heat.  'I'his  is  the  explanation 
offered  by  Bettelheim,  (5)  Auseroff  and  Beyer. 
Arduin  thinks  the  diminution  in  temperature  is 
due  to  an  influence  exerted  u]ion  the  thermogenic 
nerve-centres.  During  the  last  month  P.  J.  Mar- 
tin (7)  has  published  the  results  of  experiments 
whichshow  that,  almost  uniformly,  heat  j.iroduction 
isdiminished  by  antipyrin,  and  heat  dissipation  is 
very  much  increased.  It  thus  would  seem  to  be 
an  ideal  antipyretic.  In  the  small  proportion  of 
cases  in  which  heat  production  was  not  diminished 
heat  dissipation  was  so  far  in  excess  that  the  bo- 
dily temperature  was  lowered.  Several  observers 
have  noted  that  under  the  influence  of  antipyrin 
the  surface  temperature  rises  while  the  internal 
temperature  of  the  bjdy  fails.  (8) 

Its  power  of  allaying  pain  in  rheumatism  is  pro- 
bably not  dependent  upon  these  vascular  changes 
or  the  pyrexia  produced  by  it,  but  upon  a  direct 
action  on  the  nervous  structure  of  the  body. 
Antipyrin,  though  apparently  most  efficacious  in 
rheumatic  fever  and  least  in  muscular  rheumatism  ; 
still,  even  in  the  latter,  often  acts  beneficially. 
In  many  painful  disorders  purely  neuralgic  in 
character  it  gives  the  most  prompt  relief;  for 
example,  to  the  sharp  neuralgic  pains  of  locomotor 
ataxia.     Ungar,  (9)  T.  B.  S.  Robeitson,  (10)  and 


1  "The  Influence  of  Kairin,  Thallin,  Hydrochinon, 
Resorcin  and  Antipyrin  on  the  Blood  and  Blood  vessels." 
By  II.  G.  Beyer,  Am.  Jouin.  Men.  Sci,,  April,  1886. 

2  Quiveilo  and  Coppola.  See  article  by  Beyer,  Am. 
jour.  Med.   Sci. 

3  Auseroff,  Therapeutic  Gazette  May,  15,  1SS6. 

4"  De  I'antipyrin  contre  la  douleur."  Par  Germain  See, 
Le  Bulletin  Medical,  April  20,  18S7. 

5  Bettelheim,  Med.  Jahr.  K.  K.  Gcs.  d.  Aerzt.,  ii,  iii, 
18S6. 

7  "  Modern  Antipyretics."  By  P.  J.  Martin,  Therapeutic 
Gazette,  May    16,    1S87. 

8  See  Beyer,  Am.  Journ.  Med.  Sci. 

9  Ungar.  Centralbl.itt  f,  d.  Gesammte  Therapie, 
January,   1887. 

10  "Antipyrin  in  Migraine,  Pyrexia,  etc."  T.  S.  Rolert- 
son,  N,  Y.  Med.  Record,  May  7,  iSH-j. 


others,  say  it  is  efficacious  in  migraine.  Germain 
See  (11)  has  witnessed  its  power  of  relieving  pain  in 
other  forms  of  neuraljjic,  and  in  gout,  lumbago  and 
sciatica. 

I'lie  f.ict  that  there  was  in  these  diseases  no 
common  pathological  effect  except  that  ofjjain 
led  the  last  writer  to  study  particularly  its  action 
upon  the  nervous  system.  The  results  of  his 
experiments  he  reported  to  the  French  Academy 
of  Sciences  on  the  iSth  of  Ajjril  of  last  year. 
When  injected  subcutaneously  in  dogs  three  kinds 
of  phenomena  were  observed  :  In  the  first  place, 
a  notable  diminution  of  sensibility  was  observed, 
a  true  analgesia  of  the  limb  injected  ;  sometimes, 
also,  of  the  opposite  one.  In  the  second  place, 
electric  excitation  of  the  sciatic  nerve  ])roduced 
in  the  muscles  of  the  opposite  side  only  very 
feeble  contractions,  which  points  to  diminished 
sensibility  and  reflex  power  in  the  spinal  cord. 
In  the  third  place,  when  antipyrin  was  introduced 
into  the  circulation  of  an  animal  except  into  one 
limb,  the  vessels  of  which  were  ligated,  it  was 
found  that  throughout  the  body  the  muscles  con- 
tracted slowly  and  with  difficulty,  while  those  of 
the  ligated  hmb  contracted  with  their  wonted 
vigor.  It  is  evident,  therefore,  that  antipyrin  also 
affects  the  muscles;  or  more  properly,  perhaps, 
the  nerve-endings  in  the  muscles.  Analgesic 
effects  have  been  frequently  noted  by  others. 
Large  doses  administered  to  animals  cause  con- 
vulsions, both  clonic  and  tonic.  Lessening  of  the 
reflexes,  also,  has  been  observed  by  others,  as, 
for  instance,  by  Arduin.  (12)  This  last  author,  as 
wefl  as  Coppola,  ("13)  thinks  that  the  brain  is  influ- 
enced by  the  drug,  since,  when  convulsions  are 
jiroduced  by  it,  their  severity  is  much  diminished 
if  the  brain  is  separated  from  the  cord. 

Antipyrin  does  not  affect  the  resfiiiatory  move- 
ments, although  the  frequency  of  respiration  in 
fever  diminishes  as  the  tem|ierature  falls  under 
its  influence.  As  ordinarily  administered,  the 
rhythm  and  strength  of  the  heart's  action  are  not 
influenced.  Beyer  has  shown  by  physiological 
experiments  that  when  it  exists  in  small  amounts 
in  the  circulatory  fluids,  it  causes  an  increase  of 
work  performed  by  the  heart,  while  in  large  doses 
the  contrary  effect  is  produced.  Some  have  also 
noted  increased  force  in  the  heart's  action,  while 
others  have  observed  a  diminution  in  it.  This 
discrepancy  is  probably  due  to  the  size  of  the 
dose  administered. 

The  drug  is  eliminated  by  the  urine,  and  can  I  e 
found  in  it  two  hours  after  administration,  ard 
usually  for  thirty-six  to  forty  eight  hours  after- 
wards. (14) 

The  following  conclusic  ns  aie,  I  think,  justified 
by  our  present  kn^wledi^e   of    antipyrin    in    the 


11  .See  above,   Le  Pu'letin  Midical. 

12  .-Viduin, 'Iherap.  Gazette,  Uciober  15,  1SS5. 

13  Coppola,  Tlierapeulic  Ga/.ette,  Octol  e.'  15.    1585. 

14  Marigliano  Roberts.    Jahiesbciiclh  p  313  ;  Theiaj  fll- 
lic  Gaiette,  October  15,  1SS5, 


64 


THE  CANADA  MEDICAL   RECORD, 


treatment  of  rheumatism  :  i.  It  is  as  efficacious 
as  the  salicylate  of  soda,  producing  similar  thera- 
peutic results,  and  is  less  nauseous  than  the  latter, 
and  does  not  produce  headache  or  ringing  of  the 
ears.  2  T^sually  it.  acts  most  efficiently  in  the 
most  frankly  acute  cases.  3.  Besides  reducing, 
by  its  antipyretic  ]iroperties,  the  fever,  and  also 
the  pain,  it  reduces  the  pain  by  acting  directly 
upon  the  nervous  system. — Med.  Progress. 
65  Randolph  St.  Chicago. 


LOCAL  TREATMENT   OF    DIPHTHERIA. 

Remarks  suggested  by  the  Discussion  in  the  Sec- 
tion ON  Practice  of  the  Academy  of  Medicine, 
March  15TH, 

Bv  C.  E.  BiLLiNGTON,  M.D.,  New  York. 

The  conclusion  of  the  important  and  valuable 
discussion  which  followed  the  reading  of  mypaper 
on  "  Local  Treatment  in  Diphtheria,"  before  the 
Section  on  Practice  of  the  Academy,  on  March 
15th,  was  reached  at  so  late  an  hour  tliat  I  abstain- 
ed from  inflicting  further  remarks  on  an  audience 
which  had  been  both  patient  and  kind,  On  read- 
ing over  the  report  of  that  discussion,  however,  it 
seems  to  me  to  present  an  occasion  for  bringing 
out  distinctly  certain  difference  in  the  practical 
details  of  treatment  which  are  worthy  of  the  care- 
ful consideration  of  the  profession,  and  this  may 
now  be  done  with  more  brevity  and  clearness  than 
it  could  have  been  by  me  in  extemporaneous 
speech. 

First,  as  to  the  remarks  of  Dr.  Jacobi.  The  fact 
that  we  agree  so  fully  in  general  principles  makes 
our  differences  in  the  mode  of  there  application 
the  more  liable  to  be  overlooked  ;  although  we  have 
been  explicit  in  the  statement  of  our  methods. 

As  to  the  internal  administration  of  the  tincture 
of  iron,  we  agree  that  this  drug  is  "  among  the 
most  reliable  antiseptic  and  astringent  agents." 
Dr.  Jacobi  says  ;  "  A  cliild  a  year  old  must  take 
at  least  four  grammes  daily  ;  a  child  of  three  or 
four  years,  from  eight  to  fifteen  grammes.  The 
chloride  is  to  be  mixed  with  water  and  glycerine 
in  various  proportions,  so  that  a  dose  is  taken 
every  hour,  every  half-hour,  every  ten  minutes. 
Thus  other  local  applications  to  the  throat  become 
most  superfluous.''  (The  italics  are  inine.^ 
"  Potassium  or  sodium  chlorate,  from  one  to  four 
grammes  daily,  may  be  added  with  advantage." 

A  com])arison  of  these  remarks  and  the  formulje 
given  by  Dr.  Jacobi,  in  his  published  works,  with 
mine  on  this  point  will  show  that  there  are  differ- 
ences of  detail  to  which  my  experiences  has,  right- 
ly or  wrongly,  taught  me  to  attach  no  little  impor- 
t  uice.  But  the  most  notable  difference  is  in  tlie 
sentence  which  I  have  italicized.  I  have  from  the 
first  of  my  publications  insisted  on  the  importance 
of  also  frequently  sjiraying  the  throat  with  the 
mixture  of  carbolic  acid  and  lime  water  in  all  cases 
of  any  gravity  in  which  it  can  possibly  be  done^ 
jUnd  have  considered  this  so  valuable  as  to  iiiate- 


rially  modify  the  prognosis, it  being,  unfortunately, 
impracticable  in  very  young  children,  in  whose 
cases  I  have  recommended  the  occasional  syring- 
ing of  the  throat,  when  indicated,  for  cleansing 
purposes. 

Dr.  Jacobi  says  ;  "  The  usefulness  of  lime  water 
has  been  greatly  over-estimated."  Believing,  as  I  do, 
that  lime-water  is  one  of  the  most  valuable  medi- 
cinal agents  in  our  possession  for  combating  diph- 
theria, I  cannot,  of  course,  regard  this  difference 
as  otherwise  than  important. 

Again,  while  there  is  complete  concurrence 
between  us  as  to  the  importance  of  nasal  syringing, 
there  is  an  equally  marked  difference  between 
our  methods  in  this  procedure.  Dr.  Jacobi  says, 
"  The  tendency  to  sepsis  forbids  a  long  intermis- 
sion of  them."  "  I  again  insist  on  their  frequent 
repetition."  (In  his  book,  page  218,  Dr.  Jacobi  says, 
"  They  must  be  made  at  least  every  hour.") 
"  The  whole  procedure  need  not  take  more  than 
half  a  minute  for  the  two  nostrils  ;  the  children 
may  be  raised  in  bed,  a  towel  under  their  chins. 
One  person  holds  the  hands,  the  other  sits  behind 
and  injects  gently,  in  order  not  to  injure  the 
ears." 

The  salient  points  of  the  procedure  as  recom- 
mended by  me  may  be  recapitulated  as  follows  : 
The  jjatient,  if  too  young  to  submit  voluntarily  to 
the  operation,  should  be  firmly  held  by  a  method 
described.  The  syringing  should,  if  possible, 
always  be  perforined  by  the  physician  him- 
self. It  should  be  continued  on  each  occasion 
until,  if  it  be  possible,  the  pa-jsages  are  thorough- 
ly cleansed.  This  should  not  usually  be  repeated 
oftener  than  two  or  three  times  in  the  twenty-four 
hours,  for  reasons  stated.  The  first  syringeful  or 
two  will  often  not  go  through  at  all.  Then  will 
come  masses  and  strings  of  thick  muco-pus,  then, 
not  infrequently,  larger  or.  smaller  pieces  of  mem- 
brane. The  syringing  should  be  persevered  with 
until  the  injected  fluid  comes  through  (by  the 
throat  and  other  nostril)  clear  and  clean.  The 
patient  should  have  time  to  get  his  breath  between 
the  successive  syringefuds.  I  commonly  use  half 
a  pint,  sometimes  more,  of  the  tepid  salt-water, 
and  the  tirne  required  for  a  thorough  cleansing  is 
always  several  minutes. 

By  this  method  the  physician,  who  should  cer- 
tainly in  every  grave  case  of  diphtheria  visit  his 
patient,  if  possible,  two  or  three  times  a  day,  and 
who  is  or  should  be  an  expert  in  such  procedures, 
and  better  able  than  anyone  else  to  judge  just  how 
much  or  how  little  is  requisite,  performs  it  once 
for  all — the  patient  during  the  intervals  having  a 
complete  respite  from  the  one  measure  in  the 
whole  treatment  which  is  really  unpleasant  and 
fatiguing,  and  the  nurse  having  quite  enough  left 
to  her  in  the  half  liourly  giving  of  medicine  and 
spraying,  and  the  frequent  giving  of  nourishment. 
By  the  other  method  a  less  thorough  and  com- 
plete cleansing  (in  "half  a  minute")  is  to  be 
accomplished  "  eveiy  hour  at  least,"  and  that,  too, 
often  by  nurses  who  lack  dexterity  and  judgment^ 


The  CANADA   MKDICAL   RECORD. 


6§ 


and  ill  many  cases  being  possible  only  by  force 
and  wiih  a  renewed  struggle.  \Vhat  more  striking 
illustration  of  ilie  danger  of  intrusting  such  deli- 
cate operations  to  average  parents  and  nurses 
could  possibly  be  imagined  than  the  instances  so 
graphically  related  by  Dr.  Jacobi  of  the  pcrior- 
mances  of  some  "  trained  nurses?" 

It  must  l)e  admitted  that,  theoretically,  the 
frequency  reipiired  in  the  method  described  by 
Dr.  Jacobi  is  apparently  in  more  logical  agreement 
with  the  principles  of  local  treatment,  which 
rcipiire  frequent  medication  and  spraying  of  the 
throat,  but  it  should  be  remembered  that  this  me- 
dication and  spraying  do  not  or  should  not,  cause 
local  irritation  or  undue  fatigue,  either  of  which 
would  be  a  contra-indication  to  them.  Moreover 
it  may  be  added  that  two  or  three  times  a  day  is 
the  limit  of  frequency,  beyond  ivhich  the  washing 
"Ut  of  an  emijyemic  cavity  or  a  septic  uterus  is 
iiDt  usually  found  useful,  and  while  the  analogy 
between  the  two  is  not  perfect  it  may  yet  be  sufti- 
I  ient  to  be  suggestive.  But  the  real  question  is, 
which  of  the  two  methods  is  the  more  efficient  in 
accomplishing  the  object  for  which  it  is  employed  ? 
— and  this  can,  of  course,  be  answered  only  by 
experience.  My  own  experience  I  have  stated, 
but  my  present  object  is  far  from  dogmatic  asser- 
tion, and  still  further  from  controversy,  but  is  to 
place  both  methods  clearly  and  fairly  before  the 
l>rofession,  so  that  each  may  be  tested  on  its  mer- 
its, and  neither  suffer  discredit  from  any  faults  or 
failures  of  the  other.  Dr.  Jacobi,  who  agrees  with 
me  as  to  the  importance  of  details  in  the  treat- 
ment of  diphtheria,  will,  I  am  certain,  concur  with 
me  in  this  wish. 

The  device  mentioned  by  Dr.  Jacobi,  of  pro- 
tecting the  tip  of  the  syringe  with  a  rubber 
mounting,  is  an  excellent  one,  and  so  is  that  of 
drawing  a  short  bit  of  small  soft  rubber  tubing 
over  the  tip  of  a  syringe,  which  was  first  mention- 
ed by  Dr.  J.  H.  Douglas  in  the  discussion  of  my 
paper  in  1880,  and  again  referred  toby  Dr.  Delavan 
in  this  discussion ;  but  any  tip  whatever  may 
cause  irritation  and  epistaxis  in  awkward  hands, 
and  even  in  expert  ones,  if  the  sudden  movements 
of  a  young  patient's  head  are  not  properly  res- 
trained. 

The  importance  of  the  method  which  I  have 
described,  of  holding  a  young  child's  head 
for  nasal  syringing,  may  be  better  enforced  by  a 
single  illustrative  case  than  by  a  great  deal  of 
argument.  I  was  recently  called  in  daily  consul- 
tation in  a  case  of  nasal  diphtheria,  by  a  physician 
whose  combat  and  muscular  frame  leaves  no  room 
to  doubt  that  he  is  one  of  the  strongest  men  in 
the  profession  in  this  city.  The  patient  was  a 
babe  four  months  old.  On  the  second  day  it  was 
decided  to  syringe  the  nose,  the  syringing 
to  be  done  by  me.  The  babe  was  accordingly 
seated  across  its  nurse's  lap,  its  hands  secured  by 
her,  and  the  basin  in  place.  To  show  the  doctor 
my  way  of  holding  a  child's  head,  I  stood  behind 
itj  and,  leaning  forward,  placed  my  breast  against 


it,  holding  it  with  a  hand  on  both  side,  saying. 
You  "see  in  that  way  the  head  is  held  as  firmly  as 
in  a  vise."  The  doctor  then  took  his  place  behind 
the  patient,  and,  standing  erect,  held  the  head 
between  his  hands,  and  with  the  smile  of  conscious 
strength  said,  "  That  head  is  in  a  vise."  I  accord- 
ingly jilaced  the  syringe  in  position  for  injection, 
not  actually  touching  the  mucous  membrane ;  but 
at  the  first  entrance  of  the  fluid  into  the  nostril, 
the  babe  made  a  sudden  downward  movement  of 
its  head,  in  spite  of  the  doctor's  hand,  sufficient 
to  cause,  from  contract  with  the  smooth  tip  of  the 
syringe,  a  very  slight  hemorrhage.  After  that  this 
exceptionally  strong  doctor,  in  holding  that  four- 
months-old  baby,  did  not  scorn  to  bend  forward 
and  place  himself  in  the  position  which  experi- 
ence long  ago  taught  me  is  necessary  for  really 
holding  a  child's  head  motionless. 

Dr.  Winters  very  truly  stated  that  tact  is  of  great 
importance  in  such  procedures  as  nasal  syringing  ; 
but  the  kind  of  tact  which  is  most  valuable  is  that 
which  thoroughly  accomplishes  necessary  objects 
with  the  least  wear  and  tear  to  the  patient. 

The  treatment  of  nasal  diphtheria,  by  means  of 
any  medicament  applied  by  a  medicine-dropper, 
as  recommended  by  Dr.  J.  Lewis  Smith,  I  cannot 
but  regard  as  an  error  in  the  direction  of  danger- 
ous inefficiency.  The  object  of  local  treatment  in 
diphtheria  was  well  summed  up  by  Dr.  Loomis  in 
the  words,  "  cleanliness  and  disinfection,"  and  these 
in  this  relation,  as  elsewhere,  are  usually  attain- 
able only  by  thorough,  well-directed  measures. 

That  spraying  is  a  valuable  method  of  cleansing 
and  medicating  the  nasal  passages  in  the  treat- 
ment of  catarrh  is  well  known,  and  that  it  may 
sometimes  be  so  in  that  of  diphtheria  in  such  ex- 
pert hands  as  those  of  Drs.  Bosworth  and  Delavan 
cannot  be  doubted  ;  but  the  question  remains,  can 
any  method  of  cleansing  them  be  in  general  at  once 
as  thorough  and  as  unirritating  and  as  well  adap- 
ted to  cause  dilution  and  removal  of  poison 
and  transudative  interchange  through  diphtheri- 
tic membrane  in  situ  as  the  flowing  through  them 
of  a  stream  of  antiseptic  fluid  from  a  syringe  or 
douche?  That  these  objects  cannot  commonly  be 
effected  with  the  ordinary  throat-atomizer  [  am  posi- 
tive, as  I  have  seen  too  many  melancholy  instances 
of  fatal  toxaemia  from  nasal  diphtheria,  the  result 
of  valuable  time  having  been  lost  in  relying  on 
this  inefticient  substitute  for  syringing.  It  may 
be  added  that  by  no  atomizer  whatever  can  spray 
be  made  to  enter  one  nostril  and  come  out  of  the 
other  as  spray. 

Finally,  on  the  very  interesting  case  related  by 
Dr.  William  H.  Thomson,  which  is  typical  of  an 
important  class,  I  will  make  the  foUowmg  remarks: 
Can  Dr.  Thomson  assert  that  at  the  time  of  the 
first  chill  there  was  not  the  commencement  of  a 
local  diphtheritic  process  in  the  posterior  nares — 
or,  possibly,  in  the  trachea?  It  will,  of  course, 
be  replied  that  there  was  no  evidence  of  that 
condition.  It  is  astonishing  how  little  evidence 
is    sometimes  manifested  of  the  presence  of  con- 


66 


THE   CANADA   MEDICAL   RECORD. 


siderable  amounts  of  diphtheritic  membrane  in 
concealed  situations.  I  have  seen  quite  a  number 
of  cases  in  which  there  was  no  evidence  of  it  any- 
where, except  constitutional  symptoms,  in  wiiich 
I  have,  by  syringing,  washed  pieces  of  membrane 
from  the  posterior  nares  several  times  in  the  pres- 
ence of  other  physicians.  In  another  case  of  an 
adult  patient  who  had  previously  been  frequently 
subject  to  grave  catarrhal  and  bronchial  attacks, 
another  attack  of  a  week's  duration,  similar  in  all 
its  physical  signs  to  the  jjrevious  ones,  under  most 
competent  and  vigilant  medical  attendance,  ter- 
minated fatally — no  nasal  obstruction,  no  croupy 
symptoms  of  respiration  of  voice,  no  visible  mem- 
brane anywhere.  There  had  been  exposure  to 
diphtheritic  contagion  two  weeks  before  the  attack. 
'I'here  were  symptoms  of  toxaemia.  The  autopsy 
showed  the  trachea  and  bronchial  tubes  complete- 
ly lined  with  diphtheritic  membrane  ;  none  in  the 
larynx  ;  the  posterior  nares  not  examined. 

I  have  no  disposition  to  be  "  wise  above  what 
is  written,"  and  am  far  from  asserting  that  there 
is  never  a  case  of  "  primarily  constitutional"  diph- 
theria; but,  according  to  my  experience,  the  more 
thoroughly  such  apparent  cases  of  diphtheria  with- 
out a  diplithera  are  investigated,  the  fewer  do  they 
become. — New  York  Medical  Record. 


INFANTILE    MARASMUS. 

By  Dr.   I.  N.  Love,  St.  Louis,  Mo. 

Read  in  this  Section  on  Diseases  of  Children  of  the  Ninth 

International    Medical  Congress. 

In  presenting  a  paper  for  your  consideration; 
with  many  misgivings,  I  select  the  subject  of 
Infantile  Marasmus.  I  am  aware  that  many  other 
subjects  are  more  alluring,  and  such  as  this  are, 
as  a  rule,  unattractive,  yet  we  must  remember  that 
nothing  in  the  form  of  disease  is  trivial,  for  a 
human  life  is  always  involved,  and  all  that  influ- 
ences and  affects  life  for  good  or  ill  is  of  the  great- 
est import. 

A  series  of  interesting  cases  met  with  in  private 
practice  during  the  past  few  years,  compared  with 
other  cases  occurring  in  hospital  and  dispensary 
practice,  have  impressed  upon  my  mind  the 
importance  of  this  condition,  and  the  means  of 
antagonizing  it. 

The  term  marasmus,  like  malaria,  is  a  misno- 
mer, and  expresses  but  little  as  regards  the  patho- 
logy of  the  disease  ;  it  declares  simply  that  our 
patient  is  wasting  away,  repair  on  the  part  of  the 
tissues  having  surrendered  partially  or  completely 
to  decay. 

A  condition  of  "Marasmus,"  wasting  or  con- 
sumption occurs  in  all  foims  of  exhausting  disease, 
but  the  name  is  only  applied  in  cases  of  wasting 
unaccom[)anied  with  fever  or  symptoms  pointing 
to  any  well  defined  disease. 

It  is  more  frequently  met  with  among  the  young 
and  the  aged,  but  whether  infantile  or  senile,  it  is 
usually  dependent  upon  similar  causes  and  con- 
ditions.    Among  infants  we  meet  cases  which  can 


clearly  be  referred  to  congenital  syphilis,  which 
at  once  takes  them  oft'  the  list  of  marasmus  cases, 
and  places  them  under  the  specific  classification. 
Others  again  have  been  so  classified  when  they 
would  probably  have  been  more  correctly  diagnosti- 
cated as  tuberculosis,  tabes  mesenterica,  etc.  Care 
in  eliciting  the  family  history  and  examining  the 
cases  will  generally  avo'd  these  errors  of  diagnosis. 

Many  cafe;  of  so  called  marasmus,  if  closely 
investigated,  will  present  a  history  and  general 
indications  of  intestinal  catarrh. 

Niemeyer,  in  writing  upon  the  subject  of  chronic 
intestinal  catarrh  of  children,  refers  to  the  fact 
that  the  imperfect  diagnosis  of  "marasmus"  is  fre- 
quently assigned  to  such  cases,  and  he  is  undoubt- 
edly correct. 

Eliminating  all  cases  clearly  belonging  to  other 
classifications,  there  remain  those  cases  of  wasting 
or  general  atrophy,  in  which  no  fever  or  local 
lesion  can  be  discovered.  Pronounced  pictures 
they  are  too,  after  a  prolonged  period  of  progres- 
sion ;  muscles  shrunken  and  flabby,  osseous  pro- 
minences everywhere  visible,  with  the  pale,  shri- 
veled, dry  skin  hanging  in  broad  folds  and 
wrinkles  about  them,  like  a  pair  of  loose  and 
baggy  trousers  upon  calfless  legs ;  face  withered, 
wrinkled  and  worn,  suggesting  the  miniature 
daguerreotype  of  some  emaciated,  toothless  hag, 
the  most  pronounced  features  in  the  case  being 
loss  of  flesh,  loss  of  strength,  loss  of  color,  the 
complexion  being  of  a  dull  leaden  color. 

Having  excluded  all  cases  of  wasting  depen- 
dent upon  tangible  conditions,  such  as  tuberculosis, 
congenital  syphilis,  intestinal  or  gastric  catarrh, 
etc.,  I  shall  devote  my  attention  to  the  considera- 
tion of  the  cases  which  can  properly  be  called 
marasmus. 

They  present  all  the  symptoms  above  referred 
to,  and  in  marked  degree  we  have  inactivity  of 
the  secretory  glands. 

In  life  there  is  dryness  of  everything,  skin, 
alimentary  canal  and  the  emunctory  organs  in 
general ;  and  after  death,  upon  examination,  we 
find  further  evidences  of  lack  of  fluidity  or  proper 
moisture  of  the  tissues,  confirming  the  thought 
that  there  has  been  a  lack  of  secretion  and  excre- 
tion, exosmosis  and  endosmosis. 

Primarily,  then,  I  take  the  position  that  inac- 
tivity of  the  glandular  system  is  at  fault.  In  the 
very  outstart  of  every  infantile  career  we  have 
more  or  less  inactivity  of  the  glands,  the  liver, 
with  other  glands,  is  larger  (being  more  engorged) 
at  birth  relatively  than  at  any  later  period  of  life. 
Attention  to  the  proper  establishment  of  the 
equilibrium  of  the  circulatory,  secretory  and  ex- 
cretory system  of  the  infant  is  of  vital  importance. 

Given  this  torpid,  glandular  condition,  coupled 
with  improper  or  insufficient  food,  and  other 
hygienic  errors,  we  have  the  factors  fiivorable  to 
the  furnishing  of  a  full-fledged  case  of  typical  mar- 
asmus. The  five  digestive  juices  upon  which 
depends  the  proper  preparation  of  pabulum,  for 
prompt  appropriation  on   the  part  of  the  absor- 


THE  CANADA   MKDICAL  ftECoftD. 


07 


l)ciUs,  arc  tlic  products  of  jiaits  of  the  secretory 
glands ;  and  tlic  proper  elimination  of  effete  mat- 
ter, the  ashes  of  combustion  if  you  please,  depends 
ui)on  the  zealous  work  of  the  excretory  glands. 

'I"o  illustrate  my  jiosition  I  herewith  report,  in  a 
roucentraled  form,  the  notes  of  one  of  a  series  of 
1  ases  under  my  care  during  the  past  year. 

A.  D.,  l)orn  August  ist,  1886,  ofhealthy,  wealthy 
parents  who  have  been  under  my  observation 
constantly  for  over  ten  years  (three  other  strong, 
hearty,  robust  children  having  been  previously 
born),  no  hereditary  taint  wliatsoever.  At  iiirth 
well  formed;  fairly  well  developed  (the  labor  was, 
in  common  parlance,  a  dry  one,  but  there  were  no 
com]ilicatioi)s,  and  nothing  to  indicate  but  what 
the  child  would  lie  asliealthy  as  his  predecessors). 

.'Vfter  a  few  days,  bowels  being  slow  in  moving, 
olive  oil  was  ordered,  and  nothing  more  was  heard 
from  the  child  until  it  was  two  montlis  old.  At 
this  time  aid  was  souglit,  for  the  reason  that  the 
child  was  constipated,  uncomfortable,  and  evident- 
ly not  thriving.  Inquiry  developed  the  fact  that 
from  birth  there  had  been  habitual  constipation, 
but  little  urination,  and  continual  restlessness  and 
discomfort.  The  mouth  and  tongue  were  dry, 
the  skin  inactive,  dirty  and  yellow-looking,  the 
child  sm.iller  than  at  birth,  with  shrunken  and 
flabby  limbs,  distended,  overfilled  and  protruding 
abdomen,  with  the  blue  and  close  crowded  veins 
standing  out  like  whip  cords  over  its  surface. 

There  were  evidently  lack  of  proper  secretion, 
excretion  and  assimilation ;  the  baby  was  starving 
though  apparently  furnished  with  sufficient  and 
proper  nourishment  by  the  mother.  I  at  once 
ordered  one  grain  of  calomel  and  twenty  grains 
of  sugar  of  milk  triturated  thoroughly  for  a  full 
half  hour,  and  divided  into  twenty  powders,  one 
powder  to  be  given  every  ten  hours  dry  on  the 
tongue,  and  followed  at  frequent  intervals  with 
liberal  quantities  of  water.  After  twenty- four 
hours  had  passed,  the  bowels  began  to  move  freely, 
the  aid  of  several  warm  water  injections  being 
given,  and  enormous  quantities  of  hard,  undigested, 
cheesy  masses  were  passed,  followed  for  several 
days  by  numerous  large,  loose,  offensive  dejec- 
tions. More  than  likely  on  account  of  this  great 
accumulation  an  acute  intestinal  catarrh  would 
have  soon  been  developed.  During  this  time 
when  the  inactivity  of  the  glandular  system  was 
becoming  aroused  and  the  outlook  better,  the  moth 
er  was  taken  very  seriously  ill  with  malarial  fever, 
and  it  was  soon  apparent  that  a  substitute  was 
demanded.  A  strong,  full  habited  wet  nurse 
(with  a  baby  of  the  same  age  as  ou.r  little  star- 
ving patient,  about  three  times  as  large,  and  almost 
hoggishly  fat)  was  secured,  and  to  her  credit,  she 
refused  to  serve  unless  permitted  to  bring  her 
child  with  her,  promising  to  artificially  feed  him, 
and  reserve  her  breasts  for  our  patient.  At  this 
juncture  the  family  removed  some  distance  from 
the  city  and  beyond  my  observation,  until  about 
•  six  months  had  elapsed,  when  I  was  summoned 
and  found  my   little  patient  in  a  condition  every 


way  aggravated.  Investigation  develoiied  the  fact 
that  the  motherly  instinct  of  the  wet  nurse  had 
prompted  her  to  jjermit  her  own  lusty  boy  to 
empty  her  breasts  before  giving  them  to  the  little 
starvling  under  her  care.  Not  to  go  too  much  into 
detail,  suffice  it  to  say  that  inability  to  secure  a 
proper  wet  nurse  soon  necessitated  artificial  feed- 
ing. Various  foods  in  the  market  were  tried  with- 
out avail,  a  fermentative  dyspepsia  and  gastro- 
intestinal catarrh  presented,  and  the  beginning  of 
the  end  seemed  near.  All  milk  and  malty  foods 
were  now  relinquished  by  the  stomach,  and  a  raw 
meat  liquid  food,  ten  drops  in  a  teaspoonful  of 
water  and  two  drojis  of  brandy,  were  given  every 
hour,  and  the  child  ordered  to  be  given  a  bath 
every  ten  hours  in  either  warm,  fully  digested  milk, 
warm  cod  liver  oil,  or  wami  water  with  a  teaspoon- 
ful of  alcohol  to  the  pint. 

The  intestinal  medication  was  the  infinitesimal 
dose  of  calomel  triturate  (previously  referred  to) 
every  two  hours,  given  for  the  purpose  of  stimula- 
ting secretion  and  excretion,  antagonizing  fermen- 
tation, antisepsis  in  the  rendering  inert  of  the 
ptomaines  and  other  poisonous  products  of  de- 
composition in  the  alimentary  canal.  The  course 
was  followed  uninterruptedly,  except  by  the  gradual 
increase  of  the  food,  with  gradual  improvement  for 
one  week.  Artificially  digested  milk  was  then  cau- 
tiously added  to  the  diet  list,  and  the  amount  of  the 
liquid  raw  meat  food  doubled.  From  this  time  on, 
the  progress  toward  perfect  nutrition,  growth  and 
development  was  more  and  more  rapid,  and  with- 
in one  month  he  was  becoming  a  well  nourished 
baby,  and  possessed  of  a  ravenous  appetite,  taking 
goodly  quantities  of  water,  and  his  secretory  organs 
doing  good  service. 

The  one-twentieth  grain  of  calomel  was  con- 
tinued three  times  daily,  for  two  months,  and  after 
that  resumed  whenever  indicated.  ']  he  nutritious 
baths  with  gentle  massage  and  friction  were 
diminished  in  frequency,  but  not  thoroughness, 
to  three  times  daily,  and  later  were  given  only 
morning  and  night. 

From  the  observation  and  study  of  a  series  of 
twelve  cases  (tlie  case  which  I  have  presented 
being  typical  of  the  twelve),  where  well  defined 
causes  of  innutrition,  such  as  syphilis,  tuberculosis, 
etc.,  did  not  enter,  I  feel  that  I  am  justified  in 
deducing  the  following : 

ist.  Infantile  marasmus,  so  called,  is  dependent 
primarily  upon  torpidity  and  inactivity  of  the 
glandular  system,  and  aggravated  by  unsuitable, 
over-abundant  or  insufficient  food  and  unsanitary 
surroundings. 

2nd.  That  which  is  of  first  importance  in  the 
treatment  is  the  arousement  of  secretion  and  excre- 
tion, and  the  most  valuable  remedy  we  have  for 
this  purpose  is  minute  doses  of  calomel  given  in 
conjunction  with  as  much  water  as  can  convenient- 
ly be  administered;  the  two  agents,  calomel  and 
water,  both  being  ardent  accelerators  of  glandular 
action,  stimulators  of  the  secretion  of  the  diges- 
'  live  juices,  true  aiders  and  decided  openers  of  the 


68 


tHE  CANADA   MEDICAL   RECORD. 


dammed  up  organs  of  diuresis,  and  awakeners  of 
defecation,  cleansers  of  tiie  vital  sewerage 
system. 

3rd.  In  the  matter  of  diet,  the  mother's  milk 
is  best,  and  some  other  mother's  milk  ne.xt 
best. 

Whether  mother's  milk  or  artificial  food  be 
given,  the  quantity  and  quality  should  be  most 
carefully  guarded. 

In  many  instances,  the  liquid,  raw  meat  foods  in 
small  quantities,  well  diluted  and  frequently 
given,  will  be  of  great  service.  All  artificial  loods 
should  be  predigested. 

4th.  In  extreme  cases  the  administration  of 
soluble  foods  in  the  form  of  baths,  and  by  gentle 
friction,  will  be  of  value,  and  in  all  cases  gentle 
massage  and  frequent  bathing  (sometimes  adding 
diffusable  stimulants  to  the  water)  are  of  great 
service,  much  of  the  water  being  directly  absorbed 
by  the  hungry  and  thirsty  tissues. — Sf-  Louis 
Med.  Review. 


THE  DYSPNE.A.    OF   ASTHMA  AND  ITS 
TREATMENT. 

The  causation  of  the  asthmatic  paro.xysm  is  sti. 
in  dispute,  and  at  least  three  theories  have  advo" 
cates  more  or  less  zealous.  The  demonstration  of 
the  bronchial  muscle  gave  a  firm  anatomical  basis 
to  the  view  that  the  attack  was  due  to  its  spasmo- 
dic contraction.  Wintrich  and  Bamberger  hold 
that  such  a  condition  is  inconceivable  with  the  en- 
larged and  hyper-resonant  state  of  the  lungs  during 
the  paroxysm,  and  they  support  a  theory  of  tonic 
spasm  of  the  diaphragm,  either  alone,  or  with  the 
other  muscles  of  respiration.  A  third  view,  that 
of  Traube  and  Weber,  attributes  the  attack  to 
swelling  and  hyperemia  of  the  bronchial  mucosa 
— through  vaso-motor  agency — similar  to  that 
which  occurs  in  the  nasal  mucous  membrane  in  the 
early  stage  of  catarrh.  At  present  a  majority  of 
the  observers  are  divided  in  opinion  between  the 
theory  of  spasm  and  that  of  hyperemia  with  tume- 
faction. 

In  the  American  Journal  of  the  Medical  Sciences 
for  October,  1887,  Fraser,  of  Edinburgh,  relates 
some  interesting  observations  which  support  the 
spasm  theory,  and  have  a  very  practical  bearing  on 
the  treatment  of  the  attack.  It  occurred  to  him 
to  study  the  auscultatory  phenomena  during  the 
asthmatic  paroxysm,  in  order  to  ascertain  if  they 
could  be  modified  by  the  action  of  any  agent 
known  to  control  the  contractility  of  unstriped 
muscle.  Now,  it  is  well  known  that  the  most  con- 
stant and  striking  physical  signs  accompany  asthma, 
viz.,  the  dry  whistling  rales  (without  any  moist 
sounds)  produced  in  the  tubes,  either  by  spasm  of 
the  muscle  or  swelling  of  the  mucosa.  If  it  could 
be  shown  that  the  administration  of  a  remedy 
known  to  relax  imstriped  muscle  was  followed  by  a 
disappearance  of  the  rales  and  relief  of  the  dyspnea, 
a  strong  point  would  be  made  in  favor  of  the  spasm 
theory.     This  Fraser  has  done,  using  the  nitrites 


whose  capabilities  of  relaxing  non-striped  muscle 
in  the  case  of  arteries  is  well  known.  Eight  ob- 
servations are  recorded  in  which  either  nitrite  of 
amyl,  nitrite  of  ethyl,  nitrite  of  sodium,  or  nitro- 
glycerine was  given,  and  the  chest  carefully  aus- 
cultated before  and  after  ^very  administration.  In 
each  instance,  improvement  more  or  less  posi- 
tive followed,  and  the  dyspnea  and  sounds  disap- 
peared simultaneously.  From  the  well  recognized 
action  of  these  bodies  in  reducing  the  contractility 
of  non  striped  muscle,  it  seems  reasonable  to  at- 
tribute the  relief  to  the  relaxation  of  the  spasm  of 
the  bronchial  muscles. 

The  nitrite  of  amyl  was  given  in  solution,  five 
minims  in  two  drams  of  water,  or  inhaled,  ten 
minims  on  blotting  paper  at  the  bottom  of  a  small 
glass  tumbler.  The  nitrite  of  ethyl  (nitrous  ether) 
acts  well  in  ten  minim  doses  of  a  twenty-five-per 
cent,  alcoholic  solution.  Of  the  nitrite  of  sodium 
ten  minims  of  a  ten-per-cent  solution,  and  of  the 
nitroglycerine  five  minims  of  a  one-per-cent  solu- 
tion were  employed.  The  administration  of  nitrite 
of  amyl  in  the  asthma  paro.\ysm  has  long  been  prac- 
ticed, but  the  accurate  determination  of  the  coinci- 
dence of  the  relief  of  the  symptoms  with  the  disap- 
pearance of  the  physical  signs  has  not  before  been 
so  closely  followed.  We  believe  a  combination  of  the 
nitrite  of  amyl,  given  during  the  paroxysm,  and  the 
nitrite  of  sodium  given  continuously,  will  act  more 
surely  than  either  remedy  alone,  as  the  latter  gives 
that  permanence  which  we  miss  in  the  action  of 
the  nitrite  of  amyl. — Phil.  Medical  News. 


THE  TERRORS  OF  CHILDHOOD. 

How  often  do  we  hear  mothers,  soothing  very 
young  children  to  whom  it  has  been  found  neces- 
sary to  give  a  dose  of  medicine,  console  them  with 
such  talk  as  this  :  "  Did  the  nasty  old  doctor  give 
muzzer's precious  d-a-a-r-1-ing  nasty  old  medicine? 
Muzzev'll  whip  nasty  old  doctor  !"  or  "  Ugly  old 
doctor  cut  baby's  arm — muzzer'll  beat  him  for  it  !" 
Or,  when  a  young  one  is  refractory  we  hear  them 
say  "You'd  better  behave  yourself!  I'll  send  for 
the  doctor  and  make  him  vaccinate  you  again  !" 
These  and  a  thousand  other  foolish  things 
are  said  until  to  the  young  mind  the  doc- 
tor becomes  the  very  embodiment  of  terror — 
a  buggaboo  from  whom  the  child  shrinks  in  fright 
and  aversion.  And  yet  how  often  the  infant's  life 
depends  upon  its  love  of  and  confidence  in  the 
physician  I  The  wise  mother,  realizing  this  fact, 
should  teach  her  children  to  love  and  trust  the 
family  physician.  These  thoughts  were  suggested 
to  us  recently  in  reading  a  most  entertaining  work 
by  Professor  Mosso,  of  Turin,  entitled  La  Paura 
(Fright  or  Fear).  Among  other  anecdotes  he 
says  :  ''An  old  soldier,  whom  I  once  asked  what 
had  been  his  greatest  fright — what  had  caused  him 
the  most  suffering  from  terror,  answered  "  One 
thing  alone, — a  terror  that  has  pursued  me  through 
life  and  which  yet  affects  me.  I  have  looked 
death    in    the   face   I    know     not    how     many 


THE   CANADA   MEDICAL   RECORD. 


69 


times,  and  surrounded  by  the  greatest  car- 
nage and  danger,  I  have  never  lost  my  courage. 
But  when  I  pass  a  Htile  church  in  the  depths  of 
the  forest,  or  near  a  deserted  chapel  on  the  moun- 
tain, I  instantly  think  of  an  abandoned  oratory 
that  was  in  the  outskirts  of  my  native  village,  and 
.  I  become  frightened.  I  look  around  me  and  see 
in  imagination  the  corpse  of  an  assassinated  way- 
farer, just  as  I  saw  it  when  a  little  child,  and  with 
whose  wandering  spirit  an  old  servant  would 
threaten  me."  These  terrors,  these  buggaboos 
of  childhood,  continues  our  author,  remain  through 
life,  a  fatal  fegacy,  a  chain  enthralling  reason. 
We  remember  them  almost  every  day  of  our  lives. 
A  subterranean  vault,  the  sombre  arch  of  some 
bridge,  the  ruins  of  some  abandoned  dwelling  with 
its  mysterious  darkness  and  silence — ail  bring  back 
the  atmosphere  of  infantine  timidity.  It  is  exact- 
ly as  though  the  eye  of  the  child  again  rested  upon 
the  very  scenes.  It  is  not  the  individual  mother, 
nurse  or  servants  who  produce  this  effect — but  the 
result  of  generations  of  wrong  training,  that  have 
warped  the  human  mind  into  fantastic  shapes 
e.Kactly  as  barbaric  races  have  gradually  changed 
the  shape  of  the  generic  skull  by  ages  of  artificial 
compression.  The  children  of  Greece  and  Rome 
were  frightened  by  tales  of  vampyres  which  suck- 
ed the  blood  of  sleepers,  of  cyclops  and  chimoeras. 
This  detestable  mode  of  education  has  not  van- 
ished and  our  babies  of  to-day  are  still  terrified  by 
ogres  and  dwarfs,  giants  and  griffins,  dragons  and 
demons,  magicians  and  sorcerers.  Every  day  we 
hear  a  mother  or  nurse  say  to  a  naughty  child 
"  Look  out !  Old  bouger-man  will  catch  you  !  Old 
bear  will  eat  you  up  !"or'Sorae  such  blood-curdling 
threat,  the  effects  of  which  will  never  die,  and 
which  in  many  instances  render  the  child  the 
father  of  the  timid,  nervous  man. 


THE  TREATMENT  OF  RHEU.MATIS.M. 

Dr.  George  L.  Peabody  treats  his  cases  of  acute 
rheumatism  with  a  combination  of  salicylic  acid 
and  iron,  the  formula  for  which  was  obtained  in 
the  following  way : 

About  a  year  ago  a  nurse  was  pouring  into  a 
common  receptacle  some  remnants  of  different 
medicines,  when  she  noticed  that  a  black  preci- 
pitate formed  by  iron  was  turned  into  a  transparent 
solution  of  a  rich  red  hue  as  soon  as  she  poured 
the  fluid  contents  of  another  bottle.  Being  a  young 
woman  of  an  inquiring  turn  of  mind,  she  asked 
the  house  physician  the  cause  of  this  phenomenon. 
The  house  staff,  to  help  her  in  her  desire  for  in- 
formation, experimented  with  the  drugs  that  she 
had  been  throwing  out,  and  ascertained  that  her 
manipulation  of  chemicals  had  been  this  :  She 
had  first  poured  into  the  receptacle  a  salicylic  acid. 
Into  this  she  had  poured  a  solution  of  iron,  with 
the  result  of  producing  a  black  precipitate.  To 
this  she  added  some  sodium  phosphate,  with  the 
j'^sult  of  producing  a  clear  red  solvitioii. 


This  at  once  gave  a  clue  to  the  means  of  com- 
bining iron  and  salicylic  acid  without  forming  a 
precipitate.  The  facts  were  submitted  to  the 
apothecary  of  the  hospital,  and  from  them  he  pro- 
duced the  following  formula,  which  has  been  in 
constant  use  nearly  a  year  :  8.  Acidi  salicylici,  gr. 
XX  ;  ferri  pyrophosphatis,  gr.  v  ;  sodii  phosphatis, 
gr.  I  ;  aquas,   ?   ss. 

This  method  of  giving  this  drug  in  rheumatism 
has  now  been  fairly  tested.  It  may  be  said  to 
agree  as  well  with  the  stomach  as  any  other,  and  it 
has  the  great  advantage  of  not  being  followed,even 
if  its  use  be  long  continued,  by  the  severe  anaemia 
that  so  often  follows  the  use  of  salicylic  acid,  if  it 
be  given  without  iron. 

The  dose  which  is  described  in  this  formula  is 
given  every  two  hours  until  improvement  justifies 
a  diminution  in  the  frequency,  or  until  constitu- 
tional effects  are  pronounced. — Medical  News. 


SMALL  DOSES. 
Bv  JoH.v  AuLDE,  M.D.,  Philadelphi.^,  Pa. 

That  there  is  a  tendency  on  the  part  of  physicians 
to  discontinue  polypharmacy,  and  depend  more 
and  more  on  single  remedies  (specific  medication), 
and  prescribe  smaller  doses,  no  one  will  contra- 
dict. The  innovation  is  commendable,  and  is 
one  of  the  most  promising  features  of  the  times. 
As  a  compliment,  then,  to  the  paper  on  •'  Large 
Doses,"  which  appeared  in  the  Reporter,  Nov.  5, 
1S87,  *  I  beg  leave  to  submit  the  following 
remarks  : 

In  certain  heart  affections,  such  as  cardiac  dila- 
tation, one  or  two  drops  of  the  tincture  of  digitalis 
may  be  given  three  times  daily  with  great  benefit. 
Cardiac  hypertrophy,  on  the  other  hand,  may  be 
materially  overcome  by  the  exhibition  of  one-drop 
doses  of  aconite  tincture  three  times  daily. 
Acute  inflammatory  conditions,  like  tonsilitis, 
bronchial  catarrh,  and  threatened  pulmonary  con- 
gestion, as  well  as  headache  due  to  arterial  ten- 
sion, are  immediately  and  favorably  affected  by 
drop  or  half-drop  doses  of  tincture  of  aconite 
every  hour,  or  half-hour,  for  a  few  houis.  Fre- 
quently, headache  of  the  congestive  variety,  with 
a  band-like  feeling  around  the  forehead,  may  be 
quickly  relieved  by  drop  doses  of  nitro-slycerine, 
at  intervals  of  five  or  ten  minutes,  until  five  or  six 
drops  are  taken.  The  form  known  as  "  sick 
headache,"  dependent  on  a  bad  condition  of  the 
stomach,  will  often  disappear  in  half  an  hour, 
under  the  influence  of  two  grains  of  potassium 
iodide  dissolved  in  water,  and  taken  in  divided 
doses  at  from  three  to  five  minutes.  Like  aconite 
and  nitroglycerine,  gelsemium  occupies  an  im- 
portant position  in  cases  of  this  class,  but  its  uses 
are  not  so  well  recognized  as  that  of  the  other 
drugs  named. 

Belladonna,  or  its  active  principle,  atropine,  in 
doses  of  one  two-hundredth  of  a  grain,  is  a  valu- 

»  Also  reorta  Medical  ifonthhi^  Xovember,  1SS7, 


70 


THE   CAKADA   MEDICAL   RECORD. 


able  remedy  in  the  incontinence  of  urine  in  chil- 
dren, a  single  tablet  of  that  aniount  dissolved  in 
water  and  taken  at  bedtime  being  often  all  that  is 
required.  Quinine,  in  doses  of  one-tenth  of  a 
grain,  may  be  given  to  those  who  are  unable,  on 
account  of  idiosyncrasy,  to  take  larger  doses,  and 
it  will  often  be  found  that  these  small  doses  are 
sufficient.  The  tincture  of  hyosyamus,  in  doses 
of  from  three  to  five  drops,  or  one  drop  of  the 
fluid  extract,  in  combination  with  triticum  repens, 
made  up  in  the  form  of  a  hot  tea,  is  an  admirable 
remedy  in  cases  of  initability  of  the  bladder,  with 
fugitive  neuralgic  pains  about  the  abdomen  and 
in  the  lumbar  region. 

In  the  treatment  of  certain  classes  of  dysentery, 
a  modification  of  Hope's  camphor  mixture  will  be 
found  of  signal  service.  The  dose  may  be  limited 
to  two  or  three  drops  of  the  deodorized  tincture  of 
opium,  with  an  equal  amount  of  dilute  nitric  acid, 
or  arom.itic  sulphuric  acid,  with  sufficient  camphor 
water  to  make  a  teaspoonful,  and  taken  hourly  or 
half  hourly,  as  the  circumstances  seem  to  demand, 
hi  similar  cases,  where  it  is  desired  to  produce  an 
effect  on  the  alimentary  canal  with  a  view  of  get- 
ting rid  of  objectionable  matter,  a  single  grain 
each  of  opium  and  ipecac  may  be  combined  with 
four  grains  of  blue  mass,  and  divided  into  eight 
parts,  one  part  to  be  taken  every  hour,  or  half 
hour,  with  the  happiest  effect. 

The  malate  of  iron  in  minute  doses  is  an  excel- 
lent remedy  as  a  tonic,  and  Blaud's  pill,  one  three 
times  daily,  is  often  sufficient  in  cases  of  anemia, 
although  it  is  usually  stated  that  the  dose  should 
be  from  four  to  six  pills.  Small  doses  of  nux 
vomica,  one  drop  of  the  tincture,  or  one-twentieth 
g  rain  of  the  extract,  are  frequently  as  serviceable 
as  a  tonic  as  the  larger  doses  ;  while  strychnine, 
in  doses  of  one-sixtieth  or  one  one-hundredth  of  a 
grain,  will  accomplish  all  that  is  desired,  when 
the  stomach  is  in  a  suitable  condition  and  is  much 
better,  as  it  is  much  safer,  than  larger  doses.  In 
some  cases  of  diarrhoea,  five  grains  of  bismuth, 
with  an  equal  quantity  of  saccharated  pepsin, 
every  two  hours,  acts  like  magic. 

Dysmenorrhcea,  the  congestive  kind,  with  belly- 
ache and  excruciating  headache  and  pain  in  the 
back,  which  is  often  seen  in  young  girls,  and 
women  with  displacements,  can  often  be  relieved 
by  a  single  dose  of  ten  drops  of  choloroform  on  a 
lump  of  sugar.  Certain  cases  of  this  nature  seem 
to  do  better  with  cannabis  indica,  and  I  have  seen 
cases,  which  had  resisted  ordinary  treatment  for 
days,  wholly  relieved  in  an  hour  by  the  use  of 
half-drop  doses,  at  intervals  of  five  minutes.  Can- 
nabis indica  is  a  favorite  remedy  in  trifacial  neu- 
ralgia, and  given  in  the  manner  indicated  above, 
the  pain  will  shortly  disappear.  Profuse  diapho- 
resis may  be  produced  by  the  frequent  adminis- 
tration of  half  minim  doses  of  extract  of  pilocar- 
pus. Phosphorus,  in  doses  of  one  one-hundredth- 
and-fiftieth  of  a  grain,  given  three  times  daily,  will 
produce  such  an  effect  that  it  may  be  tasted  by  a 
susceptible   patient  for   several  days  afterwards. 


Morphine,  in  tablets  containing  one-fiftieth  of  a 
grain,  can  be  given  in  many  instances  with  mark- 
ed benefit.  One  drop  of  a  one  per  cent,  solution 
of  the  fluid  extract  of  rhus  toxicodendron  is  often 
an  efficient  remedy  in  stu'bborn  attacks  of  sciatica 
and  other  affections  of  a  like  character.  One 
tenth  of  a  grain  of  calomel,  given  every  hour,  it  is 
well  known,  will  produce  an  effect  on  the  bowels 
equal  to  ten  grains  given  at  one  time-  Corrosive 
sublimate,  one-fiftieth  of  a  grain  three  times 
daily,  is  an  excellent  remedy  in  disease  of  the 
stomach  with  fermentation  and  eructation  of  gas. 
It  is  doubtful  if  we  have  any  better  remedy  for 
the  treatme  nt  of  boils  and  carbuncles  than  small 
doses  of  calcium  sulphide,  one-tenth  of  a  grain 
every  two  hours.  Last,  but  not  least,  is  strophan- 
thus,  the  heart  tonic  par  excellence ;  two  to  five 
drops  of  the  tincture  should  be  given  three  times 
daily,  in  all  cardiac  affections  where  there  is  aortic 
or  mitral  insuflkiency. — Med.  and  Sitrg.  Rep. 

THE  TREATMENT  OF  COLDS. 
Dr.  J.  H.  Whelan,  in  the  London  Practitioner 
for  March,  gives  the  following  sure  cure  for  colds. 
The  formula  used  is  as  follows  : 

8     Quininge  sulphatis grs  xviii 

Liquoris  arsenicalis m    xii 

Liquoris  atropinje m    i 

Estracti  gentianae grs  xx 

Pulveris  gummi  acaciae q.  s. 

Ft.  pilulas xxii.  sig. 

Pulveris  gummi  acacias,  q.  s.,  in  fiant  pilulae  xii 
Sig.  One  every  three,  four  or  six  hours,  according 
to  circumstances. 

If  these  pills  be  commenced  to  the  early  stage 
of  a  common  cold — /.  e.,  when  the  affection  is  as 
yet  confined  to  the  nose  and  pharynx — the  affec- 
tion will  be  nipped  in  the  bud.  At  starting  one 
pill  should  be  taken  every  three  or  four  hours,  and 
later  on  every  six.  If  a  catarrhal  subject  has  a 
box  of  these  pills  always  at  hand  he  has  a  weapon 
wherewith  to  meet  and  defeat  his  enemy.  The 
longest  time  the  author  has  seen  a  cold  last  whilst 
the  patient  has  fairly  taken  these  pills  was  three 
days.  How  the  remedy  acts  he  does  not  know, 
except  it  be  as  a  powerful  nervine  and  tonic,  bra- 
cing the  patient's  tissues  up  to  resist  the  attacks  of 
the  exciting  cause  of  the  affection. 


COMPOUND   WINE   OF  CREASOTE   FOR 
PULMONARY  DISORDERS. 
The  following  is  prescribed  for  incipient  pulmon- 
ary  tuberculosis   where    the  temperature  is    not 
much  above  normal : 

R  Creasoti,  13  G.  ; 
Tr.  gentianai,  30  G.  ; 
Spt.  vini,  250  G.  ; 
^■ini  Xerici,  q.  s.  ad  fiat  1000  G. 

M. 
Sig. — Two  or  three  tablespoonfuls  to  be  taken 
during   the  day. — Revue  Generate   de    Clinique 
et  de  Therapeutique. 


THE   CANADA    MEDICAL   RECORD. 


71 


THE  USE  OF  INDIGO   AS    AN  EMMENA- 
GOGUE. 

Dr.  S.  T.  VdUN'T,  of  La  Fayette,  Ind,  in  a 
paper  read  before  the  'J'iiipccanoe  Comity  iMcdi- 
cal  Society,  recommends  very  higiily  the  employ- 
ment of  indigo  as  an  emmenagogue.  He  writes  : 
"  It  is  perfectly  safe,  thoroughly  reliible,  and 
painless  in  its  action.  It  is  insoluble  in  water  or 
alcohol,  but  readily  dissolves  in  strong  suljjhuric 
acid.  This  so  changes  its  character  that  it  is 
then  readily  soluble  in  water  without  changing  its 
color. 

"  It  is  odorless  and  tasteless,  and  may  be  given 
in  doses  of  3  j.  to  3  ss.  The  great  difficulty  is 
the  nausea  and  vomiting  which  the  crude  drug 
produces  when  given  in  very  large  doses.  There 
are  three  varieties  of  the  crude  drug  :  Bengal, 
Turkey,  and  Chinese. 

"  The  Bengal  is  richest  in  coloring  matter,  con- 
taining about  fifty  per  cent.,  and  inasmuch  as  the 
virtue  resides  in  the  colorhig  matter,  the  best 
effects  are  obtained  from  this  variety.  As  an 
emmenagogue  it  has  been  used  in  my  practice 
about  a  year  and  a  half  My  attention  was  first 
directed  to  it  on  one  occasion  when  I  was  called 
to  remove  a  retained  placenta  in  a  case  of  abor- 
tion at  the  third  month.  Naturally  inquiring 
what  had  been  taken  to  produce  the  abor- 
tion, I  was  told  that  the  lady  had  taken  indigo  in 
teaspoonful  doses  three  times  a  day,  that  she 
had  taken  it  several  times,  and  always  with  a  most 
satisfactory  result  to  her. 

"  She  informed  meat  the  time  that  it  always 
produced  great  nausea  and  watery  discharges  from 
the  bowels.  Acting  on  the  suggestion  offered  by 
this  case,  I  tried  it  in  many  and  various  cases.  In 
one  case,  where  a  young  lady,  aged  eighteen,  had 
missed  for  thirteen  months,  the  menses  returned 
after  taking  the  crude  indigo  for  two  weeks ;  but 
the  disgust  and  nausea  produced  by  the  bulky 
powder  rendered  her  unable  to  continue  it  longer, 
and  she  menstruated  three  more  months  ;  then 
they  stopped  again.  After  using  the  remedy  for 
eight  or  nine  months  in  this  crude  state,  I  set  about 
to  find  some  way  of  condensing  it,  or  rendering 
it  less  bulky,  for  it  is  the  bulk  of  the  dose,  not 
the  remedy,  that  disturbs  the  stomach  and  disgusts 
the  patient.  About  a  month  later  Mr.  O.  G. 
Zerse,  an  apothecary  of  La  Fayette,  turned  over 
tome  a  concentrated  extract,  as  he  called  it,  five 
grains  of  the  extract  equalling  twenty -six  grains  of 
the  crude  drug.  I  have  since  then  used  it  in 
forty-eight  cases  of  amenorrhcea,  of  all  kinds  and 
causes,  with  but  three  failures,  and  a  colleague 
has  used  it  in  six  cases  without  any  failure.  To 
test  its  effect  I  have  given  the  remedy  in  the 
amenorrhcea  of  phthisis,  and  have  always  had  a 
definite  result,  namely,  the  appearance  of  the 
menses,  the  menses  stopping  again  when  the 
remedy  was  stopped.  The  effects  with  the  crude 
drug  and  the  concentrated  preparation  are  identi- 
cal, except  that  the  nausea   does  not  occur  when 


the  extract  is  used.  The  menses  come  on  pain- 
lessly and  very  suddenly.  There  is  no  warning 
given.  In  thirty  cases  the  e fleets  occurred  about 
two  days  after  the  last  dose,  the  menses  coming 
on  without  any  warning,  gushing  out  and  running 
often  to  flow.  The  hemorrhage  in  none  of  the 
cases  was  dangerous  or  alarming.  During  the 
administration  of  the  drug  the  os  uteri  becomes 
soft  and  patulous,  admitting  the  end  of  index  fin- 
ger. There  is  often  a  serous  discharge  from  the 
vagina.  The  urine  becomes  of  a  brownish-green 
color  and  offensive  odor.  The  stools  are  of  a 
bluish  color.  The  passages  are  watery  and  offen- 
sive. 

"  To  summarize,  indigo  is  an  emmenagogue  of 
decided  value  in  any  case.  It  should  not  be  given 
to  pregnant  women.  It  should  not  be  given 
where  there  is  an  irritable  stomach.  It  should  not 
be  given  in  cases  where  there  is  a  history  of  a 
previous  pelvic  inflammation.  It  should  not  be 
given  in  cases  where  there  is  marked  cerebral 
antemia.  It  may  be  given  ia  doses  of  ^  j.  to  3 
ss.,  two  or  three  times  a  day,  of  the  crude  drug, 
or  in  five-grain  doses  of  the  concentrated  extract. 
The  powder  of  the  crude  should  be  given  mixed 
with  a  little  subnitrate  of  bismuth,  and  the 
patient  should  drink  a  little  whiskey  afterward. 
In  cases  where  given  continuously  for  a  long 
jieriod,  give  tr.  gentian  comp.  after  each  dose. 
Give  I  he  concentrated  extract  in  capsules  mixed 
with  extract  of  gentian  and  subnitrate  of  bismuth." 
—N.  Y.  Med.    Record. 


PUNCTURE  AND  INJECTION  OF  ETHER 
AND  IODOFORM    IN  PURULENT  ABS- 
CESS  OF  THE  BUTTOCKS. 

At  a  recent  meeting  of  the  Paris  Surgical  Society, 
M.  Trelat  reportedacase  of  purulent  abscess,  suc- 
cessfully treated  by  puncture  and  injection  of 
ether  and  iodoform.  The  patient,  a  girl  aged  17, 
had  been  attacked  with  typhoid  fever  eighteen 
months  previously,  and  the  abscess  was  diagnosed 
as  necrobiotic,  consecutive  to  vitreous  alternation 
of  the  muscular  fibres.  A  puncture  was  made, 
which  gave  issue  to  45  grammes  of  pus,  and  l>o 
grammes  of  ether  and  iodoform  were  injected  into 
the  cavity.  M.  Trelat  asked  whether  simple 
abscesses  might  not  be  treated  in  the  same  wa\-. 
M.  Terrier  thought  that  in  cases  like  that  cited  by 
M.  Trelat  simple  puncture  was  sufficient.  M. 
Championniere  has  found  iodoform  very  irregular 
in  its  effects,  and  objected  that  the  injection  of 
this  substance  in  ether  constituted  a  long  and 
painful  treatment.  M.  Dentu  had  obtained  better 
results  with  alcohol  and  chloride  of  zinc.  ]\f. 
Trelat,  in  his  reply  to  these  objections,  stated 
that  it  was  important,  in  an  aesthetic  [loint  of  \iew, 
to  avoid  the  cicatrix  which  always  remained  after 
an  incision,  and  this  was  practically  accomplished 
by  puncture  and  the  injection  of  iodoform. — 
London  Medical  Record,  May  16,  18S7. 


72 


THE   CANADA   MEDICAL   RECORD. 


ON  NASAL  VERTIGO. 
Dr.  Joal,  of  Mont  Dore,  read  a  paper  on  this 
subject  before  the  French  Congress  of  Laryngo- 
logy, in  April,  1887,  in  which  he  stated  the  follow- 
ing conclusions  : 

1.  There  exists  a  nasal  vertigo,  a  true  vertigo 
a  naso  laeso. 

2.  It  belongs  to  the  group  of  reflex  vertigos, 
such  as  gastric,  laryngeal,  uterine  vertigo. 

3.  Irritation  of  the  trigeminal  filaments  inner- 
vating the  mucosa  of  the  turbinated  bodies,  and 
the  septum,  is  the  starting  point  of  the  condition. 

4.  This  irritation  is  transmitted  to  the  vaso- 
motor nerves  through  the  spheno-palatine  gan- 
glion, whence  arises  circumscribed  ancemia  of  the 
brain  and  vertigo. 

5.  The  affections  which  give  origin  to  vertigo 
are  (i)  nasal  fluxions  (odors,  irritant  vapors, 
snuff,  flowering  grasses)  ;  (2)  acute  coryzas  ;  (3) 
chronic  catarrh,  especially  the  hypertrophic  form  ; 
(4)  mucous  polypi;  (5)  post-nasal  catarrh. 

6.  Vertigo  is  especially  provoked  by  nasal 
affections  of  little  importance. 

7.  The  nasal  reflexes  are  principally  develop- 
ed in  arthritic  individuals. 

8.  Vertigo  can  occur  alone  or  be  accompanied 
by  other  nervous  phenomena — troubles  of  vision, 
muscae  volitantes,  hemicrania,  nausea,  vomitings, 
great  excitability,  hypochondria,  intellectual  disa- 
bility, nightmares,  spasmodic  cough,  dyspnceic 
cases,  exaggerated  secretions,  syncope,  feeble 
pulse,  pallor  of  the  face. 

9.  In  order  to  establish  a  diagnosis,  the  nasal 
fossas  should  be  examined  in  every  individual  suf- 
fering from  vertigo. 

10.  The  recognition  of  nasal  vertigo  will  sensi- 
bly diminish  the  number  of  cases  of  gouty,  rheu- 
matic, anaemic,  congestive  vertigos,  as  well  as 
cerebro-cardiac  neuropathy. 

11.  Vertigo  ceases  with  the  cure  of  the  nasal 
affection  to  which  it  owes  its  origin.  The  condi- 
tion has  no  connection  whatever  with  Meniere's 
disease,  and  is  independent  of  any  affection  of 
the  ear.  The  author  cites  nine  cases,  on  which^ 
together  with  cases  recorded  by  Massei,  Guye', 
Gnuaro,  Hering,  Hack,  and  others,  his  essay  is 
fo\.\ndtd.— /out  nal  0/  Laryngohgy  afid  Rhinology. 

The  Canada  Medical  Record. 

A  Monthly  Journal  of  Medicine  and  burgery- 

EDITORS  : 

FKANCIS    '.V.  CAMPBELL,   M.A.,  M.D.,  L.K.C.P.  LOND 

Ktlitur  and  Proprietor. 
R.  A.  KENNEDY,  M.A.,  M.D.,  Managing  Editor. 
ASSISTANT  EDITOR: 
GEOHGE  E,  ARMSTRONG,  CM.,  M.D. 

SUBSCRIPTION    TWO    DOLLARS    PER    ANNUM. 

All  cnmmuni cation. 1  and  Exchanges  must  be  addressed  to 
the  E.l'lors.  /ii-awer'ioti,  Post   Office,  Montreal . 

.MONTREAL,  DECBIIBEE?,   1887.  ' 


PERSONAL. 
Dr.  Caswell  (M.D.  Bishops  College,  1883),  is 
practising  in  Gageville,  N,  S. 


Dr.  C.  D.  Ball  (M.D.  Bishops  College  1884),  is 
settled  in  St.  Auna,  California. 

Dr.  V/allace  Clarke  (M.D.  McGill  1871),  of 
Utica,  N.  Y.,  was  in  Montreal  on  a  brief  visit  this 
month.  ' 

Dr.  Leprohon  (M.D.  Bishops  College  1879) 
has  returned  to  Montreal  from  the  Western  States. 
He  has  commenced  practice  in  his  native  city. 

Dr.  Kingston  has  been  elected  President  of  the 
Montreal  School  of  Medicine  and  Surgery  (Vic- 
toria College),  in  place  of  Dr.  D'Oisonnens,  whose 
term  of  office  has  expired. 


THE  LONDON  ILLUSTRATED  NEWS. 

This  is  the  best  illustrated  paper  in  the  world, 
and  should  have  the  entry  into  every  household 
able  to  afford  it.  Its  high  subscription  price 
(which  is  still  retained  in  England)  prevented 
many  from  subscribing.  It  is  now  republished 
in  New  York  at  $4  per  annum,  which  places  it 
within  the  reach  of  nearly  every  one.  A  single 
copy  can  be  purchased  from  any  newsdealer  at 
ten  cents.  We  strongly  recommend  it  to  our 
subscribers. 


REVIEW. 

Lessons  in  Gynecology,  by  William  Goodell, 
A.M.,  M.D.,  Professor  of  Clinical  Gynecology 
in  the  University  of  Pennsylvania,  etc.  Third 
Edition, thoroughly  revised  and  greatly  enlarged, 
with  one  hundred  and  twelve  Illustrations. 
Philadelphia,  Pa.,  D.  G.  Brinton,  115  South 
Seventh  Street,  1887. 

This  book  is  not  a  complete  treatise  upon  the 
Diseases  of  Women,  but  is  mainly  the  outcome  of 
Clinical  and  Didactic  lectures  delivered  in  the 
Medical  Department  of  the  University  of  Pennsyl- 
vania. This  is  a  most  interesting  and  instructive 
addition  to  the  many  late  works  on  the  above  sub. 
ject ;  but  the  manner  in  vi'hich  the  component 
parts  of  this  volume  are  put  together,  viz.,  being 
Clinical  histories  in  book  form,  make  the  reading 
very  interesting  and  not  nearly  so  wearying  as  the 
ordinary  form  of  works  on  gynecology.  The  style 
of  this  book  is  very  similar  to  Sayre's  work  on 
Orthopcedic  Surgery,and  like  this  volume  Goodell's 
Gynecology  \vill,  we  predict,  have  a  wide  spread 
farrie,  and  should  be  in  the  possession  of  every 
practitioner.  The  volume  is  beautifully  bound  and 
the  letter  press  is  large,  clear  and  very  distinct  an4 
the  quality  of  the  paper  is  of  the  very  best , 


THE  CANADA  MEDICAL  RECORD. 


Vol.   XVI. 


MONTREAL,    JANUARY,    1888. 


No.  4. 


COItTTEiTTS. 


ORIGINAL  COMMUNICATIONS. 

Report  of  a  Case  of  Uiiibeles  .\Iel- 
litud,  successfully  treated  by 
Nilro-Glycerine 'i:', 

Record  for  24  Hours  endinff  8  00 
AJl .^ 75 

An    Every    Day    Case,    treated   by 

Eleclr  ciiy 80 

SOCIETY    PROCEEDINGS. 

.Medico-Cliirurgical  Society  of  Mon- 
treal      81 


PROGRESS  OF  SCIENCE. 

Kneeling    Posture     iu     Protracted 

Labor 92 

EDITORIAL 

tjuack  Advertisements  in  Religious 

Newspapers 93 

Fecal  Aoeniia 94 

Turpentine  in  Diphtheria 94 


Antisepsis  in  Medicine 95 

Personal 95 

The  Time  for  the  Administration  of 

Certaiu  Remedies 96 

Lister  (Sir  Joseph)   on  V'aricocele 

and  its  Treatment 96 

The  Treatment  of  Sick-Headache...  96 

Early  Paternity 96 

New  Built  Houses 96 


^ri^nul  6ain//iunkaUatd. 


REPORT  OF  A  C.\SE  OF  DIABETES 

MELLITUS  SUCCESSFULLY  TREATED  BY 

NTFRO-GLYCERINE. 

By  R.  A.  Kennedy,  M.D., 

Emeritus  Professor  of  Obstetrics  and  Diseases  of  Women 

and  Children,  Faculty  of  Medicine,  University 

of  Bishop's  College. 

(Read  before  the  Medico  Chirurgical  Society.) 

Mr.  President  and  Gentlemen.  Any  remedy 
which  can  arrest  the  course  or  hold  out  a  pros- 
pect of  cure  of  so  intractable  and  generally  fatal 
disease  as  diabetes  must  be  of  great  interest  to  us 
all. 

I  therefore  present  nitro-glycerine  as  one  such 
remedy  which  so  far  as  I  know  has  not  hitherto 
been  used  ibr  this  complaint.  That  it  had  a  decid- 
ed beneficial  action  is  well  shown  by  this  report, 
the  value  of  which  is  enhanced  by  the  complete 
analysis  of  the  urine,  made  daily  and  extending 
over  a  period  of  ten  months.  I  am  indebted  to 
Prof.  Bemrose,  F.  C.  S.,  for  the  interest  and  careful, 
attention  he  gave  in  determining  these  results  where- 
by an  accurate  record  was  obtained.  The  literature 
of  diabetes  leaves  us  uncertain  as  to  the  patholo- 
gical conditions  which  induce  the  disease.  Irritation 
of  the  floor  of  the  fourth  ventricle  of  the  brain 
causes  glycosuria  by  inducing  a  paralysis  of  the 
vasomotor  nerves  of  the  liver.  The  pneumogastric 
centre  being  deranged,  and  the  disturbance  of  the 
normal  conditions  of  the  nerve  affecting  the  vaso 
motor  nerve  through  its  intimate  connection  with 
the  cervical  ganglion  of  the  sympathetic.  Such 
experiments    favor   the    idea   of  disease    of  the 


medulla  oblengata  or  other  nerve  centres  of  the 
brain  as  the  cause ;  but  in  post  mortem  such 
is  not  always  found  to  be  the  case.  In  some 
no  definite  pathological  condition  has  been  discov- 
ered, while  in  others  the  disease  has  been  appa- 
rently local,  affecting  either  the  liver  or  pancreas. 
From  these  facts,  and  from  the  comparatively  few 
cases  which  liave  come  under  my  observation,  I 
have  been  led  to  the  belief  that  we  should  more 
carefully  define  our  cases  into  those  of  centric  and 
those  of  local  origin.  As  a  rule  when  sugar  is  dis- 
covered in  the  urine  we  place  our  patients  on  the 
recognised  diabetic  remedies,  without  regard  to  the 
probable  seat  of  the  disease.  Remedies  which 
effect  the  brain  centre  may  benefit  disease  in  them, 
but  can  they  be  as  effectual  or  of  any  benefit  if  the 
disease  is  in  the  liver  or  pancreas.  Should  we 
therefore,  not  vary  our  treatment  accordingly  ?  In 
the  greater  number  of  cases  treated  by  me  local 
conditions  chiefly  were  iiivolved.  This  class  of 
cases  occurred  in  elderly  people,  generally  very 
stout,  and  good  feeders.  In  these  cases  dyspeptic 
symptoms  are  prominent,  as  the  excess  of  hydro- 
carbonaceous  food  taken  into  their  stomachs 
increases  the  work  of  digestion.  Many  such  per- 
sons I  think  live  out  a  long  number  of  years  with- 
out serious  illness,  and  unless  accident  discovers 
sugar  in  the  urine  there  is  nothing  to  indicate 
their  diabetic  condition  except  it  may  be  an  excess 
of  urine.  Such  patients  I  have  been  unable  to 
place  upon  any  diabetic  diet,  as  they  will  not 
adhere  to  it  for  any  time.  One  patient,  a  woman,  to 
my  knowledge  has  had  sugar  in  the  urine  for  over 
eight  years,  is  very  stout  and  eats  largely.  She 
has  attacks  of  indigestion,  and  at  times  intense 
genital  pruritis,  otherwise  there  is   no  change  for 


74 


THE   CANADA   MEDICAL    RECORD. 


the  worse  as  the  years  pass  by.  Of  a  different 
class  is  the  case  I  report,  centric  in  its  origin  and 
more  often  met  with  in  young  persons,  which  no 
doubt  accounts  for  its  fatality  at  early  periods  of 
life. 

Mrs.  B.,  age  28  years.  Heights  ft.  6  in., weight 
123  lbs.,  of  spare  habit  of  body.  Family  history 
good,  both  parents  alive  and  well,  and  no  discovera- 
ble, hereditary  tendency.  Came  under  observation 
and  treatment  October,  1886. 

Previous  to  commencement  of  present  disease 
had  always  enjoyed  perfect  health,  and  accustomed 
to  long  daily  walks.  Had  a  miscarriage  several 
years  ago,  with  this  exception  menstruation  has 
has  always  been  normal  in  every  respect  In  July 
1S86,  first  noticed  a  slight  dimness  of  vision, 
heaviness  of  the  legs,  and  was  easily  tired,  especi- 
ally on  walking  up-hill.  The  continuance  of  this 
weakness  induced  her  to  try  change  of  air,  and  in 
September,  while  at  Providence,  Rhode  Island, 
was  troubled  with  intense  thirst,  which  was  as- 
cribed to  fatigue  of  travelling,  and  to  the  hot 
weather.  Returning  to  Montreal  in  October  I 
was  consulted  ;  there  was  great  bodily  weakness, 
excessive  thirst,  pains  increased  in  severity,  and 
her  eye  ;ight  much  worse,  a  colored  ring  being  no- 
ticed when  looking  at  a  distant  light.  As  this  lat- 
ter symptom  indicated  a  possible  glaucoma,  her 
eyes  were  examined  by  an  occulisi  without  any- 
thing being  disvoverable.  At  the  same  time  the 
urine  was  examined  with  the  result  of  finding  a 
large  amount  of  sugar.  She  was  placed  upon  as  strict 
a  diabetic  diet  as  possible,  which,  with  exceptions 
noted,  has  been  followed  throughout,  any  variations 
being  always  followed  by  a  rise  in  the  sugar,  well 
shown  on  the  record  Dec.  25th.  The  desire  for 
sweetening  was  obviated  by  the  use  of  saccharine, 
which  answered  the  purpose,  but  otherwise  had  no 
apparent  physological  action.  The  largest  amoun- 
of  sugar  excreted  in  one  day  was  on  Oct,  17th, 
1S86,  amounting  to  8.75  oz.  The  total  sugar  ex- 
creted in  10  months  was  50  lb.  10  oz.  With  the  an- 
alzsis  will  be  found  the  treatment  and  food.  The 
patient  at  this  date,  January,  188S,  feels  perfectly 
well  and  strong. 

Although  some  of  the  sugar  percentages  and 
Sp.  Gr.  agree  very  well,  as  for  example  : 

Oct.   23     s.g.      I  028S     Urine     90  ozs.     Sugar  4.5 
"      24     sg.     1.0300         "         90  ozs.         "      4.5 


Nov.  1 1 

s.g. 

1.03 

ti 

70  OZS. 

u 

2.916 

"   13 

sg- 

1.028 

(^ 

70  ozs. 

(C 

2.9I6 

"   21 

s.g. 

1. 027 

*' 

no  ozs. 

(( 

6.105 

Dec. 

'S 

s.g. 

1.027 

c. 

100  ozs. 

"   5-555 

" 

'9 

s.g. 

1. 03 1 

(.' 

88  ozs. 

"   4.884 

" 

18 

sg- 

1. 031 

a 

go  ozs. 

"   4-995 

" 

26 

s-S- 

1.031 

a 

144  ozs. 

"   7-992 

Others  are  very  wide  apaVt,  as  for  example  : 
Mcli.  24     s.g.     I  035     Urine     60  ozs.     Sugar     2.28 
27     s.g.      1.045         '"         ^°  "'S.         "       2.28 
Ap].   19     s.g.      1.032         "         60  ozs.         "       3.105 

it  was  therefore  thought  worth  while,  the  urine 
being  again  saccharine,  to  estimate  the  total  solids 
and  ash  as  well  as  the  sugar  and  urea,  and  the 
following  was  worked  out  during  the  month  of 
September,  6  days  only  being  lost. 

The  sugar  totals  vary  as  much  as  before  : 
Sept.  29th  58  ozs.  Urine     s.g.      1.0377     Sugar     1.276 
"       30lh  58  ozs.     "  sg.     1.0360         "         1.682 

but  on  the  291!!  the  ash  is  0.5234S  oz.,  on  the  30th  only 
0.36223  oz.,  and  the  urea  also  is  higher  on  the  29th. 

If  however  the  total  solids  and  Sp.  Grs.  are 
compared  with  published  tables  of  the  Sp.  Gr.  of 
carbohydrate  solutions  : 

25  %  starch  sugar  =  s.g.     I.0104 
5.0  %       "  "     =    "        1.0208 

7.5  %      "  "     =    "       >-03'3     • 

10. o  %      "  "     _    .<        1.0424 

The  September  work  will  be  found  fairly  near : — 
vSep.    4th     Total  solids     8.4   %     s.g.     1.038 
"       8th  "  10.5   %     p.g.      1.040 

"      I2th  "  7.0  %     s.g.      1.031 

"     29th  "  7.81  %     s.g.     10377 

It  appears  ti.ercfore  that  the  Sp.  G.  is  no  sure  indi- 
cator of  the  ainount  of  sugar  present;  also  up  to 
1.023  i'  ■^^■'"  "o'  determine  its  presence  or  absence 
since 

July  i6th     s.g.   1.021,     sugar,  0.562 
"     24th     s.g.   1.024         "       0.000 
"     25th     s.g.   1.023         "       0.000 
Oct.  30th     s.g.   1.917         "       0.511 
On  October  31st,  the  s.g.  was  1.021,   and  total 
sugar  1.345;  the  calculated  percentage  is  2.359  oz., 
and  that  found  by  Fehling  is   2.36  ;  total  solids 
calculated  as  above  from  the  s.g.  is   1.85,  leaving 
only  0.505  oz.  for  all  other  bodies  ;  it  is  unfortu- 
nate that  the  direct  estimation  of  solids,   ash  and 
urea  was  not  suggested  at  that  time. 

As  a  rule,  when  the  amount  of  drink' taken  is 
large  the  sugar  is  higher,  although  the  vohtnie  of 
urine  may  be  the  same,  e.  g.  ; — 

Feb.  2  Drink,  45  oz.,  Urine,  60  oz..   Sugar,  2.73 
"      4       "       62  oz,,      "       61  oz.,       "       3.385 
and   "      6       "       7902.,       "       80  oz.,        "       4000 
"      7       '■       88  oz.,      "       So  oz.,       "       4.208 
of   course  when  the  urine  is   increased  much   in 
quantity,  the  sugar  is  still  higher  : 

Feb.  12  Drink,  82  oz..  Urine,  100  oz.,    Sugar,  6.15 


i-HE   CANADA   MEDICAL   RECORD; 


75 


RECORD  FOR  24  HOURS  ENDING  8  A.M. 


^ 

Dale. 

Sp.   Gr. 

i 

Q 

1886 
Cirt 

60  F. 

oz. 

II 

1 .040 

12 

1 .042 

.... 

'3 

1.07 

.... 

14 

1.05 

80 

»■; 

1.029 

100 

16 

1.028 

120 

'7 

1.03 

100 

i8 

1.025 

loo 

«9 

1.028 

loo 

20 

1 .029 

100 

21 

1 .029 

loo 

22 

1 .029 

100 

2^ 

1.028 

112 

24 

1.030 

80 

25 

1.029 

40 

2b 

1.0242 

120 

27 

1.025 

40 

28 

1030s 

»■; 

29 

1.0246 

96 

30 

1. 017 

67 

3' 

1. 021 

4b 

**  Urine 


OZ. 

140 
140 
120 
120 
80 
100 
140 
120 
120 
120 

no 

120 

90 

90 

56 
80 

45 
80 
90 

46 

57 


Sugar 
for  34 

hours. 


7-77 
7-77 
6.00 
6.60 
5.00 
7.14 

«-7S 
5  nearly 
6.0 
6.31 
6. 105 
5.46 
4-50 
50 
,80 

79 

25' 

64 

87 

0.51  [ 

'•345 


103. 112 


Urea  for 
liours. 


Aceto 

Acetic 
Reaction. 


Medicine. 


SYMrroMS, 


/zgr. 

Codeia  t.d 

Hsr. 

( t 

4( 

C( 

Xg'-. 

it 

a 

1  gr. 

it 

(( 

Hgr. 

<( 

I  gr. 

tc 

t'X  Sr- 


Very  weak,  thirst  excessive. 
Thirst  less. 


Very  dull  and  desponding. 
Dizzy  ;  vomiting. 
Vomiting     increased,        too 

weak  to  stand. 
Heavy  night  sweats 
Night  sweats  and  chills. 


Vomiting  till  very  weak. 


.0175 

.0182 

.019 

.024 

.0265 

.0220 

.021 

.038 

.036 

.0265 

•03 
.027 

.028 

•03 
.028 

"3 
.0275 

.026 
■  025 
.025 
.027 
.029 
.025 
.025 
,028 
.026 

0315 
028 
028 
,027s 


70 

40 

60 

30 

no 

47 

100 

on 

So 

Tnr.1 

90'   100] 

90, 


92 

nS 
88 
66 
80 
95 
95 
84 

75 
82 

72 
80 
67 
72 
80 
100 
86 

63 
60 

54 
86 

75 
78 
97 


95 

104 

105 

60 

70 

90 

70 

loo 

85 
81 
90 
102 
68 

75 
no 
112 

76 
loo 

94 

100 

116 

92 

88 


0.168 
03 

■75 

o 

o 

493 

7 

848 

496 

5426 

916 

6 

916 

762 


3.269 
,685 
,6 

999 

264 
8S4 
105 
6 

5 

846 

277 

166 

55 

538 

933 
00 


Faint 



reaction 



Stronger 



V.  strong 



None. 

■  ,304 

it 

7n'ly 

.1 

■132 

it 

■455 

.283 

•752 

" 

■58 

482 

553 

43 

(( 

563 

** 

59 

(( 

374 

*' 

24 

*' 

671 

** 

4 

5' 

iC 

51 

a 

348 

It 

635 

n 

76 

ti 

832 

(t 

Tr.  Iron  and  Chloric  ether. 
No  codeia. 


Iron  &•  ether  &•  %%t-  Codeia  at  night 
"  and  I  gr.     "  " 

((  a  ti  it 

Same  with  podoph  and  nu.x  pill. 
«( 

Iron  &=  Strych  with  Ergot,  no  Code- 
ia :  20  grs.  Na.  Br.  at  night. 


"     +  I  gr.  Codeia 


Iroii  and  Strych.  with  Pil.  Opii. 

'•  with  Pil.  Codeia. 


I  gr.  Codeia  with  20  grs.   Na.    Br.  if 
sleepless. 


Pain  right  side,  bad  night. 
Side  worse. 

Heavy  night  sweats,limbs  eld 

Side  better. 

Pains  over  hack  e^  shoulders 

Bad  night,  cold  sweating. 


104.1326 


Diet  strict. 

Health  C's  crude  gluten 
Pain  in  back. 
Worse. 
Very  bad. 

Better. 

it 

No  pain,  very  tired  at  night 

a 

a 

40  oz.  milk  ;  no  gluten. 

a 
a 

Legs  very  heavy. 


76 


THE   CANADA    MEDICAL   RECORD, 


Sugar  for 

Urea  for 

Aceto 

Dale. 

Sp.    Gr. 

55 

Urine 

=!4 

=4 

Acetic 

MnuiciNE- 

Symptoms. 

hours. 

hrurs. 

Reaction. 

lSS6 
Dec. 

60  F. 

oz. 

oz. 

OZ. 

I  m  of  1%  nitroglycerine  and  I  gr.  co 

* 

I 

1 .02S 

95 

100 

3.846 

1.752 

None. 

deia.                          Gluten,  no  milk. 

2 

1 .0278 

60 

70 

2.692 

1-423 

It 

C<                                                                    C( 

Cramp  during  night. 

3 

1,024 

43 

46 

0.46 

1.288 

" 

t(                                               a 

it 

4 

I -035 

50 

53 

0.60 

I. 171 

a 

a                                               ii 

ii 

5 

I. 0195 

50 

61 

I -053 

0.966 

Strong. 

ii                                                        .1 

No  sleep  and  pain  inside  and 

back. 

6 

1 .023 

44 

56 

1. 166 

0.9367 

a 

ii                                                                      H 

it 

7 

1.0245 

57 

60 

1 .  156 

I. 212 

i( 

ti                                                                      CI 

tt 

8 

I. 0195 

58 

60 

0.577 

I  .003 

.Still  m 're 

**  with  15  grs.  am.  cl.'' 

Pain  worse. 

9 

1.028 

54 

40 

1 .000 

0.862 

i( 

it                         a                           U 

ti 

lo 

1.026 

64 

63 

2.423 

1-053 

4f 

"  with  2ogrs.  Na.Br.  *' 

II 

1.027 

80 

90 

2.314 

I  .212 

Sti-ong. 

ii                                          ii                                              U 

Pain  less,  cold  persp 

ration. 

12 

1.0288 

69 

81 

3-374 

1.288 

Faint. 

it                         ii                           (( 

»* 

'3 

1.029 

53 

70 

2.916 

0.528 

a 

tC                                it                                   (( 

Pain  gone. 

14 

1.029 

85 

90 

3-749 

I. 212 

None. 

(C                             ti                               U 

'5 

1.027 

70 

100 

5-55 

0.970 

<( 

ii                       a                         (( 

i6 

1 .026 

80 

108 

4.914 

I  .  10 

a 

((                                it                                 £( 

Sleep  good. 

■7 

1.0285 

46 

58 

3.219 

0.86 

Faint. 

rm  of  1%  nilro-glycer.  t.d.  t^Ja  little 
milk 

IS 

1. 031 

60 

90 

4-995 

I. IIS 

ii 

Im  and  two  h^\(  minims         '* 

Pain  in  back  again. 

^ 

'9 

1 .031 

66 

88 

4.8S4 

0.973 

a 

'*  +  iron  0-^  chloric  ether  *• 

Pain  worse. 

20 

1-035 

50 

56 

2.800 

0.906 

a 

^(                         11 

ti 

21 

1.032 

56 

80 

4.208 

1. 167 

'* 

ii                         ii 

11 

22 

1 .02S 

39 

64 

1.645 

1. 104 

Stronger. 

a                                   (1 

Pain  better. 

23 

1-033 

50 

52 

2.6 

0.803 

a 

3  X  _J^m  doses  nitro-glycer.     *' 

No  pain  ;  weak. 

24 

1.032 

54 

70 

3-5 

1.094 

ti 

ti:                                      it 

a 

25 

1. 031 

40 

62 

2.384 

0.819 

a 

2x}im  doses  er^  im  dose.  Biscuit  dr'ale 

'* 

26 

1. 031 

90 

144 

7.992 

1. 164 

None. 

it                                     ti 

" 

27 

1. 031 

60 

82 

4.10 

0-973 

" 

"                   Diet  strict. 

" 

28 

1-033 

40 

56 

2.667 

0.996 

Faint. 

it                                     n 

it 

29 

1-034 

58 

72 

3-6 

1-307 

'( 

it                             <( 

" 

3° 

1-0335 

43 

60 

2.730 

0.970 

Stronj^er. 

tt                             «< 

tt 

3' 

1 .032 

60 

80 

3.809 

1. 161 

^    t      1 

it                                          u 

Feels  stronger. 

92.926 

Note  rise  of  sugar  on  26th  after  starch  food  and  ale 


035 
033 
032 

035 
034 
038 

033 
031 
032 

033 
032 

035 

0315 
032 

0315 

035 

036 

034 
036 

035 
033 
033 
031 
032 

0355 

o3'5 
032S 

0332 
035 
037 
0325 


So 

30 
102 
82 
80 
50 
52 
70 

94 
85 
90 

42 
42 
54 
78 
70 
60 
.66 
60 

75 
60 
76 

lOI 

47 
66 
66 
60 
6S 

65 
60 
76 


00 

872 

623 

3^3 

44 

50 

261 

50 

997 

25 

995 

554 

164 

690 

549 
885 
996 
472 
528 
0S5 
156 
8 

05 
23S 

880 

749 

857 

40 

6075 

85  7 


1 .208 
0.728 
I.  too 
1. 061 
1.078 
0-943 
0-953 
0.800 
S61 


102.082 


1. 164 

0.974 

0.906 

'-'93 

1-323 

1 .  132 

0.936 

067 

792 

on 

905 
5>5 
307 
0.766 
1 .067 
1. 103 
1.03 
1.45 
1 .052 
1.07 
'■25 


Faint. 

No  medicine. 

Diet  not  strict. 

None. 

it 

it 

a 

Faint. 

it 

Cramp  at  night. 

(( 

2m  nitro-glvcerine  p.  day        " 

Acid  vomiting  all  nii^ht. 

a 

Diet  strict. 

Legs  heavy  and  tired. 

Strong. 

^i 

Faint. 

'* 

None. 

u 

" 

ii 

l( 

ti 

Diet  not  strict. 

ii 

(( 

Faint. 

(( 

"     cold  sweat. 

None. 

(( 

(( 

(I 

a 

u 

n 

a 

Faint. 

Gluten  and  strict  diet 

a 

ti 

Better  nights. 

Strong. 

11 

(( 

Faint. 

a 

None. 

" 

If 

None. 

(( 

Faint. 

ii 

tt 

it 

it 

<i 

tt 

ii 

tt 

a 

A  Im  dose 

tt 

tt 

Two  im  doses. 

c< 

Vision  slightly  affected. 

It 

it 

it 

(( 

tt 

a 

a 

it 

TUE  CANADA  MKDICAL  KKCOUB. 


77 


■^s 

Sugar  for 

Urea  for 

Accto 

Date.  S 

).    Gr. 

<51 

Urine 

hours. 

hours. 

Acclic 
Reaction. 

Mhdicine. 

Symptoms. 

1887 

5o  F. 

oz. 

oz. 

I'eb. 

I     I 

035 

48 

50 

2-775. 

0.892 

None . 

Iron  and  strychnia.     Gluten  Food. 

Eyes  better  and  feels  well. 

2     I 

0335 

45 

60 

2-73 

I. 132 

i( 

((                                   a 

te 

3    I 

°35 

S5 

80 

4-44 

I.  121 

" 

ti                                  ti 

t( 

4    I 

OS 

62 

61 

3-385 

1.185 

ii 

(I                                              (( 

tc 

5    ' 

046 

54 

46 

2.03 

I.     147 

<{ 

"                                  •*  I  oz.br'd 

cc 

6    I 

034 

79 

80 

4.00 

1     .     164 

it 

(C                                          te         a 

ti 

7    I 

031 

88 

80 

4.208 

1.037 

11 

"                                "no  bread 

iC 

8    I 

034 

III 

120 

6.312 

I.     166 

a 

<(                                       a 

« 

9    I 

035 

70 

74 

4-35' 

1.037 

il 

C(                                                              n 

(C 

10    I 

0365 

86 

72 

3-744 

I     .  009 

i( 

ii                                             tc 

(C 

II    I 

033 

74 

86 

4.032 

I.     159 

1( 

"  +  im  nitro-glyc.    " 

Very  tired,  legs  heavy. 

12    I 

034 

82 

no 

6.15 

I     .260 

(.' 

((              ((                    « 

it                       i( 

13    ' 

036 

76 

81 

3-302 

I.     157 

<( 

it     3m    "                   " 

it                       cc 

14    I 

035 

118 

132 

6.204 

o.SiS 

li 

ti                   it 

it                       it 

15    I 

031 

75 

82 

2.788 

1 .  105 

n 

(1                                    (C 

tc                       (C 

16    I 

033 

54 

60 

2.64 

0.873 

a 

it                          ii 

Better                " 

17    I 

03s 

50 

54 

2.808 

0.S15 

it 

((                      a 

it                             cc 

18    I 

034 

56 

60 

2.640 

0.9H 

it 

a                      ic 

i<                        tc 

19    I 

035 

54 

56 

2.52 

0.785 

Cl 

ti 

ii                        cc 

20    I 

032 

83 

98 

4-5'2 

1135 

a 

logrs.jumbol,  imnitro.gl." 

Very  heavy  and  duil. 

21    I 

035 

56 

61 

2.562    0.75 

it 

15  grs.       "     only                " 

cc 

22    I 

035 

62 

78 

3.276   0-967 

tc 

30grs.       **       "                    '' 

Which  got  worse  to  end  of 

23    I 

033 

70 

91 

4.50      I. 164 

tc 

((                            tt 

month. 

24    I 

034 

46 

58 

2.262   0-770 

(C 

Cl                                                   it 

25    I 

033 

44 

63 

2.205    0-815 

(C 

<(                                               K 

26    I 

032 

64 

81 

3.402    1. 571 

It 

tl                                         ii 

27    I 

0335 

50 

74 

3.108    0-958 

a 

It                                         it 

28    I 

0337 

62 

74 

3  996 

100.945 

0.838 

C( 

U                                             (C 

Eyes  weak  again. 

Sugar  in 

creased 

again  by  sn 

all  quantity  of  bread 

aken  on  5th  and  6th.     Gluten  food  alone  become  very  disagreeable,   and  nothing  suitable  to 

be 

obtait 
)rm-eat 

ed :  almonds 
en. 

and  nuts  disliked  a 

id   therefore 

indigestible.      The  Jumbo!    was  found  to  be  inert  as  the  leeds  were  old  and 

1887 

Mch 

I    I 

0336 

76 

lol 

4-494 

0.813 

None. 

im  of  1%  Nitrog.  Gluten  Food  all  the 

Pains  in  legs. 

2    I 

031 

40 

52 

1.456 

29 

n 

im  Ng.  and  2  doses  Iron.          month. 

if 

3    I 

034 

50 

48 

1-44 

09 

11 

2m  "        "I         *' 

Better. 

4    I 

0336 

55 

67 

2.412 

41 

n 

im  "       "     2         *' 

tc 

5    « 

031 

66 

73 

2.4S2 

77 

(4 

a                a 

it 

6    I 

033 

65 

60 

2. 10 

23 

(( 

2        (<        ''      I            '* 

iC 

7    I 

0335 

60 

70 

2-95 

35« 

(1 

•  ( 

Still  improving. 

8    I 

03' 

5' 

50 

2. 10 

05 

{( 

** 

it 

9    I 

0342 

45 

48 

1.68 

081 

(f 

2         and  I  dose  Iron  and  Strych. 

cc 

10    I 

032 

63 

78 

3-465 

4x2 

i( 

it 

cc 

II    I 

03'5 

45 

60 

2. 10 

261 

({ 

it 

Eyes   better  and  feels   quite 

12    I 

034 

58 

63 

2.772 

«55 

Strong. 

(1 

well- 

'3    I 

0355 

60 

76 

3-496 

27 

None. 

tc 

it 

14    I 

037 

55 

60 

3-038 

053 

Strong. 

it 

it 

'5    I 

0365 

53 

51 

2-397 

004 

it 

(( 

*' 

16    I 

035 

53 

68 

2.970 

I 

Faint. 

cc 

(C 

17    I 

0349 

62 

57 

2.494 

032 

Strong. 

" 

cc 

18    I 

033S 

56 

60 

2.46 

07 

a 

No  Ng.,  I  dose  Iron  and  Strych, 

cc 

19    I 

032 

62 

76 

3-306 

213 

Alm.n*ne 

" 

iC 

20    I 

036 

48 

56 

2.295 

072 

u 

im  Ng.  only. 

iC 

21    I 

037 

54 

56 

2.688 

146 

u 

cc 

22    I 

031S 

71 

87 

3-4375 

0 

5S6 

None. 

** 

23    I 

035 

42 

45 

1.665 

0 

946 

'^ 

(I.. 

" 

24    I 

035 

54 

60 

2.28 

229 

.i 

" 

25    I 

035 

57 

68 

1.768 

32 

a 

'* 

26    I 

0352 

58 

70 

3-15 

19 

i( 

Legs  heavy. 

27    I 

045 

65 

60 

2-28 

067 

Sttong. 

tc 

28    I 

0352 

52 

48 

1-776 

00 

a 

"     and  I  dose  lion  and  Strych, (tramps  at  night. 

29    I 

034 

70 

71 

2-982 

224 

a 

' 

30    I 

028 

56 

60 

1.62 

02 

i  t 

Cramps  gone,  feels  stronger. 

3'    I 

0317 

64 

62 

2.048 
77-5495 

1-07 

(( 

78 


THE   CANADA    MEDICAL   RECORD. 


Ig 

Sugar  for 

Urea  for 

Aceto 

Date. 

Sp.    Gr. 

A-^ 

Urine 

24 
hours. 

24 
hours. 

Aceiic 
Reaction. 

Mbdicinb. 

Symptoms. 

1887 

60  F. 

oz. 

OZ. 

UZ. 

Apil 

im    Nitro-gl.   and   I   dose    Iron    and 

I 

I  .036 

67 

66 

3-036 

I  .21 

Faint. 

Strych.         Gluten  Food  all  month. 

Cramp. 

2 

'•0335 

74 

70 

2.94 

1.32 

Strong. 

it 

(C                « 

3 

'•035 

80 

72 

3-312 

■-35 

'* 

it 

Better. 

4 

'•035 

80 

78 

3-424 

1-33 

None. 

iC 

a 

S 

■■034 

55 

50 

2.05 

1 .00 

" 

No  medicine. 

it 

6 

1-0353 

48 

46 

1.794 

0.915 

Faint. 

*' 

ii 

7 

1.0341 

64 

68 

2.584 

1-33 

u 

(1 

Cramp  again. 

8 

'•033 

70 

72 

2.736 

1-27 

(I 

£( 

ii 

9 

'•035 

60 

58 

2.203 

1-03 

(C 

({ 

a 

10 

1.034 

72 

68 

2.  176 

1. 10 

(I 

Continued  as  on  ist. 

ii 

II 

■•035 

52 

48 

1.824 

1. 01 

*' 

it 

it 

12 

'•035 

60 

56 

2.632 

1. 12 

Strong. 

(t 

Better. 

13 

'■037 

43 

41 

1.886 

0.84 

ti 

tt 

it 

14 

1-033 

59 

58 

2.262 

1 .00 

a 

No  medicine. 

<t 

15 

'•035 

62 

60 

3-35 

1. 14 

a 

it 

ii 

16 

1 .032 

44 

42 

2-35 

1. 02 

n 

it 

a 

17 

1.032 

76 

74 

3-99 

1 .01 

n 

tt 

(( 

18 

1.032 

54 

52 

2-75 

0-953 

(I 

yim.  Nitro-glycerine. 

a 

19 

1.032 

62 

60 

3105 

1.26 

ti 

tt 

a 

20 

1. 031 

69 

74 

3-815 

1. 21 

it 

a 

it 

21 

1. 031 

80 

63 

3-257 

1-43 

V.  strong 

"     and  I  dose  Iron  6^  Strych. 

ii 

22 

1 .029 

77 

76 

3-382 

1 .40 

(1 

Ct                                             CI 

ii 

23 

1.027 

70 

74 

3-663 

1.07 

" 

tt 

Well  to  end  of  month. 

24 

1.027 

77 

74 

2826 

1 .  10 

a 

tl 

25 

1.028 

72 

75 

3-7125 

1 .06 

a 

tt 

26 

1.030 

70 

62 

2-79 

1-153 

K 

4C 

27 

1 .030 

56 

52 

2.691 

I  - 12 

*' 

tt 

28 

1.034 

56 

58 

3-00 

1-125 

<C 

ii 

29 

'-033 

70 

66 

4-158 

1. 121 

(( 

5  grs.  Jumbul. 

30 

1.029 

60 

57 

2-565 
8=;.  2735 

1 .002 

a 

15  grs.       '« 

1687 
May 

I 

1 .029 

65 

70 

3.06 

1-43 

Strong. 

15  grs.  Jumbul.    Gluten  Food  all  the 

Feels  well. 

2 

1-034 

49 

40 

2.25 

0-835 

^( 

"                                        month. 

3 

1.034 

63 

58 

3-523 

1.22 

a 

(C 

4 

1.034 

59 

50 

315 

0-943 

None. 

ti 

5 

■-033 

70 

57 

3-69 

1.26 

a 

i  t 

6 

1.034 

55 

57 

3.84 

1 .11 

a 

>c 

7 

■-033 

65 

59 

3.18 

1 .04 

a 

( ( 

8 

1.032 

58 

57 

2.95 

1.07 

i  i 

it 

9 

1 .032 

53 

58 

3.26 

1.56 

a 

iC 

10 

1.031 

53 

30 

0.945 

0.566 

ti 

No  medicine.                 Onions. 

Very  well  to  end  of  month. 

II 

1.02S 

44 

40 

1-35 

0.755 

it 

tt                                                                  it 

12 

1.02S 

40 

38 

1.06 

1 .01 

a 

H                                                           tl 

13 

I  025 

35 

39 

1-05 

1 .00 

a 

"                 Apples  and  oranges. 

14 

1.025 

44 

52 

1 .22 

I.OOI 

ti 

tC                                                     it 

15 

I  -027 

65 

70 

2.835 

1.24 

tt 

it                                     (t 

16 

1-031 

47 

52 

2.34 

I  .121 

a 

a                                            it 

17 

1 .032 

55 

54 

2.187 

1.05 

a 

(C 

18 

1.030 

57 

60 

3.375 

1-03 

ti 

2  doses  Jumbul  (15  grs.  ea.) 

19 

1.032 

59 

64 

4.212 

I  .072 

ii 

" 

20 

1.030 

39 

42 

1.795 

0.9 

it 

3 

21 

1-031 

56 

60 

3.105 

1.07 

ti 

"          One  orange. 

22 

1-031 

72 

66 

3.564 

1.08 

(( 

No  medicine. 

23 

1-030 

54 

48 

1 .809 

0.84 

(( 

3  doses  Jumbul. 

24 

1.032 

71 

54 

3.24 

0 

( ( 

tc 

25 

1 .032 

76 

56 

2.898 

rt  _J 

ti 

" 

26 

1 .032 

60 

42 

1.2285 

.1^ 

** 

it 

27 

1  -030 

60 

44 

1.482 

gg- 

a 

a 

28 

1 .025 

52 

5° 

1-52 

a  c 

n 

^i 

29 

1 .027 

56 

68 

2.601 

11 

tt 

No  medicine. 

30 
3> 

1.027 
1.025 

50 
50 

64 

50 

2.304 
1.4625 

76.790 

£-" 

it 
a 

it 

'*         abont  I  oz.  of  bread. 

■A.  J  U  ^t.L, 

>i.!.J.-i  1 

rra:«r-= 

.i:--i.jv  ,s- 

^t:^ 

■  ■-■'     

-  -■- -^-.'-.^^ -             — ■  - 

TIIR   CANADA   MEDICAL   RECORD. 


79 


=  g 

Sugar  for 

Urea  fo 

r        Aceto 

Diiic 

Sp.    Gr 

02 

Urin< 
oz. 

hours. 
OZ. 

hours. 

Acetic 
Reaction. 

Mkdicinp 

SVMI'IOMS. 

i88; 

60  K. 

gz. 

June 

I 

1.030 
1.029 
I  .031 
'033 
•033 
'•033 

94 
61 

90 
60 

6.277 

2. 8-,; 

M^  «.^.i;,^;„^             T^« 

cieam  a  little 

Well. 

2 

•    •••..u     i.<-.vt<v.iiiv,.                                XV.V, 

■I 

46 
40 
40 
42 

56 
46 

39 

0  J 

1.458 

3-'5 

2.898 

2.34 

Saccharine 

fuod  and  fiuit 

li 

J 

4 
5 
6 

(C 

cc 

0.69 

None. 

(C 

7 

1.030 

46 

44 

1.287 

0-55 

" 

l( 

a 

1.028 

42 

44 

2.178 

0.57 

(C 

ii 

9 

I  .029 

37 

35 

'•338 

0.7 

te 

ii 

10 

1.029 

44 

34 

0.9945 

0.7 

(.' 

ii 

II 

I  .030 

37 

3« 

1. 196 

0.74 

(•' 

ii 

12 

1.034 

36 

42 

0.945 

0.71 

a 

ii 

'3 

1.034 

56 

54 

3-645 

0.S4 

a 

ii 

'4 

1.032 

46 

42 

1. 512 

1 .02 

" 

ii 

15 

1.027 

48 

50 

1.687 

■-45 

" 

ii 

16 

I  .031 

49 

42 

1. 512 

1.2 

*' 

iC 

•7 

1.030 

48 

40 

'-35 

1. 01 

*' 

\ 

a 

18 

1.0255 

52 

52 

1. 17 

1.32 

a 

i( 

19 

1.026 

42 

38 

1.026 

1.044 

** 

ii 

20 

1.025 

36 

42 

1.228 

1. 177 

V.  faint. 

« 

21 

1.028 

29 

38 

0.795 

1.069 

Nunc. 

(( 

22 

1.027 

42 

40 

1. 17 

1.207 

( t 

li 

23 

I  .024 

44 

42 

1. 174 

'-34 

(( 

ii 

24 

1.025 

42 

46 

0.S24 

1. 19 

if 

ii 

25 

I  .025 

46 

40 

0.45 

1 .00 

a 

ii 

26 

C  — 

i( 

ii 
it 

27 

35 

43 

0.262 

28 

50 
42 

2.475 
2.36 

0  c 

Fruit. 

ii 

Pain  and  bad  cramps. 

29 

46' 

30 

1-031 

40 

30 

0.607 

a 

ii 

50.10S5 

Sugar  increas 

cs  4-8  < 

)7.  after  I  oz.  bre.-iil  taken  0  ntlie  last  clay  of  May. 

1S87 

July 

I 

1.032 
1.028 
1. 031 

40 

36 
26 

^6 

O.64S 

0.4725 
0.4725 

Strict  diet 

Bad  cramjsat  night, 
ii 

a 

2 

30 
30 

Iron  and  Stiychnine. 

kj^^tv-k     vllVta 

3 

4 

5 
6 

1.027 
1.032 
1.032 

40 

44 
46 

38 
42 
40 

I  .  I  I  I 

a 

■•4175 
1.62 

a 

ii 

7 

1.032 

49 

42 

2-173 

IC 

8 

1.027 

40 

34 

0.765 

'  * 

Better. 

9 
lo 

1  .031 

70 

60 

2.16 

i( 

1.023 

56 

42 

0.378 

Cramp  gone. 

1 1 

I  .022 

48 
52 

52 
50 

O.46S 
0.562 

12 

1.025 

I  2 

I  .024 
I  .022 

•58 

42 
60 

0.525 

0-429 
0.228 

'0 

14 

'5 
16 

3^ 

70 

I  .022 

40 
52 
53 

35 

1 1 

I  .021 

50 
60 

0.562 
I. 215 

2.7 



Fruit. 

17 
18 

1.024 
I  .029 

a 

60 

....... 

None. 

ct 

19 
20 

1.023 
I  .028 

•5 
40 

49 
26 
40 
39 

40 

44 
16 

0.63 

1 

Continued. 

(t 

I.21S 

it 

2 1 

I  .027 
1.022 
I  .020 

0.555 

o.Si 

0 

Cl 

22 

60 
40 
34 

ti 

Vone, 

Cucumbers. 

i** 

24 

1.023 

0 

a 

25 

z6 

I     .023 

40 
42 

%6 

0 

Si 

1.020 

36 

0 

(( 

27 

[     .022 

40 

32 

(_) 

•( 

2I.II95 

80 


THE   CANADA   MEDICAL   RECORD. 


AN  EVERY  DAY  CASE,  TREATED  BY 

ELEClRlCTfY. 

By  A.  Laptiiorpi  Smith, B.A.,  M.D.,  M.  R.  C.  S.  Eng., 

Lecturer  on  Gynecology,  Faculty  of  Medicine, 

University  of  Bishop's  College. 

Mrs.  P.,  set,  50,  26  years  married,  had  8  boys, 
8  girls,  and  4  miscarriages  ;  came  utder  my  care 
for  her  womb,  two  years  ago.  I  confined  her,  how 
ever,  of  her  i6th  living  child  6  years  ago,  since 
which  she  has  not  had  any  more.  She  was  atten- 
ded 1 2  years  ago  by  the  late  Dr.  Schmidt  for  com- 
plete procidentia,  her  womb  at  that  time  hanging 
between  her  legs,  and  sticking  to  her  clothes.  He 
gave  her  some  internal  treatment,  from  which  she 
derived  great  benefit.  After  her  fifteenth  confine- 
ment, however,  her  womb  came  down  as  bad  as 
ever,  and  she  was  treated  by  Dr.  Thompson,  who 
after  a  month  succeeded  in  healing  the  ulceis  and 
getting  the  womb  to  remain  inside  the  vulva,  more 
or  less,  for  it  always  came  down  after  exertion, 
about  one  or  two  inches. 

When  she  came  to  me  in  Feb.,  '86,  I  took  down 
the  following  notes  :  Previous  history ;  always 
healthy  before  marriage  and  since,  except  that  she 
menstruated  every  two  or  three  weeks,  and  even 
during  pregnancy,  imtil  within  three  months  of  de- 
livery. 

Present  condition :  bilateral  laceration  of  the 
cervix,  with  cystic  cervical  glands ;  lacerated  peri- 
neum almost  to  the  sphincter  and  procidentia  of 
the  uterus  about  two  inches;  and  the  sound  enters 
a  little  more  than  4  inches. 

Treatment  during  the  next  two  months.  As  she 
declined  any  operative  measures  whatever,  I  ap- 
plied iodized  phenol  to  the  cervical  canal  and 
glycerine  of  tannin  tampons  to  the  vaginal  vault, 
with  the  result  that  she  menstruated  only  every  4 
weeks,  and  without  pain,  and  she  felt  lighter  and 
belter  in  every  way.  When  I  returned  from 
Europe  in  Sept.,  1 88 7,  she  came  to  me  again  ;  owing 
to  the  very  hot  summer  she  was  feeling  very  miser- 
able ;  the  vulva  was  very  swollen  and  full  of  larg- 
veins,  there  was  a  cystocele  and  rectocele,  and  the 
uterus  protruded  from  the  vulva  almost  as  much 
as  when  I  first  attended  her.  The  sound  entered 
four  and  a  half  inches. 

I  at  once  began  the  use  of  the  secondary  faradic 
current,  through  the  coarse  short  wire,  applied 
with  Apostoli's  vaginal  bipolar  excitor;  this  had  a 
very  marked  effect ;  the  vaginal  muscular  t'ssue  and 
the  muscles  of  the  Hgaments  of  the  uterus,  being 
put  into  such  a  state  of  contraction  that  the  instrur 
ment  could  be  felt  to  be  grasped  firmly  and  drawn 


upwards.  After  the  first  application  the  uterus 
remained  up  for  two  hours.  I  continued  to  apply 
the  faradic  current  of  quantity  to  the  vagina  during 
10  minutes  at  intervals  of  two  days,  and  after  each 
time  the  prolapsed  organ  rejnained  up  longer  and 
longer,  until  at  the  end  of  a  month  it  did  not  come 
down  at  all.  She  now  felt  very  much  relieved,  and 
more  able  to  do  her  work;  still  I  was  not  satisfied, 
because  she  yet  complained  of  a  tired  feeling  at 
the  bottom  of  her  body  when  she  remained  many 
hours  standing ;  on  reflection  this  was  easy  to 
understand,  I  had  strengthened  the  supports 
without,  however,  diminishing  the  weight  to 
be  supported.  The  four  and  a  half  inches  to  which 
the  sound  penetrated  represented  a  weight  at  least 
double  that  of  the  normal  organ,  and  although  they 
were  able  to  hold  it  up  for  a  considerable  time, 
they  would  at  last  become  tired  out  and  let  it  fall. 
On  the  23rd  of  Sept.,  I  began  to  apply  the  constant 
galvanic  current,  60  miiliamperes  for  10  minutes,  to 
the  interior  of  the  womb,  by  means  of  the  platinum 
sound,  and  continued  to  repeat  it  every  4  or 
5  days  between  the  menstrual  periods.  Menstru- 
ation, which  by  the  tampon  and  hot  water 
treatment  had  been  reduced  to  three  days,  with 
intervals  of  four  weeks,  in  May,  had  gradually 
gone  back  to  8  days  in  the  following  Sept.  But 
after  10  positive  galvano  cauterizations,  her  period 
in  Nov.  only  lasted  3  days. 

She  came  to  my  office  a  few  days  ago  to  report 
herself,  as  I  had  requested,  and  stated  that  her 
last  period  (Jan.,  18S8)  only  lasted  2  days,  and 
she  was  feeling  better  than  she  ever  felt  in  her  life, 
and  that  those  clay  plasters  (as  she  called  them) 
had  done  her  more  good  than  all  the  other  reme- 
dies put  together.  She  certainly  looks  now  ten 
or  fifteen  years  less  than  her  age. 

Conclusions  :  this  is  just  one  of  a  class  of  cases 
that  come  to  our  office  every  day,  and  which  give  us 
a  great  deal  of  trouble  and  very  unsatisfactory  re- 
sults. Most  often  they  decline  to  be  operated  upon, 
and  the  time  honored  pessary  will  not  only  not 
hold  the  uterus  up,  but  it  will  not  even  hold  itself 
in.  For  such  the  electrical  treatment  is  the  most 
rational  one,  for  without  cutting  away  any  part  of 
any  organ,  it  restores  to  the  supports  their  lost 
function,  and  removes  from  the  uterus  its  morbid 
pertrophy,  merely  by  increasing  the  vitality  ofhe 
the  trophic  nerves,  and  thereby  calling  back  into 
the  circulation  the  morbid  material  deposited  in  the 
midst  of  the  normal  tissues.  In  cases  where  there 
is  no  hypertrophy,  the  faradic  current  of  quantity 


THE   CANADA    MEDICAL    RECORD. 


81 


alone  would  suffice  to  restore  the  organ  to  its  nor- 
mal position  (as  I  have  witnessed  many  times  in 
my  ofiice),  but  in  other  cases  it  is  absolutely  nec- 
essary to  restoie  the  uterus  to  its  normal  size  and 
weight  first. 

Another  remarkable  thing  in  this  case  which  I 
have  noticed  in  nearly  all  the  others,  is  the  deci- 
ded feeling  of  well  being  after  the  constant  current, 
and  also  the  tonic  effect  it  has  upon  the  bowels. 
With  this  remedy  then  at  our  disj)0salwe  need  no 
longer  dread  the  arrival  of  these  cases  at  our 
office,  for  instead  of  being  an  opprobrium  to  our 
skill,  the  treatment  of  each  one  of  them  becomes 
a  triumph. 

Sodei§  J^mceedin^k 

MEDICO-CHIRURGICAL      SOCIETY     OF 
MONTREAL. 
Stated  Meeting,   October  2%th,  1887. 

JAS.    PERRIGO,    M.D.,    PRESIDENT,  IN  THE  CHAIR. 
PATHOLOGICAL  SPECIMENS. 

Parasitic  Onychia. — Dr.  Johnston  exhibited 
( I  j  a  microscopic  section  of  a  nail  showing  parasi- 
tic onychia.  The  specimen  was  sent  him  by  Dr. 
Bell  who  hah  believed  the  case  to  be  of  this  na- 
ture. The  chains  of  trichophyton  were  seen  in  mod- 
erate numbers  in  the  deeper  layer  of  the  nail  and 
between  the  nail  and  its  bed,  though  a  mass  of  dry 
porous  tissue  formed  over  the  bed  of  the  nail  was 
free  from  the  parasite. 

Dr.  Bell  gave  the  following  history  of  the  case  : 
Miss  E  ,  aged  20,  in  scraping  the  back  of  her  thumb 
nail  about  a  year  ago,  cut  through  it  about  the 
middle.  A  light  brown  spot  developed  at  this  point 
and  gradually  extended  to  its  free  margin,  and  then 
began  to  grow  backwards  towards  the  cicatrix.  It 
was  painless.  When  seen  the  anterior  two-thirds 
of  the  nail  was  dull  and  dry-looking,  yellowish- 
brown  in  color,  and  raised  from  its  bed  at  the  free 
anterior  margin  to  the  extent  of  nearly  half  an  inch. 
The  tissue  between  the  nail  and  its  bed,  at  the 
margin,  was  quite  dry  and  cancellated,  resembling 
the  cancellated  structure  of  a  dry  bone.  The  nail 
was  removed  by  sitting  down  the  centre  and  remov- 
ing the  two  portions  separately.  This  cancellated 
structure  was  separated  from  the  nail-bed  by  a 
thin  fibrous  layer,  beneath  which  the  nail-bed  was 
absorbed.  Owing  to  its  peculiar  appearance  the 
nail  was  macerated  and  sections  cut  through  the 
diseased  part.     On  examination,  there  showed  in 


considerable  quantities  the  mycelium  and  sporse 
of  the  trichoijhyton,  resembling  the  fungous  as  seen 
in  tinea  circinata  rather  than  as  usually  seen  in  T. 
tonsurans.  'I'here  was  no  history  of  tinea  on  this 
patient's  skin,  nor,  as  far  as  she  knew,  on  other 
members  of  her  family. 

Brone/to- Pneumonia. — (2)  A  microscopic  sec- 
tion through  the  lung  of  a  sheep  in  a  case  of 
broncho-pneumonia,  where  great  numbers  of  the 
embryos  of  strongylus  filaria  were  found  in  the  al- 
veoli, which  were  filled  with  exudation,  and  there 
was  severe  bronchitis  and  peribronchitis  of  the 
smaller  tubes.  The  adult  forms  were  not  found 
within  the  bronchi,  having  probably  been  coughed 
up.  The  embryos  are  not  able  to  develop  beyond 
this  stage  in  the  lung. 

Amputation  of  the  Thigh. — ^Dr.  Bell  exhibited 
a  patient  whose  thigh  had  been  amputated  for 
periosteal  sarcoma.  (The  specimen  was  exhibited 
at  the  last  meeting.)  This  patient  was  18  years 
of  age,  and  at  the  time  oT  operation  was  in  a  very 
bad  condition.  His  temperature  ranged  from 
loo'^F.  to  io3j°F.,  his  pulse  from  120  to  140  per 
minute,  and  he  was  greatly  emaciated.  Amputa- 
tion was  performed  by  the  circular  method,  about 
two  inches  below  the  base  of  the  trochanter  major, 
on  the  3rd  of  October,  and  from  that  time  his  con- 
dition improved  with  extraordinary  rapidity.  His 
temperature  remained  steadily  at  98^°,  and  he  rap- 
idly regained  flesh.  The  dressing  was  changed 
once  only  on  the  eight  day,  and  finally  removed 
on  the  twenty-fourth  day  after  operation,  when  the 
stump  was  soundly  and  perfectly  healed. 

Osteotomy  for  Bow-legs. — A  child  t,^  years  of 
age  was  shown  to  the  Society,  on  whom  Dr.  Bell 
had  performed  double  osteotomy.  The  condition 
was  the  result  of  rickets,  from  which  the  child  had 
perfectly  recovered.  The  operation  had  been  done 
by  MacEwen's  method,  and  had  resulted  very 
favorably.  Photographs  were  shown  of  the  child's 
legs  before  operation. 

Discussion. — Dr.  Roddick  referred  to  the  good 
results  obtained  by  Dr.  Bell  using  bone  drains. 
His  experience  with  this  mode  of  draining  was  not 
so  favorable,  as  he  found  that  the  bone  drains  were 
too  rapidly  absorbed.  While  he  congratulated  Dr 
Bell  on  the  excellent  results  obtained  in  his  opera! 
tion  for  bow-legs,  yet  he  could  not  agree  with  the 
necessity  for  the  operation.  Dr.  MacEwen,  who  in- 
troduced the  operation,  does  not  recommend  its 
application  in  patients  under  9  years.     He  (Dr. 


82 


TUE   CANADA   MEDICAL   RECORD. 


Roddick)  had  obtained  quite  as  good  results  from 
the  use  of  mechanical  contivances  in  children  even 
older  than  the  patient.  He  thought  that  in  most 
cases  subcutaneous  fracture  is  to  be  preferred  to 
osteotomy  as  it  is  a  less  serious  operation,  and  of- 
fers less  risk.  While  opposed  to  operations  in  most 
of  these  case  of  deformity  he  thought  it  was  more 
often  called  for  in  knock-knees  than  in  bow-leg,  as 
the  former  requires  much  longer  and  more  painful 
treatment. 

Dr.  Shepherd  said  that  in  one  of  the  few  times 
he  had  used  bone  drains  he  found  patient's  tem- 
perature had  risen  and  the  drain  plugged  with  a 
clot.  He  always  prefers  using  rubber  drains,  which 
he  cuts  down  to  three-quarters  of  an  inch  at  end 
of  twenty-four  hours.  In  Germany  the  "  single 
dressing"  mania  often  results  disastrously  to  the 
patient.  In  German  hospitals  he  was  frequently 
shown  single  dressing-cases  where  the  temperature 
chart  indicated  an  unhealthy  condition  of  the 
wound.  He  had  seen  Dr.  Bell's  patient  before 
operation,  and  could  heartily  congratulate  him  on 
the  success  of  his  operation.  With  regard  to  the 
osteotomy  case,  he  referred  to  the  erroneous  but 
common  opinion  that  all  cases  of  bow-legs  results 
from  rickets.  The  peculiarity,  is  often  hereditary, 
and  is  quite  normal  in  many  of  the  anthropoid  apes. 
Dr.  Armstrong  referred  to  Dr.  Lewis'  system 
of  drainage.  He  used  solid  rubber  strings  placed 
side  by  side,  instead  of  tubes,  thus  obviating  the 
danger  of  plugging. 

Dr.  GuRD  said  he  had  seen  very  good  results 
from  treatment  ofbow-legs  by  improving  the  general 
health.  He  had  great  faith  in  the  efficacy  of  good 
hygienic  surroundings  and  the  use  of  tonics  in  such 
cases.     Instruments  have  proved  unsatisfactory. 

Dr.  Bell,  in  reply,  stated  that  the  drains  used 
were  made  from  chicken  bones,  by  the  method  re- 
commended by  Dr.  MacEwen  of  Glasgow.  These 
could  be  obtained  as  hard  or  as  soft  as  desired.  In 
the  case  of  osteotomy,  the  curve  in  the  child's  legs 
was  greatest  just  above  the  maleolus,  so  it  could 
not  by  treated  by  subcutaneous  fracture. 

Notes  on  Acetaiiilide. — Dr.  McConnell  first 
briefly  stated  what  was  known  about  acetanilide 
or  antifebrine  up  to  the  present  time.  It  was 
procured  from  aniline  acetate.,  is  a  white  powder 
resembling  santonin,  insoluble  in  water,  but  solu- 
ble in  alcohol.  It  is  neither  alkaline  nor  acid,  and 
resists  the  majority  of  reagents.  Belongs  to  the 
order  Phenylaeetamides,  quite  different  from  the 
orders  containing  the  majority  of  antipyretics,  viz. 


the  Phenols  and  Chinolins.  Actions  claimed  for 
it  are  that  it  rapidly  reduces  the  temperature  in 
febrile  states,  without  producing  any  untoward 
effects  ;  that  it  is  also  hypnotic  and  analgesic,  being 
especially  useful  in  relieving  pain  linked  with  nerve 
alterations.  In  poisonous  doses  it  will  destroy  oxy- 
hsemoglobin,  changing  it  into  methremoglobin.  It 
is  inexpensive,  being  only  lo  frances  per  i  kilo- 
gramme in  France.  Had  used  it  in  about  20  cases 
16  of  which  he  had  records  of — 9  were  cases  of 
typhod  fever — in  all  of  which  the  temperature  was 
promptly  reduced.  The  following  case  may  be 
regarded  as  typical  of  its  action  in  this  disease  : 

Girl  aged  9  ;  Oct  25th  was  seventh  day  of  fever 
at  5  P.M., five  grs.  acetatiilide  were  given,  when 
pulse  was  120,  respirations  28,  and  temperature 
105^0 

5.  00  p.m. — Pulse  120,    resp.   28,  temp.   105!° — 

Face  and  general  surface  pale,  dry,  and  hot. 
5.10   p.m. — Pulse    120,   resp.    20,    temp.    105'' — 

Pink  flush  on  both  cheeks,  pulse  stronger. 
5.20  p.m. — Pulse    120,    resp   32,    temp.   104^8 — 

Forehead,  neck  and  trunk  moist,  and  whole  sur- 
face of  Reddish  hue  ;  somwhat  more  restless. 
5.  30  p.m. — Pulse   112,  resp.  32,  temp.  103I? — 

Has  become    tranquil   and  fallen    asleep  ;  skin 
moist,  no  visible  perspiration. 
6.00  p.m. — Pulse    120,  resp.    30,  temp.   102^? — 

Surface  in  same  condition  ;  still  sleeping. 
6.30    p.m. — Pulse  108,  resp.    24,   temp.    looj'^ 
7.00   p.m. — Pulse     102,  resp.   24,    temp.    100° — 

Asked  for  a  piece  of  bread. 
7.30    p.m. — Pulse    102,  resp.    24,   temp.   loo** 
8.00  p.m. — Pulse   108,    resp.  25,  temp.    looj'- — 

Skin  has  become  dry. 
8.30  p.m. — Pulse    108,    resp.  30,    temp.    101° — 

Pulse  diminished  in  volume  and  of  less  force. 
9.00   p.m. — Pulse    112,   resp.  30,  temp  \o\\° 


930 

(f 

a. 

112, 

it 

3°> 

ii 

I02?« 

10.00 

(( 

a 

116, 

a 

28, 

a 

IO2I'' 

10,30 

(( 

li 

120, 

t( 

30> 

li 

IO3IS 

11.00 

(( 

li 

120, 

a 

32, 

ti 

i03« 

1.20 

a.m. 

(( 

120, 

i< 

3o> 

ii 

103=0 

Oct.  26  ;  II  A.M. — Mother  states  child  appeared 
to  be  very  feverish  from  12  to  8  a.m.,  and  was  rest- 
less and  drank  milk  frequently.  Six  grs.  were  given 
to-day ;  same  effects  observed,  only  there  was 
more  perspiration,  and  temperature  became 
normal,  remaining  so  for  only  an  hour. 
Temperature  subsequently  rose  on  the  30th  to 
106  °  ,  and  on  the  31st  to  io6|  °  ,  but  was  always 
reduced  to  about   normal;  but   the  doses  were 


fflE   CANADA   MEDICAL   RECORD. 


83 


increased  to  8  grs.  Three  and  four  doses  were 
required  in  the  24  hours  to  keep  the  temperature 
at  or  about  normal,  child  resting  quietly  after 
each  dose  and  taking  nourishment  freely  at 
present  date,  Nov.  7th.  It  would  seem  in  this 
case  that  the  temperature,  after  the  effects  of 
acetanilide  had  passed  away,  rose  higher  through 
its  action. 

Case  I. — Boy  aged  12,  typhoid  ;  Oct,  20th.  1.30 
P.M.,  ninth  day  of  fever,  pulse    120,    temperature 


I04r  : 


five  grs.  reduced    teniperature    98s 


in 


three  hours.  This  dose  acted  in  the  same  manner 
on  ^he  2 1  St  and  22nd.  Did  not  rise  again  above 
102°,  and   gradually  declined. 

Case  2  has  a  similar  record,  and  also  Case  3. 

Case  4.— Young  lady,  aged  29  years  ;  mild  ty- 
phoid, Sept.  nth,  tenth  day  ,  has  had  troublesome 
headache  since  she  became  ill,  and  could  not 
sleep  during  last  two  nights.  Six  grs.  acetanilide 
were  given  at  10  p.m.  Patient  fell  asleep  in  fifteen 
minutes  and  slept  all  night,  and  was  free  from 
pain  when  she  awakened ;  it  returned  the  two 
following  days,  but  was  slight. 

Case  5. — Lad  aged  12,  typhoid.  On  March 
28th,  the  27th  day  of  fever,  temperature'was  1045° 
Six  grs.  acetanilide  caused  a  profuse  perspira- 
tion and  slight  cyanosis.  Subsequently  4  grs. 
reduced  the  teniperature  below  normal ;  3  grs. 
was  found  to  be  a  sufficient  dose.  After  April  1st 
temperature  gradually  came  down  to  normal. 

Case  6. — Young  lady,  aged  19  ;  mild  typhoid. 
The  severe  headache  was  also  promptly  relieved 
by  6  grs.  acetanilide;  did  not  return. 

Case  7. — Boy  aged  9  ;  double  lobar  pneumonia. 
June  13th,  pulse  144,  respirations  48,  temperature 
i°5°°  i  5  gfs.  acetanilide  reduced  temperature, 
to  normal  in  three  hours  ;  in  five  hours  after  dose, 
pulse  120,  temperature  1005°,  respirations  32. 
14th,  I  P.M.,  pulse  140,  respirations  44,  temperature 
106  °  ;  at  2  P.M.,  5  grs.  were  given  ;  at  5  p.m.  tem- 
perature 97?°  ,  and  at  9.30,  pulse  132,  temperature 
io2|°,  respirations  ^6.  i6th,  5  grs.  at  2  p.m. 
reduced  temperature  from  105  to  101?°  in  three 
hours;  11  p.m.,  pulse  112,  temperature  102'°, 
respirations  56.  19th,  11  a.m.,  respirations  68, 
pulse  120,  temperature  103J.  20th,  temperature 
normal. 

Case  8,  Septicemia  (Puerperal). — Patient  aged 
37,  her  first  child.  Forceps  used  and  artificial 
extraction  of  placenta  ;  antiseptic  uterine  douches 
were  used  and  iodoform  suppositories.  Temper- 
ature was  not  high  until  the  tenth,  day  104°  j  on 


the  eleventh  day,  8  grs.  acetailide  reduced  tem- 
perature to  normal.  Did  not  rise  again  above 
102  °  ;  curette  used  on  the  thirteenth  day  ;  in  two 
evening  days  after,  temperature  was  normal,  with 
slight  exacerbations. 

Case  9. — Young  man,  aged  23 ;  pneumonia 
(double).  On  Oct.  i6th,  sixth  day,  pulse  120, 
respirations  64,  temperature  103J;  8  grs.  reduced 
temperature,  causing  profuse  perspiration.  17th,  i 
P.M.,  temjierature  io2j;8p.m.,  temperature  99?°, 
pulse  90,  respirations  36. 

Case  1 1    has  much  the  same  record. 

Case  12,  Puerperal  Septicaemia. — Patient  con- 
fined in  a  house  where  there  was  a  case  of  erysi- 
pelas in  next  room.  All  antiseptic  precautions 
were  observed,  but  next  day  temperature  was 
1055°  ;  uterine  douches  of  corrosive  sublimate, 
followed  by  carbolic  acid  and  then  iodoform 
suppositories  were  used;  8  grs.  acetanilide  brought 
temperature  to  normal,  with  profuse  sweating. 
This  dose  was  repeated  on  the  two  following  days, 
after  which  there  was  no  further  elevation  of  Tem- 
perature. 

Case  13 — Nervous  headache,  lady  aged  28,  had 
lasted  two  days  ;  5  grs.  acetanilide  gave  complete 
relief  in  about  two  hours.  Same  results  in  two 
subsequent  attacks. 

Case  14. —  Erysipelas. — Boy  aged  15.  Oct.  27th, 
noon,  7  grs.  acetanilide  were  admiaistered  ;temper- 
ture  was  104^  °  .  In  three  hours  temperature  was 
still  103  °  ;  8  grs.  were  then  given  ;  in  two  hours 
temperature  was  102°.  28th,  2.30  p.m.,  pulse 
no,  temperature  105°;  15  grs.  acetanilide  were 
given.  In  3!  hours  temperature  was  100  °  ;  in  4^ 
hours  after,  respirations  20,  temperature  99'  °  ; 
perspiration  has  ceased.  For  several  days  these 
large  doses  were  required  to  keep  temperature 
down  ;no  fever  Nov.  2nd. 

Case  15. — Lady,  aged  22  ;  one  day  ill.  Severe 
headache,  general  soreness,  pains  in  back,  anor- 
exia, coated  tongue,  and  temperature  104^°  ;  8 
grs.  acetanilide  at  10  p.  m.,  purgative  in  morning. 
Went  asleep  shortly  after  taking  powder.  Tem- 
perature next  day  normal ;  no  headache  ;  feeling 
quite  well. 

In  Case  9,  typhoid,  young  man  aged  23,  half- 
hours  record  of  temperature  was  kept  on  the  two 
occasions  when  it  was  administered,  with  results 
similar  to  Case  i. 

According  to  Wood,  Macalister  and  others, 
fever  is  a  disturbance  of  calorification  in  which, 
through  the  nervous  system,  heat  production  and 


84 


THE   CANADA   MEDICAL   RECORD. 


heat  dissipation  are  both  affected  ;  that  there  is  a 
nervous  centre    whicli  inhibits  the  production  of 
heat  and  a  thermogenic  centre    (located  by  Aron- 
sohn    and  Sachs  at  the  inner   side   of  the  carpus 
striatum),  which  excites  increased    tissue  change  ; 
that  heat  dissipation  is  regulated  by  the  vaso-motor 
nerves;  that  temperature  is  no  indication  of  fever, 
as  heat  production  may  be  normal,  but  elevation  of 
temperature  results  from  diminished  heat  loss,  and 
we  may  have   increased  heat  production  (pyrexia) 
but,  owing  to  increased  heat  loss,  no  elevation  of 
temperature.     Hyperpyrexia    ensues    when    heat 
production  is  increased  with  diminished  heat  loss. 
Antipyretics  act  either  by  lessening  the  production 
of  heat,  as  quinine,  salicylic  acid,  and  all  cardiac 
depressants,    or  by  increasing  the  loss  of  heat,  as 
alcohol,  sudorifics,    cold,   antipyrin.     Acetanilide 
also  belongs  to  the  latter  group.  From  the  reports 
of  these  cases,  we  can  gather  that  acetanilide  in 
proper  doses  will,  in  the  elevation  of  temperature 
of  typlioid  fever,  pneumonia,  erysipelas,  septicae- 
mia, and   doubtless  all  febrile  states,  bring  about 
a  state  of  apyrexia,  or  a  subnormal  temperature  if 
the  dose  is    larger,  in  from  two  to    four  hours,  the 
temperature  beginning  to  full   usually  in  from  ten 
to  15  minutes  after  its  administration,    instead   of 
an  hour  as  hitherto  usually  reported,  the  reduction 
ordinarily  being  five  or  six  degrees,  and    may   be 
over  eight ;  the  pulse  rate  is  lessened  simultaneously 
with  the    fall    of  temperature  and  also    the  num- 
ber of  respirations.     The  dose  varies  from  6  to  15 
grains  for  an  adult,  is  easy  of  administration,  and 
best  given  in  wine  or  simple  elixir.     In  an  hour  or 
two  after  the  lowest  temperature  the  dose  produces 
is  reached,  it  again  begins  to  rise,  and  in  four  to 
eight  hours  may  be  as  high  as  before  the  dose  was 
taken,  or  it  may  not  rise  as  high  again  for  several 
days  or  even  throughout  the  illness. 

Idiosyncrasy  or  individual  susceptibilty  to  the 
action  of  the  drug  varies  considerably,  and  in  cases 
where  there  is  not  any  apparent  evidence  for  anti- 
cipating dissimilar  effects;  disease  also  exercises  a 
modifying  influence,  cases  of  erysipelas  requiring 
larger  than  ordinary  doses.  Hence  it  is  desirable  to 
begin  with  small  doses  and  increase,  if  necessary, 
until  the  quantity  which  will  bring  the  temperature 
down  to  normal  is  lea/ned.  It  first  stimulates  the 
vasomotor  (constrictor)  system,  leading  to  increa- 
sed arterial  tension,  quickly  followed  by  dilatation  of 
the  cutaneous  arterioles,  thus  permitting  increased 
radiations  or  heat,  perspiration  immediately  super- 
venes, and  the  temperature  rapidly  declines  with 
lowered  arterial  tension. 


It  is  an  analgesic,  giving  speedy  reliefin  neural- 
gic pain  and  headache,  being  especially  service- 
able in  the  headache  present  in  the  early  stage  of 
typhoid  fever. 

It  is  also  a  reliable  hypnotic  and  nervous  seda- 
tive in  the  sleeplessness  and  excitability  of  febrile 
states. 

It  doubtless  in  ovei  doses,  as  evidenced  by 
cyanosis,  inhibits  the  respiratory  functions  of  the 
blood  probably  as  explained  by  so  modifying  the 
hajmoglobin  that  less  oxygen  is  conveyed  by  the 
corpuscles  and  a  state  of  internal  asphyxia  ensues, 
the  diminished  oxidation  thus  lessening  heat  pro- 
duction. It  has  no  influence  in  shortening  the 
course  of  zynotic  affection  ;  hence  in  typhoid, 
would  not  consider  its  administration  advisable 
unless  the  evening  temperature  was  above  103,  the 
the  dose  to  be  repeated  in  five  or  six  hours,  as 
necessary.  No  untoward  effects  result  when  pro- 
per doses  are  given,  the  patient's  invariable  state- 
ment being  that  they  feel  better,  and  in  the  state 
of  apyrexia  may  experience  hunger;  even  in  over- 
doses, the  temporary  cyanosis  is  quickly  recovered 
from  without  and  evil  result. 

Discussion. — Dr.  Proudfoot  had  used  acetani- 
ide  in  painful  affections  of  the  eye,  such  as  iritis  and 
glaucomata,  in  doses  of  10  to  15  grs.  He  found 
it  reduce  the  temperature  and  relieve  the  pain  al- 
most instantly.  If  the  pain  was  not  relieved  in  one 
hour,  he  usually  repeated  the  dose. 

Dr.  Stewart  said  he  had  very  little  experience 
in  the  use  of  the  drug.  He  had,  however,  ad- 
ministered it  in  five-grain  doses  to  relieve  the 
lightning  pains  of  locomoter  ataxia,  and  found 
it  very  efficient.  He  regarded  it  as  dangerous  to 
give  powerful  drugs  in  fever  cases  to  reduce  the 
temperature,  as  these  act  on  the  oxyhaemoglobin, 
thus  reducing  the  patient's  powers  of  resistance. 

Dr.  Reed  stated  that  from  Dr.  Charcot's  recom- 
mendation he  had  used  it,  but  had  not  been  able 
fo  relieve  pain.  He  had  found  it  reduce  the 
temperature  for  a  time,  though  not  sufficiently  to 
encourage  him  to  continue  its  use. 

Dr.  Perrigo  said  that  the  drug  failed  entirely 
in  a  case  of  malaria,  in  which  he  had  tried  it. 

Dr.  Roddick  congratulated  Dr.  McConnell  on 
finding  something  to  relieve  the  distressing  head- 
ache of  typhoid.  He  had  given  it  in  a  case  of 
erysipelas,  but  it  had  no  effect  on  the  temperature. 

Dr.  Blackadkr  had  also  administered  the  drug 
in  erysipelas  with  very  little  effect.  The  German 
authorities  state  that  it  is  without  effect  in  scarlet 


The   CANADA   MEDICAL   KECORO. 


8S 


fever  and  erysipelas.  He  thought,  however,  that 
the  anodyne  properties  of  tiie  drug  would  keep  it 
in  the  pliarmacopu;ia. 

In  reply  to  remarks  of  Dr.  Stewart  that  its 
action  on  oxyhfemoglobin  was  an  objection  to  its 
use.  Dr.  McConnell  said  this  only  occurs  to  any 
appreciable  extent  when  over-doses  are  taken. 
The  antipyretic  action  is  almost  altogether  exerted 
through  the  nervous  system,  and  chiefly  the  vaso- 
motor. The  want  of  effect  in  cases  referred  to  by 
Drs.  Reed  and  Perrigo  was  owing  to  its  having 
been  administered  in  too  small  doses. 


Stated  Meeting,  Nov.  \it/t,  18S7. 
WiM.  G.ARDNE.'?,    M.D.,   1ST  Vice-President,  in 

THE    Cll.MR. 

Treatment  of  Ulcers  after  Thiersch's  Method. — 
Dr.  Bell  read  a  paper  on  the  treatment  of  ulcers 
by    Thiersch's   method  of    skin    transplantation. 

Discussion. — Dr.  Kingston  regarded  the  results 
obtained  by  Dr.  Bell  as  highly  satisfactory.  He 
thought  the  greatest  drawback  to  the  method  was 
the  difficulty  of  obtaining  these  large  pieces  of  skin 
sufficiently  thin. 

Dr.  Roddick  thought  that  this  mode  of  treatment 
was  an  improvement  on  all  others  for  certain  kinds 
of  ulcers.  He  did  not  think  it  was  necessary  to 
dissect  out  the  ulcer;  a  fresh  surface  could  be  ob- 
tained by  scraping.  The  first  case  shown  was 
under  his  care  in  the  hospital.  He  at  one  time 
held  suspicions  that  it  was  a  case  of  epithelioma ; 
he  intended,  however,  to  have  scraped  out  the 
ulcer  and  filled  it  up  by  skin-grafting. 

Dr.  Shepherd  referred  to  some  cases  he  had 
seen  treated  in  this  way  in  New  York  three  years 
ago.  Surgeons  have  been  known  to  use  the 
whole  thickness  of  the  skin. 

Dr.  Campbell  said  that  many  old  methods  are 
often  forgotten  in  the  search  after  new  ones.  He 
regarded  the  old  method  of  strapping  ulcers,  known 
as  Beyuton's  method,  as  one  of  the  best.  This 
method  and  the  treatment  by  blistering,  though 
now  largely  suppHnted  by  others,  had  formerly 
yielded  him  excellent   results. 

Dr.  Bell,  in  replying,  stated  that  he  did  not 
claim  this  method  to  be  the  best  for  all  classes  of 
ulcers,  but  did  believe  that  it  was  applicable  to 
ulcers  that  could  not  be  healed  by  other  methods- 
He  always  carefully  removed  all  the  diseased 
tissue  before  applying  the  skin-grafts,  but  did  not 


think  dissecting  out  every  ulcer  was  necessary. 
He  had  dissected  out  the  ulcer  in  the  first  case 
because  he  feared  that  deejier  tissues  were  involved. 
He  had  seen  successful  cases  in  Germany  where 
the  deeper  tissues  had  to  be  removed,  and  even 
pieces  of  bone  chii)ijed  off  before  applying  the  new 
skin.  The  longest  lime  taken  by  any  of  the  ulcers 
to  heal  was  thirty  days  ;  that  was  his  first  case.  It 
was  dressed  on  the  fifth  and  thirteenth  day  ;  none  of 
the  other  cases  were  dressed  before  the  twenty-first 
day,  when  he  invariably  found  the  ulcer  healed. 
This  method  possessed  the  great  advantage  of 
growing  a  good  sound  skin  to  the  ulcer,  and  does 
not  necessitate  reducing  the  ulcer  to  a  healthy 
condition  before  grafting. 

Vi/stine  Calculi. — Dr.  Roddick  exhibited  several 
small  cystine  calculi  passed  per  urethram.  The 
patient  is  a  delicate-looking  man,  57  years  of  age  ; 
he  gave  a  history  of  several  attacks  of  renal  colic, 
the  first  occurring  three  years  since,  followed  by 
the  passage  of  some  fifty  calculi  varying  in  size 
from  a  pin's  head  to  a  pea.  Lately  the  attacks 
have  been  less  severe,  and  all  have  not  been 
followed  by  passage  of  stones,  but  always  gravel. 
Pain  formerly  equally  severe  over  both  kidneys, 
of  late  only  over  left.  No  hereditary  history  of 
stone  of  any  kind. 

Rertiarhs. — Cystine  calculi  are  exceedingly 
rare — less  than  one  per  cent,  in  European  collec- 
tions. Gross  says  he  never  met  with  it.  The 
disease  is  common  in  dogs.  Nearly  all  cases  pre- 
viously reported  show  hereditary  history.  This 
from  of  calculi  always  forms  in  the  kidney,  and  is 
usually  multiple.  They  have  the  appearance  of 
beeswax,  and  soft  enough  to  be  compressed,  as  in 
the  specimens  exhibited,  where  from  lying  in 
contact  either  in  the  kidney  pelvis  or  the  prostatic 
urethra  have  become  faceted.  The  majority  of 
the  stones  paised  in  this  case  are  coated  over  with 
uric  acid. 

Discussion. — Dr.  Ruttan,  after  showing  a  slide 
of  crystals  of  cystine  under  the  microscope,  demon- 
strated some  of  its  chemical  reactions.  He  also 
stated  that  this  variety  of  calculi  is  not  always 
soft  when  passed,  as  by  remaining  in  the  bladder 
for  any  length  of  time  they  may  become  coated 
with  uric  acid  or  phosphates.  Some  of  the  calculi 
shown  are  coated  with  uric  acid ;  one  calculus 
containing  about  25  per  cent.  Owing  to  the 
peculiar  constitution  of  cystine,  it  combines  with 
and  is  soluble  in  either  strong  alkalies  or  acids, 
thus  easily    distinguished    from  uric  acid.      The 


S6 


*flE  Canada  medical  record. 


sulphur  is  readily  detected  either  by  boiling  the 
powdered  calculi  in  lead  acetate  and  caustic  potash, 
or  by  fusing  with  potash  and  adding  a  drop  of  nitro- 
prussiate  of  soda  ;  the  purple  color  in  the  test  is 
very  marked.  As  no  other  calculus-forming  sub- 
stance contains  sulphur,  the  detection  of  its 
presence  in  a  calculus  proves  it  to  be  cystine. 
Cystine  was  also  found  in  marked  quantity  in  the 
patient's  urine. 

Dr.  Reed  referred  to  a  fine  specimen  belonging 
to  Dr.  Fenwick,  which  had  been  removed  by 
lihotomy.  It  was  soft  like  wax  while  in  the  bladder. 
The  appearance  of  the  hexagonal  crystals  under 
the  microscope  resembles  iodoform,  and  care  must 
be  taken  not  to  confound  the  one  with  the  other 
when  this  drug  has  been  used  in  injections. 

Case  of  Perioslc'il  Sarcoma  of  Femur. — Dr. 
Roddick  gave  the  following  history:  The  patient 
was  a  young  man,  a  civil  engineer  by  profession,  24 
years  of  age,  thin  and  anaemic.  Distant  family 
history  of  tubercle,  but  none  of  cancer  or  tumor 
of  any  kind.  No  history  of  syphilis.  He  was 
quite  well  up  to  July  last,  when  he  sustained 
slight  injury  to  left  knee,  aggravated  later  by  kneel- 
ing in  canoe  for  several  days  paddling.  The  case 
looked  at  first  like  simple  or  rheumatic  synovitis, 
and  he  was  treated  as  such  by  blistering,  etc. 
When  he  came  under  observation  here  the  effusion 
was  very  great,  causing  severe  pain  from  tension  ; 
skin  thickened  and  slightly  cedematous,  not  like  the 
smooth,  ghstening  or  white  appearance  of  ordinary 
or  strumous  synovitis.  Aspiration  showed  thin, 
bloody  serum  containing  blood-clots  and  debris  of 
tissue.  Suspected  sarcoma,  and  made  exploratory 
incision. 

Remarks. — Had  patient's  condition  warranted, 
would  have  preferred  amputation  at  hip,  as  I 
believe  periosteum  sarcoma  more  liable  to  recur 
owing  to  continuity  of  periosteum.  Would  be  less 
afraid  of  recurrence  in  central  or  myeloid  sarcoma. 
Patient  was  doing  well  at  time  of  report,  one  week 
after  operation. 

Discussion. — Dr.  Kingston  said  he  could  agree 
with  Dr.  Roddick  in  the  unsatisfactory  nature  of 
an  amputation  in  the  continuity  of  the  bone  in 
periosteal  sarcoma,  He  had  formerly  operated 
leaving  a  portion  of  the  bone,  but  found  he  had 
almost  invariably  to  operate  again  later  to  remove 
the  rest  of  the  bone.  In  his  opinion,  operation  in 
the  continuity  of  the  bone  is  always  unsatisfactory, 
while  removal  of  the  entire  bone  has  given  him  the 
best  of  results. 


Dr.  Shepherd  said  that  in  his  experience  the 
disease  generally  reappeared  in  either  form  of 
operation,  not  in  the  stump,  as  a  rule,  but  in  some 
of  the  organs  of  the  body. 

Dr.  Bell  could  recall  many  cases  during  his  expe- 
rience in  the  General  Hospital,  where  the  limb 
had  been  amputated  in  the  continuity  of  the  bone. 
In  all  these  cases  the  disease  had  recurred  in  some 
of  the  internal  organs.  Cancer,  in  his  opinion, 
does  not  spread  by  the  periosteum,  but  through 
the  lymphatic  system.  . 

Resection  of  the  Intestine. — Dr.  Jas.  Bell  show- 
ed a  specimen  from  the  following  case : — B.    D., 
aged  17,  was  admitted  to  hospital  on  the  evening 
of  the  8th  of  November,  suffering  from  a  strangu- 
lated inguinal  hernia.     The  boy  was  a  plumber  by 
occupation,  and  had  never  had  a  hernia  until  Sun- 
day, the  6th  of  November,  two  days  prior  to  admis- 
sion, when  he  complained  of  pain  in  the   upper 
zone  of  the  abdomen  and  noticed   the  swelling  in 
the  right    scrotum.      He  took  a  dose    of    black 
draught,  which  produced  in  the  night  one  small 
motion.     Vomiting  set   in  the  following  morning 
and  continued  until  his  admission  to  hospital.  The 
patient   was    anaesthetized,    and   moderate    taxes 
having  failed,  herniotomy  was  performed.  The  sac 
was  opened  and  found  to  contain  about  ten  inches 
of  small  intestine,  very  firmly  strangulated  in  the 
whole  length  of  the  canal,  which  was  enlarged,  and 
the  bowel  drawn  out  and  examined.     It  was  very 
black,  but  glistening,  and  distended  with  air,  and 
was  consequently  returned.  The  obstruction  symp- 
toms, however,  remained  unrelieved,  and  tympani- 
tic distension  of  the  abdomen  developed  gradually. 
The  pulse  and  temperature,  as  well  as  the  general 
symptoms,  indicated  peritDnitis.     Thirty-six  hours 
after  the  herniotomy  it  was  decided  to  open  the 
abdomen  and  endeavor  to  relieve  the  obstruction. 
The    abdomen  was  opened  in  the   middle   line. 
There  was  general  peritonitis,   and  the  intestines 
were  hyperdistended  with  gas.     The  obstruction 
was  found  to  be  due  to  the  collapsed  and  kinked 
condition  of  the  portion  of  gut  which  had  descen- 
ded in  the  hernial  sac.  It  was  the  lower  portion  cf 
the  ileum,  and   was  quite  gangrenous,  lines  of  de- 
marcation forming  at  the  points  where  it  had  been 
constricted  at  the   internal  ring.     The  gangrenous 
bowel    was   excised  with  a  triangular  portion  of 
mesentery,  the  operator  cutting  through  the  healthy 
bowel  about  half  an  inch  beyond  the  forming   line 
of  demarcation  at   either   end,  the   lower  section 
being  about  three  inches  from  the  caacal  valve.  The 


TIIK   CANADA    MEDICAL    RECORD. 


87 


distended  intestines  were  punctured  by  hollow  as- 
pirating needles  to  evacuate  the  gas  before  they 
could  be  returned.  After  excision,  the  ends  of  the 
bowel  were  carefully  united  by  silk  sutures,  the  first 
six  or  eight  being  carried  through  the  wliole  thick- 
ness of  the  wall  of  the  gut  at  opposite  points  to 
secure  accurate  coaptation  and  then  a  continuous 
Lembert  suture.  The  abdomen  was  washed  out 
with  warm  water,  a  drainage  tube  left  in  the  lower 
end  of  the  wound,  and  a  gauze  dressing  applied. 
The  operation  occupied  one  houi'  and  a  half,  and 
the  patient,  who  only  partially  rallied,  died  two 
hours  after  its  completion. 

Discussioii. — Dr.  Shepherd  said  that  he 
regarded  the  so  called  lustre  as  a  very  deceptive 
characteristic  of  healthy  intestine.  The  bowels  of 
subjects  in  the  dissecting-room  show  a  well  mark- 
ed lustre. 

Dr.  Roddick  thought  that  the  operation  of  the 
future  would  be  to  open  the  abdomen  at  once  and 
thus  obtain  a  good  view  of  the  affected  intestine. 
This  is  the  great  difficulty  of  the  ordinary  method 
of  operation.  He  had  seen  many  worse  cases 
than  Dr.  Bell's  recover. 

Dr.  Kingston  said  his  rule  in  strangulated  iier- 
nia  is  to  operate  at  once.  He  had  been  often 
astonished  to  see  how  quickly  cases  would  recov- 
er where  the  hernial  mass  was  quite  black  when 
returned  to  the  abodmen.  Removal  of  a  piece  of 
intestine  is  always  a  very  serious  operation.  He 
made  a  practice  to  return  the  bowel  in  every  case. 
Specimen  of  Tubercular  Cystitis. — Dr.  Johnston 
exhibited  the  bladder  and  kidneys  of  a  tubercu- 
ous  case  occurring  in  the  practice  of  Dr.  Roddick. 
An  unhealed  fistula  was  shown  opening  into  the 
urethra  in  front  of  the  jjrostate ;  upon  the  walls  of 
the  fistula  and  about  the  base  of  bladder  were  a 
a  few  tubercles  ;  the  rest  of  the  bladder  was  free 
from  tubercles.  The  right  ureter  showed  numer. 
ous  patches  of  tubercular  ulceration,  and  in  right 
kidney  two  of  the  calices  presented  extensive  case- 
lous  softening ;  left  kindey  and  ureter  free  from 
tuberclei  ;  acute  miliary  tubercular  peritonitis  and 
pleuritis  ;  miliary  tuberculosis  and  amyloid  of  liver, 
spleen  and  kidneys,  commencing  tubercular  men- 
ingitis. 

Dr.  Johnston  stated  that  he  had  examined  a  spe- 
cimen of  the  patient's  urine, sent  him  about  a  week 
before  the  death,  and  could  find  no  bacilli.  It  had 
surprised  him  when  on  making  the  autopsy  such 
extensive  caseous  softening  of  the  pelvis  of  the 
right  kidney  was  seen,  as  this  usually  yields  enor- 


mous numbers  of  tubercle  bacilli.  Examination 
of  the  caseous  masses  in  the  kidney,  however,  in 
about  twenty  si)ecimens  he  found  no  bacilli.  A 
small  number  of  bacilli  weic  found  in  the  ulcers  in 
right  ureter  and  in  the  walls  of  the  fistula,  and  this 
should  have  shown  the  true  nature  of  the  case  had 
a  larger  quantity   of  urine  been  examined. 

Dr.  Bell  had  the  case  under  observation  some 
time,  and  about  a  year  since,  suspecting  either 
stone  or  tumor  of  the  bladder,  performed  median 
lithotomy,  but  failed  to  find  any  foreign  body. 
The  perineal  opening  never  closed,  and  it  was  to 
receive  some  relief  for  this  that  he  was  admitted  to 
hospital  under  Dr.  Roddick's  care. 

Dr.  Roddick  stated  that  he  attempted  to  close 
the  perineal  opening  by  a  plastic  opeiation,  but 
this  failed.  The  immediate  cause  of  death  was 
tubercular  meningitis.  He  had  a  case  at  present 
in  hospital  where  he  had  long  suspected  tubercu- 
lar disease  of  the  kidney,  his  suspicions  being  at 
length  confirmed  by  the  discovery  of  bacilli. 

Dr.  Shepherd  said  that  Dr.  Guion  of  Paris 
states  that  tuberculous  affections  of  the  trigone  of 
the  bladder  or  of  the  prostate  is  always  character- 
ized by  symptoms  closely  resembling  tho.se  of  cal- 
culous, such  as  pain  at  the  end  of  the  penis  and 
frequent  micturition,  the  pain  increased  by  move- 
ment, etc. 

Dr.  Johnson  stated  that  in  this  case  the  oldest 
disease  was  near  the  prostatic  portion  of  the  blad- 
der, and  that  there  were  caseous  masses  in  each 
epididymus. 

Saccharine. — Dr.  Reed  made  a  few  remarks 
on  this  remarkable  substance,  and  passed  around 
a  specimen.  It  is  obtained  from  toluene,  a  coal- 
tar  dirivative.  The  intense  sweetness  of  the  com- 
pound, two  hundred  and  fifty  times  that  of  cane 
sugar,  and  its  inertness,  have  made  it  useful  in 
preparing  anti-diabetic  diets,  and  it  is  now  being 
used  with  success.  It  is  a  white  powder,  sparingly 
soluble  in  water  ;  half  a  grain  is  sufficient  for 
sweetening  a  cup  of  tea  or  coffee.  Even  at  its 
present  price  of  seventy-five  cents  per  ounce,  it 
competes  with  sugar. 


Stated  Meeting  November  2<,tk,    1887. 

Dr.  Guerin,  2ND  Vice-President,  in  the 
Chair. 

New  Members. — Drs.  H.  Perry  and  Lome 
Campbell  were  elected  members. 

Multiple  Onychia. — Dr.  James  Stewart  exhib- 
ited for  Dr.  R.  J.  B.  Howard  a  case  of  multiple 
onychia  occurring  in  a  young  man  aged  iS. 


88 


THE   CANADA    MEDICAL   RECORD. 


Some  Questions  suggested  by  the  present  Epide 
mic  of  Diplitheria  in  Montreal. — Dr.  Armstrong 
then  read  a  paper  on  this  subject. 

Discussion. — Dr.  Proudfoot  could  thoroughly 
concur  in  what  Dr.  Armstrong  had  said  with  regard 
to  the  difficulty  sometimes  experienced  in  diagnos- 
ing a  case  of  diphtheria  from  "  follicular  tonsillitis.'' 
He  had  seen  cases  where  the  tonsil  was  inflamed, 
and  there  was  no  membrane  to  be  seen,  but  which 
subsequently  developed  a  severe  form  of  diphtheria. 
He  thought,  however,  that  where  the  glands  of  the 
neck  were  simultaneously  inflamed,  we  might  be 
pretty  sure  that  the  case  was  one  of  diphtheria. 
With  regard  to  the  recurrence  of  the  disease  in  the 
same  person,  he  was  of  opinion  tliat  a  patient  who 
had  true  diphtheria  was  seldom  again  atacked  by 
the  disease  ;  he  had  never  seen  more  than  two  or 
three  cases  of  the  kind. 

Dr.  Mills  thought  that  one  of  the  most  interest- 
i.ig  and  important  questions  in  connection  with 
diphtheria  was  the  causation  of  the  cardiac  weak- 
ness and  the  lesions  peculiar  to  the  heart.  Exper- 
imental examination  of  numerous  animals  had  now 
made  it  clear  that  the  vagus  was  all  important  to 
the  nutritive  processes  of  the  heart.  There  were 
many  clinical  and  pathological  facts  which  sup- 
ported the  same  view  for  man.  It  seemed  doubt- 
ful if  the  poison  of  diphtheria  injured  the  heart  sole- 
ly or  chiefly  by  affecting  the  muscular  tissue  direct- 
ly through  the  blood.  Did  the  virus  act  directly 
on  the  nerve  terminals  or  on  the  active  centres  of 
the  cardiac  nerves  or  other  centres  of  distribution 
(sympathetic  ganglia  is  case  of  accelerators)  ?  Fatty 
degeneration  of  the  cardiac  tissue  follows  section 
of  the  vagi.  May  not  the  degenerations  in  diphthe- 
ria have  also  a  nervous  origin  ?  It  is  important  to 
determine  this,  as  behind  it  lies  the  question  in 
this  and  many  other  cases  of  cardiac  disease  of 
therapeutic  treatment  through  the  nerves  of  the 
heart  or  their  centres.  Dr.  Mills  thought  the  present 
time,  when  diphtheria  was  so  prevalent,  afforded 
a  good  opportunity  to  raise  the  question  as  to  what 
action  the  Society  should  take  in  regard  to  some 
expression  of  opinion  on  the  general  sanitary  con. 
dition  of  the  city,  with  a  view  of  calling  more  di- 
rectly the  attention  of  citizens  to  the  subject,  and 
if  possible  of  rousing  the  civic  authorities  to  take 
such  steps  as  were  called  for  by  the  gravity  of  the 
sanitary  situation  for  some  years  past.  It  seemed 
to  him  that  it  was  the  privilege  and  duty  of  soci- 
ety, representing  the  English  part  of  the  profession 


at  least,  to  enlighten  and  warn  the  public  in  regard 
to  matters  of  such  vital  importance,  and  on  which 
the  Society  was  supposed  to  be  specially  compe- 
tent to  form  opinions.  Their  warnings  might  not 
always  be  heeded,  but  they  tended  to  form  and 
strengthen  enlightened  public  opinion ;  and,  at  all 
events,  the  question  was  not  one  of  practical  result 
but  one  of  the  duties  of  the  more  informed  towards 
the  less  informed,  and  in  not  a  few  cases  the  infan- 
tile and  helpless  members  of  the  community. 

Dr.  Geo.  Ross  said :  The  only  difficulty  in 
dealing  with  the  paper,  which  was  of  much  interest 
at  the  present  time,  was  the  extensive  ground  cov- 
ered by  it ;  indeed  any  one  or  two  of  the  important 
points  raised  would  be  sufficient  to  occupy  the  at- 
tention of  the  Society  for  an  entire  evening.  The 
question  of  the  accurate  diagnosis  of  diphtheria  was 
even  yet  a  vexed  and  undecided  one.  Some  emin- 
ent observers,  notably  a  somewhat  recent  writer 
in  New  York,  go  so  far  as  to  say  that  there  are 
more  cases  of  diphtheria  walking  about  than  are  to 
be  found  in  bed  ;  thus  assuming  that  practically  all 
those  sore  throats  which  most  of  us  call  exudative 
or  follicular  tonsillitis  are  really  of  a  specific  and 
infectious  nature.  He  cannot  agree  to  this.  An 
immense  amount  of  clinical  evidence  might  be  ad- 
duced against  the  supposition.  It  is  true  that 
occasionallya  genuine  diphtheritic  exudation  is  seen 
occupying  the  crypts  of  the  tonsils, and  showing  as 
small  and  circumscribed  yellow  patches  upon  the 
faces  of  these  two  organs,  but  this  occurrence  is 
very  rare  in  his  experience.  A  recent  case  in  hos- 
pital practice  exemplified  the  condition  where  the 
duration  and  the  fact  of  its  occurring  in  a  family, 
where  three  other  members  were  simultaneously 
suffering  from  rather  severe  diphtheria,  conclusively 
demonstrated  its  specific  character.  As  regards 
nasal  diphtheria,  this  form  is  generally  and  .with 
much  justice  looked  upon  with  alarm,  the  situation 
affected  being  thought  to  add  considerably  to  the 
risk  of  septic  infection  of  the  system.  In  cases  of 
moderate  severity,  when  the  nasal  passages  are 
secondarily  involved,  this  would  certainly  appear 
to  be  the  case,  but  in  at  any  rate  some  of  the 
cases  of  primary  nasal  diphtheria,  the  course  of 
the  disease  is  remarkably  subacute  and  of  mild 
form,  without  any  danger  to  life.  This  fact  is  some- 
times lost  sight  of  by  practitioners,  and  children 
thus  affected  arc  supposed  to  be  suffering  from 
common  coryza,  often  with  disastrous  results  in 
the  family.     During  the  epidemic  prevalence   of 


THE   CANADA   MKDICAL   BECOED. 


89 


diphtheria,  in  all  cases  of  apparent  catarrhal  fever, 
the  nasal    fossse  should  be  carefully  examined  for 
membrane.     It  is  seldom  tliat  this  cannot  be  read- 
ily seen,  if  i>resent.     W'hh  reference  to  Dr.  Arm- 
strong's question  as  to  the  causation  of   urinary 
supijrcssion,  he  was  of  opinion  that  in  some  cases 
this  was  the  result   of  organic  changes  in   the  kid- 
neys, other  phenomena  being    quite  secondary  to 
tliis;  whereas  in   a  second  class  of  cases,  the  pri- 
mary effect  was  upon  the  nervous  mechanism  of  the 
heart,  disturbing  its  regularity   and  lowering  the 
force  of  its  contractions,  the  partial    or  complete 
suppression  following  from  diminution    of  blood- 
pressure.     As  intubation  of  the  larynx  was  a  novel 
procedure  here.  Dr.    R.    would   like  to   mention 
his  experience  of  three  cases  (further  details  would 
be  furnished  by  Dr.  Major  who  operated).     No.  i 
was  first  seen  on  the  eighth   day  of  illness — a  boy 
5  years  of  age,  was  cyanotic,  intensely  distressed, 
and  rapidly  asphyxiating.     Tube  in  larynx  gave 
instant  relief.     He  died  ten    days  later  from   gra- 
dual heart  failure,  but  air  entered  lungs  freely.  No. 
2,  girl  of  5 — too  small  a  tube  introduced  was  soon 
coughed  out,  followed  by  expulsion  of  complete 
cast  of  larynx  and  upper  trachea  ;  immediate  relief 
and  complete  recovery.     No.  3,  girl  of  4   years, 
admitted  to  hospital  after  some  days  illness ;   very 
extensive,  thick  and  foul  membrane  in  fauces;  very 
weak ;  soon  had  nephritis,  and  showed  a  marked 
septic  state  ;   a  fatal  prognosis  given  ;  but  intense 
laryngeal  dyspnoea  came  on  ;  to  relieve  this,  larynx 
was  intubated,  with  immediate  and  complete  relief 
to  breathing  for  twelve  hours  before  death.     It  re- 
mained, of  course,  for  further  experience  to  enable 
us  to  compare  this  procedure  with  the  operation  of 
tracheotomy.     Dr.  Ross  said   he  was  trying  the 
local  application  of  "  papoid  "  in  diphtheria.     It 
was  applied  by  means  of  a  brush  in  five  per  cent, 
solution  every  half  hour.    In  hospital  he  had  treat- 
ed 26  cases,  many  of  them   severe,  and   some    of 
them  very  severe,  also  some    mild.     Of  these,   13 
were  discharged  well ;    12  remained  under   treat- 
ment, but  he  thought,  without  doubt,  would  all  re- 
cover ;  one  only  died.     He  was  certainly  favorably 
impressed  with  the  action  of  the  drug,  but  could 
not  say  more  than  this  until  extended  observations 
had  corrected  or  confirmed  first  impressions. 

Dr.  Cameron  remarked  that  in  his  practice  ear 
and  nasal  complications  have  been  very  common 
during  the  present  epidemic.  In  some  cases  a 
chronic  nasal  discharge,  more  or  less  irritating  in 
nature,  persists  for  a  considerable  time.  He  raised 


the  question  whether  such  nasal  discharges  were 
infectious,  whether  there  was  any  way  of  deter- 
mining when  they  ceased  to  be  infectious,  and 
whether  it  was  right  to  give  a  clean  bill  of  health 
to  a  patient  with  chronic  nasal  discharge  after  diph- 
theria. He  was  inclined  to  consider  these  nasal 
discharges  as  always  more  or  less  dangerous.  He 
then  called  attention  to  the  lax  and  unsatisfactory 
manner  in  which  the  health  officials  deal  with  the 
infectious  cases,  which  they  now  compel  medical 
men  to  report  to  them.  It  is  hard  to  say  just  where 
the  fault  lies,  yet  it  is  painfully  evident  that  under 
present  arrangements  the  reporting  of  infectious 
cases  results  in  very  little  good.  The  public  have 
a  right  to  expect  preventive  measures,  and  are  not 
satisfied  with  so  called  disinfection  of  premises  and 
the  compilation  of  statistics  and  reports.  It  seems 
as  if  aldermanic  patronage  lay  at  the  root  of  the 
soil.  .Satisfactory  administration  of  our  health 
department  can  never  be  secured  while  health 
officials  are  blocked  and  thwarted  in  the  fulfilment 
of  their  duty,  and  made  to  feel  that  their  tenure  of 
office  depends  upon  their  pliability. 

Dr.  Major  strongly  pronounced  against  the  idea 
that  lapse  of  time  granted  immunity  fiom  conta- 
gion in  diphtheria.  In  the  cases  of  persons  in  at- 
tendance on  diphtheria,  no  specified  time  would 
be  sufficient  to  destroy  the  germs.  In  so  far  as 
danger  to  others  was  concerned,  such  persons  were 
as  likely  to  convey  the  disease  in  three  weeks  after 
exposure  as  in  three  days.  In  proper  disinfection 
alone  could  we  look  for  safety.  In  persons  afflicted 
with  the  disease,  after  all  traces  had  disappeared, 
he  considered  a  few  days  ought  to  be  allowed  to 
elapse,  during  which  daily  disinfection  should  Le 
practised  before  allowing  of  contact  with  others. 
The  question  of  the  influence  e.xerted  by  an  un- 
healthy condition  of  the  nose  or  throat  in  favoring 
the  development  tf  diplitheria  is  an  important  one. 
There  can  be  but  little  doubt  that  a  chronic  state 
of  hyperaemia,  such  as  is  so  commonly  met  with, 
will  increase  the  liability  to  diphtheria.  In  the 
case  of  a  little  girl,  a  patient  of  Dr.  A.  A.  Brown, 
I  excised  a  large  tonsil ,  within  a  year  afterwards 
this  child  contracted  diphtheria.  The  duration  of 
the  illness  was  three  weeks,  and  although  the  op- 
posite tonsil  and  the  surroundings  of  the  ablated 
one  were  covered  with  membrane,  the  cicatricial 
surface  remained  free  throughout  the  period  of 
three  weeks,  d  iring  which  membrane  was  present 
in  quantity.  The  same  observation  was  made  re- 
cently   in  a  case    of    syphilitic    cicatrization  of 


90 


THE   CANADA   MEDICAL    RECORD. 


pharynx^  wherein  the  cicatricial  tissue  was  wholly- 
free  from  exudation.  In  the  case  of  a  child  whose 
pharnyx  had  been  injured  by  swallowing  lye,  the 
same  absence  of  membrane  on  cicatricial  tissue 
was  remarked.  All  this  goes  to  show  that  mem- 
brane is  favored  by  an  excessive  circulation  and 
vice  versa.  In  reply  to  Dr.  J.  C,  Cameron's  ques- 
tion, Dr.  Major  stated  that  in  nasal  diphtheria  care 
should  be  taken  that  all  discharge  from  the  nose 
has  ceased  before  a  clean  bill  of  health  was  grant- 
ed. As  Dr.  George  Ross  had  referred  to  "  intuba- 
tion of  the  larynx,"  and  associated  Dr.  Major's 
name  therewith,  he  would  make  a  few  remarks 
with  reference  to  a  few  of  his  more  recent  cases. 
He  wished  it  understood  that  tubage  had  been 
resorted  to  by  him  in  cases  where  all  possibility 
of  saving  life  was  out  of  the  question,  and  had 
been  undertaken  merely  as  a  means  of  allaying 
the  suffering  produced  by  strangulation. 

D.  T.  L.,  aged  5  years,  was  seen  in  consultation 
with  Dr.  Browne  on  June  8th,  at  5  a.  m.  The 
breathing  was  most  difficult,  and  suffocation  was 
impending.  An  O'Dwyer's  tube  was  introduced 
with  instantaneous  relief.  The  tube  was  removed 
on  June  i  ith,  at  9  P.  M.,  when  the  breathing  seem- 
ed quite  satisfactory  ;  at  mid-night  of  same  day, 
however,  it  was  necessary  again  to  return  it,  as 
dyspncea  with  marked  retraction  supervened. 
The  tube  was  permanently  withdrawn  at  3  p.  m. 
on  June  i7tli.  On  laryngoscopic  examination,  a 
slight  abrasion  of  left  ventricular  band  was  noti- 
ced. 

The  foregoing  case  was  one  of  inflammatory 
croup,  and  developed  as  alarming  symptoms  of 
suffocation  as  I   have  ever  seen. 

T.  J.,  aged  3  years,  also  a  case  of  catarrhal  croup, 
was  seen  with  Dr.  Browne  at  2  a.  m.,  Saturday,  Oct. 
29th.  The  patient  was  in  a  very  critical  condition, 
and  it  was  with  difficulty  that  the  tube  was  introdu- 
ced in  time^to  prevent  a  fatal  issue.  On  introduction, 
however,  the  breathing  was  immediately  relieved, 
and  continued  good  until  the  morning  of  Wednes- 
day, Nov.  2nd.  On  Thursday,  Nov.  3rd,  at  noon 
I  removed  the  tube  and  found  it  filled  up  with 
some  material  which,  on  examination  by  Dr.  Wyatt 
Johnston  and  Dr.  Ruttan,  proved  to  be  starch 
granules,  caseine,  epithelial  scales,  etc.  The 
breathing  improved  at  once,  and  continued  in  a 
satisfactory  condition. 

J.  C,  aged  5  years,  was  a  case  of  diphtheria  with 
laryngeal  extension.  On  examination  of  larynx 
with  laryngoscope,  membrane  was  found  there  in 


quantity.  The  difficulty  in  breatliing  was  very 
great,  when  Dr.  Geo.  Ross  requested  intubation. 
The  tube  was  introduced  at  noon  on  Tuesday, 
Nov.  I  St,  it  was  removed  at  3  p.  M.  on  .Sunday, 
Nov.  6th,  but  as  dyspncea  became  urgent  it  was 
reintroduced  at  8  p.  m.  of  same  day.  The  child's 
breathing  continued  good  until  Thursday,  Nov. 
loth,  when  death  resulted  from  sepsis. 

On  Sunday,  Nov.  6th,  Dr.  George  Ross  desired 
that  a  child  aged  6  years,  suffering  from  diphthe- 
ria in  the  contagious  wards  of  the  Montreal  Gen- 
eral Hospital,  should  be  intubated.  As  I  was  at 
the  time  possessed  of  but  one  set  of  O'Dwyer's  in- 
struments and  tubes,  I  had  not  a  tube  suitable 
for  the  child's  age,  as  it  was  already  in  use  in  the 
former  case.  On  examining  the  larynx  with  the 
laryngoscope,  I  made  sure  that  a  smaller  tube 
might  be  used  with  safety,  as  it  would  not  pass  into 
the  trachea,  although  it  probably  would  not  be 
retained.  The  breathing  was  very  much  oppres- 
sed, and  membrane  was  seen  extending  some  way 
into  the  trachea.  On  intubating,  the  tube  after  a 
few  minutes  was  coughed  up,  and  with  it  a  cast  of 
the  larynx  and  trachea.  The  breathing  now  became 
good,  and  recovery  was  rapid.  This  was  only  a 
fortunate  accident  attending  the  manipulation  of 
^ubing. 

W.  A.,  aged  18  months,  was  suffering  from  catar- 
rhal croup,  and  was  in  a  bad  way  on  Monday, 
Nov.  14th,  when  Dr.  R.  P.  Howard  requested 
intubation.  Tfae  tube  was  introduced  at  3  p.  m., 
and  removed  on  Friday,  Nov.  i8th,  at  i  p.  m., . 
when  the  necessity  for  a  tube  no  longer  existed. 
A  good  recovery  resulted. 

J.  Q.,  aged  3  years,  a  patient  of  Dr.  Guerin, 
was  tubed  Thursday,  Nov.  17th,  at  6  p.m.  Pul- 
monary collapse  was  observed,  and  the  tube  remo- 
ved on  Sunday,  Nov.  20th,  at  6  p.  m.  The  case 
terminated  fatally  the  same  night.  The  child  was 
suffering  from  catarrhal  croup  ;  on  examination  of 
larynx,  no  membrane  could  be  seen.  The 
collapse  probably  antedated  the  tubage. 

Hospital  case,  girl  oi  iij4  years,  suffering  from 
a  very  malignant  type  of  diphtheria,  with  excessive 
septic  poisoning.  The  breathing  was  so  very  dis- 
tressing that  Dr.  Geo.  Ross  requested  intubation 
for  its  relief.  The  case  was  of  an  utterly  hopeless 
nature.  The  lube  was  introduced  at  9  p.m., 
Friday,  Nov.  iSth,  and  afforded  instantaneous  and 
marked  relief.  The  child  was  enabled  to  lie  down 
and  sleep  quietly,  dying  the  following  morning  at 
6  p.  m.,  of  sepeis. 


TUE   CANADA   MKDICAL   KECOKD. 


91 


Hospital  case  :  j.  C,  aged  4  years,  suffering 
fro'Vi  laryngeal  diphtheria,  was  tubed  at  4  a.  m., 
Friday,  Nov.  25th,  and  died  at  noon  the  day 
following.  Probable  cause  of  death  extension  of 
membrane  into  bronchi. 

Intubation  may  be  practised  with  one  of  two 
objects  in  view,  viz.,  to  save  life  or  merely  to  re- 
lieve dyspnoea  (when  the  savingof  life  ishopeless\ 
Statistics  endeavor  to  show  the  life-saving  power 
as  compared  with  tracheotomy,  the  comparison  is 
certainly  in  favor  of  intubatioa.  The  measure  of 
relief  tubage  affords  in  laryngeal  stenosis  from 
whatever  cause,  the  readiness  with  which  friends 
give  consent,  and  the  rapidity  with  which  a  tube 
can  be  inserted,  are  all  ix)ints  strong  in  favor  of 
intubation.  There  are  a  number  of  conditions  that 
should  be  well  considered  in  tubing,  and  as  one's 
experience  exteads  the  recognition  of  possible 
accidents  increases.  In  uibing,  if  breathing  is  not 
satisfactorily  restored  within  a  few  minutes,  with- 
draw the  tube,  reintroduce  it,  and  again  withdraw 
it  if  necessary,  reintroducing  it  ;  if  the  breathing  is 
still  imperfect,  contemplate  tracheotomy.  The 
fcar  of  forcing  membrane  down  before  the  tube  is 
one  often  urged,  but  is  one  of  the  accidents  least 
likely  to  happen.  Tubage  does  not  interdict  sub- 
sequent tracheotomy,  and  tubage  is  proportion- 
ately valuable,  as  it  is  performed  early.  Many  cases 
of  pulmonary  collapse  no  doubt  antedate  the 
operation,  and  experience  probably  will  prove 
that  pulmonary  collapse  is  one  of  the  conditions 
most  to  be  feared  as  likely  to  be  attributed  to  the 
operation,  and  [not  to  the  state  for  the  relief  of 
which  the  intubatioa  was  undertaken . 

Dr.  Reed  suggested  that  the  knee  jerk  be  sought 
for  in  all  cases,  as  involvement  of  the  nervous  sys- 
tem has  been  known  to  occur  even  when  the  throat 
trouble  has  been  slight  as  to  pass  unheeded. 
According  to  Formad,  bacteriology  is  insufficient 
to  distinguish  simple  follicular  tonsillitis  from  fatal 
cases,  the  same  microbe  having  been  found  in 
both. 

Dr.  McCoNNELL  stated  that  although  the  health 
department  were  not  entitled  to  much  credit  for  the 
part  they  have  taken  towards  staying  the  present 
epidemic,  yet,  in  view  of  the  multiplicity  of  views 
held  in  regard  to  the  etiology  of  the  disease  and  its 
management,  some  allowance  inight  be  made  for 
failure  in  making  specific  efforts  towards  its  arrest  if 
some  of  the  ordinary  sanitary  requirements  of  tlie 
city  were  not  so  sadly  neglected.  He  believed  it  to 
be  a  parasitic  disease  (Zoefjer's  b^'  iUus,  proljably). 


and  hence  amenable  to  all  means  which  are  known 
to  destroy  them  or  prevent  their  devclc])ment.  If 
this  view  was  more  generally  adopted,  our  manage- 
ment and  treatment  of  these  cases  would  have  a 
more  definite  aim  and  be  apjjlied  more  intelligently. 
He  thought  it  unfortunate  that  Jacobi,  in  a  standard 
modern  work  like  Pepper's,  should  not  countenance 
this  origin  for  diphtheria,  as  it  explains  satisfac- 
torily the  chief  feature  of  the  disease.  From  his 
observations  he  believed  it  to  be  at  first  a  local 
disease;  the  growth  in  the  mucous  or  abraded  sur- 
face resembling  perfectly  culture  tube-growths 
of  bacillus,  etc.,  precedes  constitutional  symptoms, 
and  the  latter  disappear  when  the  surfaces  are 
free  from  the  membrane.  This  was  well  seen  in  a 
child  of  3  years  now  under  treatment  for  the 
fourth  attack  ;  he  had  recovered  from  the  third  but 
four  or  five  days.  Pharynx  clear  and  no  ferer, 
when  he  used  apiece  of  gum  that  a  sister,  suffering 
from  the  disease,  had  been  inasticating;  in  five  or 
six  hours  after  a  fresh  patch  appeared  on  the  ton- 
sil, and  there  was  a  return  of  pyrexia.  Each  of 
the  other  members  of  this  family  had  had  the 
disease  twice,  showing  a  family  predisposition. 
He  treated  his  cases  with  germicides,  using 
acid  sulphurous,  boric  acid,  liq.  ferri  mur. 
internally,  and  corrosive  chloride  with  atomizer, 
and  the  air  of  the  room  saturated  with  vapor  from 
boiling  water,  on  which  was  kept  constantly  a 
quantity  of  equal  parts  of  carbolic  acid  and  tur- 
pentine. If  pathogenic  bacilli  were  the  cause  to 
prevent  their  development,  the  remedy  should  be 
brought  into  contact  with  the  rapidly-growing 
patch  almost  constantly,  hence  atomizer  and  inter- 
nal mixture  (whose  action  is  chiefly  local)  should 
be  alternated  every  fifteen  minutes  or  half  hour. 
This  had  given  most  satisfactory  results.  A  case 
of  laryngeal  diphtheria  had  recovered  under  the 
use  of  Lq.  Bichlor  internally  and  the  antiseptic 
inhalations  already  mentioned. 

Dr.  Armstrong,  in  reply,  said  ■  I  think  it  is 
generally  agreed  that  a  healthy  nasal  and  pharyn- 
geal mucous  membrane  is  protective  against  the 
poison  of  diphtheria.  Unfortunately,  in  our  cli- 
mate perfectly  healthy  noses  and  throats  are  not 
too  commonly  met  with.  The  great  objection  to 
the  idea  of  Prof.  Hughlings  Jackson  mentioned  by 
Prof.  Mills  is  that  ant.  pol.  myelitis  is  essentially 
an  incurable  disease,  and  the  paralysis  of  diphthe- 
ria nearly  always  gets  well.  I  am  glad  Dr.  Ross 
still  finds  reason  to  hold  the  views  he  has  expressed 
in  regard  to  diagnosis.     The  cause   I  purposely 


92 


THE   CANADA   MEDICAL   RECORD. 


avoided  in  my  paper.  It  is  a  large  subject.  The 
plumbing  of  Montreal  is  bad — very  bad,  and  the 
Board  of  Health  deserve  the  same  qualifying 
adjectives.  They  are  nearly  useless.  I  am  willing 
to  do  all  in  my  power  to  improve  things,  but  under 
the  present  regim.e  at  the  City  Hall  lam  afraid 
that  all  our  efforts  intelligently  put  forth  would 
avail  little  or  nothing. 


of  Sciet 


mmm. 


KNEELING    POSTURE  IN  PROTRACTED 
LABOR. 

Dr.  Edwin  M.  Hale,  Chicago,  m.  Journal  of  Ob- 
stttric: 

Mrs.  J.,  a  short,  fat  woman;  in  her  first  labor, 
the  progress  was  very  slow  and  painful.  The  pains 
had  lasted  twenty-four  hours  before  the  os  had 
dilated  sufficient  for  the  head  to  descend.  But 
it  did  not  descend,  nor  did  progress  beyond  that 
stage,  notwiihstandir^g  the  use  of  the  hot  sitz  bath 
the  douche,  caulophyllin  and  cimicifuga.  I  was- 
ted six  hours,  the  soft  parts  became  hot  and  swoll- 
en, and  the  woman  showed  signs  of  severe  exhaus- 
tion. The  long  forceps  were  applied,  but  my 
strength  was  not  sufficient  to  move  the  head.  I 
called  on  Dr.  George  A.  Hall,  who  used  another 
kind  of  forceps  and  succeeded,  after  nearly  an 
hour  of  forcible  traction,  with  the  aid  of  an  assis- 
tant. The  perineum  was  badly  ruptured ;  was 
sewed  up  immediately,  and  the  patient  made 
a  good  recovery. 

Three  years  after,  the  same  history  was  repeated. 

Four  years  later  the  woman  was  again  taken  in 
labor.  The  os  rapidly  dilated,  but  the  head 
became  impacted  at  the  same  spot.  It  occurred 
to  me  to  suggest  to  the  patient  to  kneel  down  by 
the  bed.  After  assuming  this  posture  the  pains 
immediately  became  more  violent  and  expulsive. 
She  did  not  have  more  than  six  or  seven  before  ; 
placing  my  hand  on  the  perineum  I  found  it  was 
rapidly  descending,  another  pain  expelled  the 
child.  There  was  no  rupture  of  the  perineum  ; 
recovery  rapid.  If  she  had  assumed  this  posture 
with  her  first  labor,  would  the  child  have  been 
born  naturally  ? 

I  think  not,  owing  to  her  peculiar  physical  con- 
formation. 

With  the  second  child,  the  result  of  the  keeling 
posture  might  have  been  successful.     In  a  fourth 


labor  she  assumed  the  kneeling  position,  at  about 
the  same  stage  of  labor,  and  the  child  was  born 
before  any  physician  could  be  procured.  I  have 
often  seen  protracted  labors  rapidly  terminated  by 
the  same  procedure.      . 

One  of  the  most  plausible  explanations  of  labor 
in  the  second  stage  is  given  by  Lusk.  "  It  is 
either  due  to  exhausted  nerve  power,  or  excessive 
uterine  retraction ;  in  the  latter  case  the  with- 
drawal upward  of  the  uterine  muscle  and  the 
consequent  lessening  of  the  intrauterine  pressure." 
He  quotes  Hofmeier,  who  reports  a  number  of 
instances  when  the  head  rested  on  the  pelvic  floor, 
that  the  ring  of  Bande,  which  was  made  and  by 
palpation  through  the  abdominal  parietes,  was 
situated  at  from  five  to  seven  inches  above  the 
symphysis  pubis,  so  that  the  contractile  portion  of 
the  uterus  covered  not  more  than  one-third  of  the 
foetus.  Under  such  circumstances,  while  the  pa- 
tient suffers  from  intense  pain,  the  contractions 
of  the  partially  emptied  uterus  do  not  possess  the 
force  to  overcome  the  resistance  of  the  rigid  peri- 
neum. I  have  observed  several  instances  of  this 
kind,  when  the  kneeling  posture  caused  the  retrac- 
tion to  give  way. 

But  ill  the  case  of  Mrs.  J.  and  some  others,  this 
could  not  have  been  the  condition  present,  unless 
the  contraction  with  retraction  of  the  uterus  oc- 
curred at  an  earlier  stage,  for  the  head  had  not  des- 
cended sufficiently  to  press  on  the  perineum. 
While  the  presentation  appeared  normal,  the  head 
did  not  descend  ;  there  was  no  flexion.  Perhaps 
this  non-flexion  was  the  cause  of  the  arrest  of 
labor.  But  why  does  the  head  not  flex  ?  I  believe 
it  is  because  the  expulsive  force  is  not  applied  in 
the  proper  direction.  Nor  can  it  be  applied 
while  the  woman  is  in  any  other  position  than 
kneeling  with  the  body  bent  forward.  One  pecu- 
liar symptom  observed  in  these  cases  is,  tliat  the 
vagina,  which,  previous  to  arrest  of  labor,  seemed 
open  enough — soon  after  the  descent  of  the  head 
was  arrested,  appeared  to  "  fill  up, "  and  the  head 
actually  seemed  iiigher  than  before.  This  would 
imply  that  the  so-called  "  tonic  retraction"  may 
occur  before  the  head  reaches  the  floor  of  the 
pelvis. 

Patients  delivered  in  this  position  usually  kneel  on 
X  pillow,  with  the  knees  apart,  and  the  arms  upon 
a  chair,  bed  or  lap  of  an  attendant.  The  physician 
takes  his  seat  on  a  low  ottoman  on  her  left  side, 
and  placing  his  hand  on  the  perineum,  watches  for 
the  descent  of  the  head.     There  is  no  fear  of  the 


I 


tHE   CANADA   MEDICAL   RECORD. 


03 


child  being  precipitated  from  a  height  with  injury 
to  itself  or  its  mother.  The  space  between  the 
uterus  and  the  pillow  upon  which  the  patient  kneels 
is  so  small  that  the  head  of  the  foetus  is  arrested 
before  the  whole  of  the  body  is  ex])elled,  and  the 
average  length  of  the  funis  is  sufiicient  to  preven 
it  dragging  down  the  placenta  or  uterus,  even  it 
the  accoucheur  did  not  atteud  to  the  taking  of 
the  child.  The  posture  is  strictly  scientific,  for 
when  the  woman  is  thus  placed  the  outlet  of  the 
pelvis  rests  perpendicular  and  the  greatest  gravi- 
lory  influence  of  the  fcetal  h.eadis  secured.  More 
than  this,  the  expulsive  efforts  of  the  woman  can 
be  exerted  with  far  greater  force  and  ease  than  in 
any  other  position. 

As  the  trunk  of  the  woman  is  bent  forward,  the 
propelling  force  of  the  abdominal  muscles  are  ex- 
erted at  a  proper  angle,  to  best  insure  flexion  of 
the  foetus  through  the  curve  of  the  genital  canal. 

If  accoucheurs  will  carefully  consider  the  many 
mechanical  reasons  for  the  use  of  this  position 
during-thc-  second  stage  of  labor,  they  can  not  fail  to 
be  convinced  of  its  utility.  It  certainly  ought  to 
be  tried  in  all  cases  of  lingering  labor  in  the 
second  stage  before  we  resort  to  the  forceps. 

The  Canada  Medical  Record. 

A  Monthly  Journal  of  Medicine  and  burgery- 

EDITORS  : 

FRANCIS    W.  CAMPBELI.,   MA,,  M.D.,  L.K,C.P.  LOND, 
Editor  and  Pjoprietor. 

E.  A,  KENN£DY,  M.A,,  M.D,,  Managing  Kditor. 

ASSISTANT  EDITOR: 
GEORGE  E,  ARMSTRONG,  CM.,  M.D. 

SUBSCRIPTION    TWO    DOLLARS    PEP.    ANNUM. 

All  communications  and Exchangp.s  inust  bi  addressed  to 
the  J^dttors,  Drawer  3oG,  Post   Of/icc^  Montreal . 

.MONTREAL,  JANUARY,   18S8. 

QUACK     advertisements    IN     RELI- 
GIOUS NEWSPAPERS. 

We  thoroughly  endorse  the  following  which  ap- 
peared in  the  Philadelphia  Mciiical  and  Surgical 
Reporter  of  Dec.  31st,  1887. 

"  From  time  to  time  medical  men  and  medical 


journals  have  protested  against  the  prostitution  of 
the  columns  of  religious  newspajjcrs  to  the  use  of 
advertisers  of  quack  nostrums.  This  protest  does 
not  apply  to  temi)erately  worded  representations 
of  what  seems  to  have  been  accomplished  by,  or 
what  may  reasonably  be  expected  of,  a  remedy  or 
device  for  the  cure  of  disease  or  injury.  But  it 
does  apply  to  advertisements  couched  in  language 
which  bears  the  stamp  of  falsehood  on  its 
face,  or  which  is  of  such  a  character  as  to  arouse 
suspicion  in  the  mind  of  an  intelligent  man,  unin- 
fluenced by  a  money  consideration. 

The  editors  of  the  most  religious  journals  are,  as 
a  rule,  men  of  so  much  intelligence  that  they  will 
hardly  attribute  to  trade-jealousy  alone  the  ob- 
jection which  medical  men  have  to  the  recommen- 
dations of  ''  sure  cures  "  for  baldness,  fits,  rupture, 
consumption,  and  so  on,  to  persons  who  are  apt  to 
regard  their  religious  teachers  as  safe  guides  in 
matters  of  health  or  disease  ;  and  who  are  not 
sufficiently  familiar  w'ith  the  subtleties  of  the 
newspaper  business  to  distinguish  between  the 
responsibilities  of  the  editor  and  those  of  the  pub- 
lisher. As  a  fact  most  readers  i^f  periodicals  have 
the  impression  that  the  advertisements  they  con- 
tain are  endorsed  by  the  editor.  Advertisers 
rely  upon  this  fact ;  and  we  cannot  understand  the 
casuistry  which  satisfies  the  conscience  of  a  man 
who  edits  a  periodical  ostensibly  devoted  to  reli- 
gion, which  replenishes  its  coffers  with  the  price 
of  palpable  falsehoods. 

If  it  were  true  that  a  religious  paper  could  not 
be  financially  successful  without  taking  money  for 
the  advertisements  of  worthless  or  delusive  reme- 
dies, a  course  might  be  suggested  worthy  of  the 
main  object  of  these  papers.  But  it  is  not  true; 
for  there  are  a  few  happy  illustrations  of  the  fact 
that,  even  in  a  religious  newspaper,  "  honesty  is 
the  best  policy." 

We  call  the  attention  of  our  large  circle  of 
readers  to  this  matter,  in  the  hope  that  they  will 
use  their  influence  to  put  an  end  to  what  we  re- 
gard as  a  serious  blemish  in  religious  newspapers, 
and  one  which  injures  the  good  reputation  which 
they  ought  to  enjoy.  And  we  call  the  attention 
of  those  religious  newspapers  to  which  our  re- 
marks may  apply  to  this  matter,  in  the  hope  that 
we  shall  not  have  to  recur  to  in  a  more  explicit 
manner. 


04 


THE   CANADA  MEDICAL   RECORD. 


FECAL  ANEMIA. 

The  Ntw  York  Medical  Record  says  : — 
This  is  a  title  of  a  paper  read  recently  by  Sir 
Andrew  Clark  before  one  of  the  London  societies. 
The  essential  ideas  expressed  were  not  new,  but 
their  grouping  was  somewhat  novel.  Under  the 
heading  of  fecal  anaemia,  the  writer  discussed  tlie 
question  of  anaemia  occurring  in  young  girls  about 
the  time  of  the  establishment  of  menstruation.  We 
have  usually  been  taught  to  regard  these  blood, 
changes  as  due  to  the  very  systemic  disturbance 
incident  to  tlie  inauguration  of  a  new  and  most 
important  function.  We  have  recognized  the  ex- 
citing causes  as  well.  On  these  general  grounds 
we  have  been  content  to  let  the  matter  rest.  Sir 
Andrew  Clark  takes  up  one  aspect  of  the  case,  and 
elaborates  therefrom  a  novel  and  highly  probable 
theory.  He  alludes  to  the  profound  mental  and 
emotional  changes  occurring  in  the  female  sex  at 
the  time  of  puberty.  The  young  girl,  who  has 
been  only  a  creature  full  of  mere  animal  spirits, 
becomes  shy  and  retiring.  Questions  of  personal 
physiology  force  themselves  upon  her.  She  shrinks 
from  the  contemgjation  even  of  matters  relating  to 
the  hygiene  of  the  pelvic  organs,  much  more  from 
their  performance.  The  importance  of  regular 
evacuations  is  not  recognized,  and,  unless  friendly 
maternal  counsel  is  at  hand,  she  speedily  becomes 
the  victim  of  obstinate  constipation.  However 
great  the  bodily  discomfort  therefrom  may  be.  she 
suffers  in  silence,  not  daring  to  ask  for  relief.  As 
a  result  of  this  perversion,  or,  rather,  abeyance  of 
function,  the  system  speedily  becomes  clogged, 
effete  materials  accumulate  in  the  bowels,  and 
there  remaining  they  undergo  chemical  change. 
Poisons  of  the  ptomaine  and  leukomaine  classes 
are  formed.  These  are  absorbed  into  the  circula- 
tion, and  set  up  a  form  of  systemic  infection.  This 
runs  a  slow  chronic  course,  evincing  its  presence 
in  the  usual  clinical  picture  of  paleness,  headache, 
dyspnoea,  palpitation,  dyspepsia,  and  the  other  cus- 
tomary features  of  anasmia.  The  old  idea  made 
constipation  simply  one  feature  of  its  condition  ; 
the  new  makes  it  the  direct  cause.  Of  course  all 
cases  of  anaemia  cannot  be  brought  under  this 
category,  nor  does  Sir  Andrew  Clark  make  any 
such  claim.  Experience  shows,  however,  the  cor. 
rectness  of  his  views  in  a  large  proportion  of  cases. 
The  marked  relief  that  follows  from  a  thorough 
cleaning  out  of  the  bowel  is  a  matter  too  well  known 
for  more  than  mention.     It  ensues  even  before  any 


blood-forming  tonics  are  given,  and  often  the 
patient  seems  to  improve  about  as  rapidly  without 
as  with  the  latter.  The  constant  absorption  of  poi- 
son being  checked,  natufe  regains  the  upper  hand, 
and  the  vital  machinery  once  more  runs  smoothly. 
It  is  in  such  cases  as  these  that  excellent  results 
have  been  obtained  by  the  use  of  cascara.  This 
drug  is  distinctly  a  tonic-laxative,  of  which  the 
dose  can  be  gradually  reduced  instead  of  increased, 
as  is  usually  the  case  with  laxatives.  It  restores 
the  norma!  vitality  of  the  muscular  fibre  of  the 
gut,  exhausted  by  over  distention. 


TURPENTINE  IN  DIPHTHERIA. 

A  recent  number  of  the  New  York  Medical  Re- 
cord says : — 

We  have,  on  several  occasions,  referred  to  the 
use  of  turpentine  in  diphtheria.  Recommended 
originally  in  Germany,  and  claimed  to  be  almost  a 
specific,  it  was  there,  also,  that  the  employment  of 
the  drug  was  subjected  to  the  most  severe  criti- 
cism. Some  recent  publications  have  again  drawn 
attention  to  the  alleged  value  of  this  substance, 
and  most  remarkable  among  these  is  an  article  by 
Dr.  Roese,  which  appeared  in  the  Theraj>eutische 
Monatshcfte.  The  author  asserts  that  he  has 
em])loyed  turpentine  in  diphtheria  for  the  past  four 
years.  In  that  time  he  lost  only  five  cases  out  of 
sixty  that  came  under  treatment.  Two  of  the 
fatal  cases  concerned  infants  one  year  old,  who 
appeared  moribund  when  first  seen,  and  died  a 
few  hours  later.  The  other  fatal  cases  were  also 
unusually  severe  from  the  start,  two  dying  in 
thirty-six  hours,  and  one  surviving  five  days.  This 
is  certainly  a  noteworthy  record,  as  diphUieria 
statistics  go.  | 

The  oil  of  turpentine  was  administered  in  j 
drachm  doses,  three  times  a  day.  Sweet  spirits  of  ■■ 
nitre  was  used  as  a  corrective,  in  the  proportion 
of  one  part  of  the  spirits  to  of  fifteen  of  the  tur- 
pentine. Symptoms  of  intoxication  were  never 
observed  by  the  author.  In  addition  to  the  tur- 
pentine, a  two  per  cent,  solution  of  sodium  sali- 
cylate was  given  every  two  hours,  in  tablespoonful 
doses.  A  gargle  of  chlorate  of  potash  solution 
was  likewise  employed  whenever  possible.  LTnder 
this  plan  of  treatment  rapid  amelioration  of  local 
signs  and  constitutional  symptoms  was  observed, 


THE   CANADA   MEDICAL   RECORD. 


&^ 


Usually  improvement  began  at  once,  and  it  was 
rarely  necessary  to  pusli  the  drug  beyond  five  or 
eight  doses.  It  should  be  remarked  in  this  con- 
nection, however,  that  a  very  generous  and  stimu- 
lating fluid  diet  (strong  broth,  port  wine,  milk, etc.) 
formed  a  feature  of  Dr.  Roese's  plan  of  treatment. 
Those  who  are  inclined  to  be  sceptical  with  re- 
gard to  the  utility  of  tiiedicines  in  the  severer 
forms  of  diphtheria  (and  the  profession  contains 
many  such)  will  scarcely  accept  the  author's 
figures  without  challenge.  On  the  other  hand,  for 
the  very  reason  tliat  violent  diphtheria  ordinarily 
justifies  so  gloomy  a  prognosis,  we  are  ever  ready 
to  emi)loy  any  means  at  our  command  which  may 
possibly  reduce  its  frightful  mortality.  There  is 
no  nason,  therefore,  why  the  turi)entine  treat- 
ment of  this  disease  should  not  be  given  a  fair 
trial. 


ANTISEPSIS  IN  MEDICINE. 
In  a  late  number  of  the  Dublin  Medical  Press, 
there  is  an  article  by  Drs.  Casson  and  Brownen, 
drawing  attention  to  the  fact  that  in  the  treatment 
of  infectious  diseases,  the  reinedies  employed  for 
the  protection  of  attendants  or  for  the  prevention 
of  the  spread  of  infection  may  produce  beneficial 
results  in  the  condition  of  the  patients  themselves. 
They  say  that  iodine,  slowly  evaporated,  might 
prove  a  useful  adjunct  to  other  means  of  treatment. 
According  to  Koch,  the  only  effective  disinfec- 
tants, besides  chlorine,  bromine,  and  iodine,  are 
corrosive  sublimate,  osmic  acid,  and  potassic  per- 
manganate. They  necessarily  exclude  the  mer- 
curial sublimate  from  consideration.  "  Valuable, 
perhaps  the  most  valuable,  as  it  is  among  antisep- 
tics for  local  surgical  application,  its  highly  poison, 
ous  character  forbids  its  employment  as  a  general 
medical  disinfectant."  Osmic  acid  and  bromine 
are  too  expensive,  and  the  offensive  odor  of  the 
latter  is  against  its  employment.  Chlorine  is  objec- 
tionable from  the  disagreeable  pungency  of  its 
vapor.  The  potassic  permanganate  is  compara- 
tively valueless  unless  employed  in  considerable 
strength.  Iodine,  however,  presents  none  of  these 
disadvantages.  It  has  long  been  recognized  by 
all  authorities  as  a  true  germicide  disinfectant. 
They  point  out  that  its  employrnent  as  a  general 
disinfectant  has  been  greatl}'  lessened,  owing  to  the 
difficulties  experienced  in  its  regular  and  gradual 
vaporization.  Combined,  however,  with  salicylic 
acid,  they  find  that  "it  can  be  readily  and  per- 
manently incorporated  with  fats,  paraffins,  or  wax, 


and  when  candles  made  from  these  hydrocarbons 
thus  treated  are  ignited,  iodine  and  plienol  are 
evolved  in  a  gaseous  vaporized  form.  The  phenol 
is  |)roduced  by  the  decomposition  of  the  salicylic 
acid,  and  its  amount  varies  according  to  the  tem- 
perature or  rate  of  the  combustion.  Its  presence, 
may  be  verified  by  passing  the  vapors  of  the  com- 
bustion through  dilute  nitric  acid,  and  thus  pro- 
ducing trinitrophenol  or  picric  acid.  But  where 
the  combustion  is  rapid  and  complete  the  phenol 
is  entirely  destroyed,  as  all  other  ^;,(,''(2«/V materials 
such  as  eucalyptus,  which  has  been  suggested  for 
somewhat  similar  treatment,  must  necessarily  be. 
It  is  not  so,  however,  with  regard  to  the  iodine. 
Being  i/wrga/iic,  it  is  wholly  volatilized  and  thrown 
out  as  vapor  into  the  surrounding  atmosphere,  but 
it  is  in  no  sense  destroyed.  Its  presence  in  the 
gaseous  products  of  the  combustion  may  be  de- 
monstrated by  passing  them  through  a  solution  of 
starch,  or  along  a  tube  moistened  with  starch  mucil- 
age. In  either  case  the  iodide  of  starch  is  speedily 
produced,  and  may  be  recognized  by  the  usual 
tests.  A  very  faint  odor  of  iodine  may  be  detected 
when  these  candles  had  been  burnt  in  quantity  in 
a  close  atmosphere;  but  this  is  never  unpleasant, 
or  in  the  least  degree  irritable  to  breathe  ;  indeed, 
in  several  cases  of  asthma,  spasmodic  cough,  and 
'hay  catarrh,'  the  patients  have  experienced  great 
relief  from  the  iodine  vapor  thus  liberated.  As  a 
deodorizer  its  action  is  most  marked  ;  the  smell  of 
tobacco  smoke  is  quickly  and  entirely  destroyed 
by  the  combustion  of  these  candles  in  the  smok- 
ing room.  The  air  of  stuffy  rooms  and  smelling 
closets  may  be  rapidly  purified  by  the  same  means. 
The  odor  of  sulphuretted  hydrogen  and  of  am- 
raoniacal  air  froin  a  close  stable  have  been  very 
speedily  and  completely  discharged  by  contact 
with  the  same  vapor." 


PERSONAL. 
Dr.  Rolland,  of  Montreal,  Professor  of  diseases 
of  the  ear  and  throat  in  Victoria  Medical  Faculty, 
has  been  elected  a  member  of  the  Otological  and 
Laryngocical  Society  of  Paris. 

We  are  pleased  to  learn  that  Dr.  Robt.  Howard 
of  St.  Johns  is  still  improving  in  his  general  health, 
and  that  quite  recently  he  saw  a  case  in  consultation 
with  one  of  his  confreres.  This  is  the  first  profes- 
sional work  he  has  done  in  two  years. 

Dr.  Bower,  of  Waddington,  N.  Y.,  was  in  Mont- 
real recently. 


THE   CANADA   MEDICAL   RECORD. 


THE  TIME  FOR  THE  ADMINISTRATION 
OF  CERTAIN  REMEDIES. 

The  late  Sir  Robert  Christison,  in  his  Hfe-time 
Professor  of  Materia  Medica  in  the  University  of 
Edinburgh,  gave  the  following  directions  as  regards 
the  time  at  which  certain  remedies  should  be 
taken: 

"  Iodine  and  the  iodides  should  be  given  on  an 
empt)'  stomach.  If  given  during  digestion,  the 
acids  and  starch  alter  and  weaken  their  action. 
Acids,  as  a  rule,  should  be  given  between  meals. 
Acids  given  before  meals  check  the  excessive  se- 
cretion of  the  acids  of  the  gastric  juice.  Irritating 
and  poisonous  drugs,  such  as  salts  of  arsenic,  cop- 
per, zinc  and  iron,  should  be  given  directly  after 
meals.  Oxide  and  nitrate  of  silver  should  be 
given  after  the  process  of  digestion  is  ended ;  if 
given  during  or  close  after  meals  the  chemicals 
destroy  or  imjjair  their  action.  Potassium  per- 
manganate also  should  not  be  given  until  the  pro- 
cess of  digestion  is  ended  ;  inasmuch  as  organic 
matter  decomposes  it  and  renders  it  inert.  The 
active  princijile  of  the  gastric  juice  is  impaired 
and  rendered  inert  by  corrosive  sublimate,  tannin 
and  pure  alcohol ;  hence  they  should  be  given  at 
the  close  of  digestion.  Malt  extracts,  cod  liver  oil, 
the  phosphates,  etc.,  should  be  given  with  or 
directly  after  food." 


LISTER  (SIR  JOSEPH)  ON  VARICO- 
CELE AND  ITS  TREATMENT. 

I  wish  to  impress  this  important  fact  upon  you : 
do  not  think,  because  a  man  is  discovered  to  have 
varicocele,  that  therefore  it  is  your  duty  to  subject 
him  to  an  operation.  The  cases  which  call  for 
operative  interferences  are  few,  and  surgical  mea- 
sures employed  under  other  circumstances  are 
unjustifiable. 


THE  TREATMENT  OF  SICK-HEADACHE. 
Dr.  W.  Gill  Wylie  of  New  York  has  produced 
excellent  results  with  the  following  method  of 
treatment :  So  soon  as  the  first  pain  is  felt,  the 
patient  is  to  take  a  pill,  or  capsule,  containing  one 
grain  of  inspissated  ox-gall  and  one  drop  of  oil  of 
gaultheria,  every  hour  until  relief  is  felt,  or  until 
six  have  been  taken.  Dr.  Wylie  states  that  sick- 
headache  as  such  is  almost  invariably  cut  short  by 
this  plan,  although  some  pain  of  a  neuralgic  char- 
acter remains  in  a  few  ca.ses. 


EARLY  PATERNITY. 

A  correspondent  of  the  British  Medical  Journal 
reports  a  well-authenticated  case  in  which  a  boy 
thirteen  years  and  four  meunths  old  successfully 
impregnated  a  woman.  The  Journal  states  that 
the  earliest  case  heretofore  recorded  of  precocious 
puberty  is  that  of  a  boy  aged  fourteen. 


Cablegram,  London,  Oct.  25th. —  W.  R.  War- 
ner &  Co.,  Phila.,  received  highest  award  from 
American  Exhibition  in  London  for  superiority  of 
their  sugar-coated  Pills  and  Effervescing  Salts. 


NEW  BUILT  HOUSES. 

A  recent  number  of  the  Dublifi  Medical  Press 
says  : — 

"  A  great  many  people  could  testify  to  the 
numerous  ill-effects  which  follow  residence  in  newly 
built  houses  before  there  has  been  time  to  get  rid  of 
the  moisture  contained  in  the  walls.  It  has  been 
estimated  that  a  modern  brick  dwelling  of  medium 
size  requires  about  ten  thousand  gallons  of  water 
for  its  construction,  a  large  proportion  of  which  is 
still  present  when  building  operations  are  com- 
pleted. Nothing  is  more  deceptive  then  the 
appearance  of  the  walls  within  a  month  or  two  of 
their  being  coated  with  plaster.  To  the  touch  and 
sight  they  appear  beautifully  dry,  but  no  sooner 
are  fires  lighted  than  the  moisture,  displaced  by 
the  warmth,  deposits  elsewliere  and  shows  itself  in 
patches  of  damp.  Heat  alone  will  not  materially 
expedite  the  presence  of  dessication  ;  free  venti- 
lation is  even  more  essential.  The  evaporation 
of  this  moisture  absorbs  enough  heat  to  keep  down 
the  temperature  of  the  rooms,  and  inflicts  positive 
injury  on  the  tenants  by  provoking  the  reduction 
of  heat.  The  effect  of  radiation,  apart  from  mere 
temperature,  is  easily  seen  by  the  sense  of  coolness 
experienced  on  leaving  a  crowded  room  for  an 
emptyone,  even  when  the  actual  temperature  of 
the  latter  is  not  less  than  that  of  the  former. 
Further,  damp  walls  are  better  conductors  of  heat 
than  dry  walls,  and  subject  the  occupants  to  great- 
er and  more  rapid  changes  of  temperature.  At 
the  town  of  Basle,  in  Switzerland,  a  regulation  has 
recently  been  put  in  force  prohibiting  the  habita- 
tion of  houses  within  four  months  of  their  comple- 
tion, and  it  would  be  well  if  this  provision  could 
be  extended  to  other  places. 


I 


THE  CANADA  MEDICAL  RECORD. 


Vol.  XVI. 


MONTREAL,    FEBRUARY,    1888. 


No.  5. 


ORIGINAL  COMMUNICATIONS. 

Obstetrics  anil  Gjnecology i>7 

SOCIETY  PROCEEDINGS. 

Siodico-Cliiriirgical  Society  of  Mon- 
treal       99 

CORRESPONDENCE. 

Letter  from  New  York 107 


COlsTTElsTTS. 

PROGRESS  OF  SCIENCE. 

Feeding  riitlilsis)  ll'> 

The  Cause  and  Treatment  of  Infan- 
tile Eczema 113 

'A'ben  and  how  to  use  -Mydriatics  in 

the  Eye 115 

Siippnralive  Peritonitis;  Op-ning, 
Washing  anil  Sponging  the 
Peritoneum;  Recovery US 

The  Treatment  of  Ophthalmia  Neo- 

natiiriini '18 


EDITORIAL. 

A  New  Treatment  for  CoiU   and 

Carbuncles 119 

The  Cancer  P>acillu8  and  the  Sar- 
coma Uacillus 119 

Personal 120 

Review.... 120 

Josef  Hofmann 120 


I 


0n6inal  jSQinmimkaUani. 

OBSTETRICS  AND  GYiNECOLOGY. 
By  a.  Laptiiorn  Smith,   B.A.,  M.D.,  M.R.C.S.  Eng., 
Lecturer  on  Gynecology  in  Medical   Faculty  BLshop's  Col- 
lege. 

How  many  women  have  died  from  the  rupture 
of  an  undiagnosed  e.\tra  uterine  foetation,  it  is  im- 
possible to  say,  but  it  is  certain  that  the  num- 
ber must  be  very  large.  As  the  general  practitioner 
becomes  more  expert  in  diagnosing  these  cases, 
and  as  the  gynecologist  is  always  ready  to  operate, 
their  condition  will  become  less  and  less  desperate. 
When  in  Berlin  last  year  I  saw  two  such  cases  in 
one  week,  I  think,  in  the  practice  of  one  operator 
in  which  the  ruptured  tubes  were  ligatured  and  re- 
moved. One  of  these  women  was  up  and  about 
before  I  left  Berlin,  and  the  other,  as  I  learned 
from  Martin  at  the  Congress  at  Washington,  died 
a  few  days  later,  fiom  anemia.  Martin  at  the  time 
complimented  the  physicians  who  had  made  the 
diagnosis. 

A  case  of  successful  operation  of  one  of  these 
cases  was  mentioned  at  the  last  meeting  of  the 
medical  society  here,  by  Dr.  Gardner.  The  case 
occurred  in  the  practice  of  Dr.  Brown,  who  prompt- 
ly diagnosed  the  condition  and  called  Dr.  Gardner 
in  consultation,  who  as  promptly  decided  to  oper- 
ate with  the  gratifying  result  that  the  lady  is  alive 
and  doing  well,  and  with  every  prospect  of  continu- 
ing so. 

In  quite  a  contrast  to  this  is  a  case  reported  in  the 
British  Medical  Journal,  3rd  March,  i888,  in 
which  the  attendant  says  :  "He  found  the  patient 
pallid  and  pulseless,  and  refusing  to  be  moved.  Sur- 


mising the  nature  of  the  case,"  he  says,  "he  decided 
that  nothing  could  be  done."  At  the  autopsy  his 
surmise  was  confirmed. 

Testimony  still  continues  to  pour  in  from  every 
quarter  in  favor  of  Apostoli's  treatment  of  fibroids 
and  chronic  metritis  and  endometritis.  Even  Keith, 
one  of  the  greatest  of  English  Laparotomists,  is  so 
satisfied  with  the  result  of  a  year's  work  with  the 
method,  that  he  says  that  he  does  not  intend  ever 
to  remove  a  fibroid  with  the  knife  again.  Dr. 
Burton  {British  Medical/ournal,3TdUa.rch,'8S,') 
says  :  "  As  one  of  the  English  surgeons  who  have 
profited  by  Apostoli's  teachings,  and  as  I  haveptit 
the  teachings  into  practice,  I  may  be  considered 
to  be  in  a  position  to  say  something  on  the  question. 
In  the  first  place  I  have,  seen  no  appearances 
threatening  danger  to  life  from  the  use  of  electricity, 
and  I  have  used  it  sixty  times.  Secondly,  I  have 
used  it  in  seven  cases  of  uterine  myoma,  and  of  this 
number  three  are  already  practically  cured,  the 
tumors  having  become  so  much  reduced  in  size  as 
to  have  become  insignificant.  As  I  only  began 
the  treatment  in  Dec,  I  claim  that  three  recoveries 
out  of  seven  cases  in  the  short  space  of  two  months 
quite  equals  the  success  obtained  by  castration 
operations.  I  look  upon  the  latter,  as  regards  the 
treatment  of  the  tumors  under  discussion,  as  dead" 
as  amputation  of  the  finger  for  whidow  (which 
was  the  recognized  treatment  in  the  time  of  Charles 
the  II)." 

I  have  been  using  electricity  in  gynecology 
since  June  of  last  year,  several  hundred  times,  and 
have  not  yet  seen  any  dangerous  symptoms,  and 
the  results,  which  I  from  time  to  time  publish,  are 
very  satisfactory.  Of  course  the  ovariotomists, 
especially  the  ones   who   annually   reap   a  large 


98 


The  CANADA  MEDICAL   RECORD. 


harvest  of  healthy  ovaries,  pain  in  which  is  so 
easily  cured  by  high  tension  faradism,  are  not 
pleased  with  Apostoli,  and  they  have  declared  war 
to  the  knife  against  his  method.  As  a  rule  the 
fight  is  conducted  fairly,  but  in  the  last  British 
Medical  Journal,  Mr.  Tait  has  been  tempted 
to  use  an  argument  which  is  quite  unworthy  of  a 
man  of  such  acknowledged  greatness.  He  was  in 
Paris  a  year  ago,  and  because  the  leading  gyneco- 
logists there  did  not  tell  him  anything  about  Apos- 
toli, Mr.  Tait  argues  that  the  treatment  of  fibroids 
by  electricity  is  worthless.  If  Mr.  Tait  will  turn 
to  page  33  of  the  English  Edition  of  Apostoli's 
book  on  Metritis,  he  will  find  this  objection  antici- 
pated. Apostoli  says;  "It  was  in  France  that 
curetting  the  uterus  was  first  practiced;  it  was 
a  Frenchman,  Recamier,  who  was  the  first  to  formu- 
late it  scientifically,  and  it  is  in  our  country  full 
of  new  and  original  ideas,  which  timidity,  to  say 
7iothing  else,  soon  so  often  strangles,  that  it  is 
actually  practised  the  least." 

Thus  it  has  always  been  and  thus  it  will  always 
be.  When  Mr.  Tait  himself  goes  abroad  he  is 
everywhere  received  with  the  highest  honors ;  it 
is  principally  in  his  own  country  that  his  state- 
ments are  treated  with  coolness  and  suspicion. 

If  Mr.  Tait  would  say  that  he  had  tried  Apos- 
toli's treatment  in  the  balance  and  found  it  want- 
ing, the  argument  would  have  far  more  weight ; 
but  Mr.  Tait  does  not  want  to  learn  anything 
about  it,  for  he  will  not  even  give  it  a  trial,  as  the 
honest  old  Scotchman,  Keith,  has  done  with  the 
result  I  have  mentioned  at  the  beginning  of  my 
article.  To  add  to  the  weakness  of  his  argument 
he  says :  "  I  have  just  been  called  to  Paris  to  a  lady 
with  a  fibroid  who  has  been  given  up  by  all  the 
doctors."  We  see  the  same  thing  here  in  Montreal 
every  day,  "patients  going  to  New  York  to  have 
wax  removed  from  their  ears,"  or  to  have  a  lacera- 
tion of  the  cervix  repaired,  which  could  be  quite 
as  well  done  at  their  very  door.  The  fact  that  Mr. 
Tait  was  called  to  Paris  to  attend  a  lady,  who  could 
be  far  better  treated  by  a  gynecologist  at  her  very 
door,  therefore  proves  nothing.  If  Mr.  Tait  should 
be  convinced  of  the  advantages  of  Apostoli's 
treatment,  as  Mr.  Keith  has  been,  there  will  still 
remain  for  .his  skill  thousands  of  cases  which 
Apostoli's  method  does  not  pretend  to  touch. 

I  recognize  in  Mr.  Tait  the  most  skilful  remov- 
er of  ovaries  the  world  has  ever  seen,  but  this  does 
not  render  me  blind  to  the  advantages  of  a  treat- 
ment which  leaves   the   ovaries   in. 


Dr.  George  McKeough  of  Chatham,  Ontario, 
is  the  author  of  an  important  paper  appearing 
in  the  Canada  Medical  and  Surgical  Jour- 
nal, in  which  he  records  ,eleven  cases  of  puer- 
peral albuminuria  which  may  be  recapitulated 
thus  :  Nine  mothers  recovered  and  four  children- 
were  born  alive.  One  case  in  which  convulsions 
did  not  occur  was  no  seen  until  labor  had  set  in 
naturally  ;  the  mother  made  a  good  recovery  but 
the  child  was  still  born.  In  the  four  cases  in  which 
temporizing  measures  were  instituted  until  labor 
came  on,  convulsions  came  on  in  three,  one 
mother  died  and  three  recovered,  the  child  perished 
in  all  four.  In  the  two  cases  in  which  labor  was 
excited  after  convulsions  occured,  both  children 
born  dead,  one  mother  recovered  were  and  one 
died.  In  the  four  cases  in  which  labor  was  in 
duced  after  a  temporary  trial  of  expectancy,  but 
before  convulsions  took  place,  all  the  mothers 
made  good  recoveries  and  the  four  children  lived. 

After  reviewing  the  advice  given  in  the  standard 
text  books,  which  is  altogether  in  favor  of  letting 
things  alone,  he  comes  to  the  conclusion  that  it  is 
better  to  induce  labor  without  waiting  for  the  ap- 
pearance of  nervous  signals,  which  only  come  on 
after  the  child  has  been  irretrievably  damaged  and 
the  mother's  life  has  been  placed  in  danger. 

In  a  paper  which  I  read  a  little  over  a  year  ago 
(14  Jan.,  1887,  before  the  Medical  Society  of 
Montreal)  Can.  Med.Rec,  Mar.,  1887, 1  laid  down 
dogmatically  as  a  guiding  principle  of  treatment  : 
that,  unless  for  grave  reasons  to  the  contrary,  we 
should  induce  premature  labor  at  any  time  after 
the  seventh  month,  at  which  we  find  the  urine  of 
the  pregnant  woman  loaded  with  albumen  or  con- 
siderably deficient  in  urea.  By  freely  accepting 
this  course,  I  said,  all  doubt  and  hesitation  in  the 
treatment  of  these  most  anxious  cases  were  remo- 
ved. I  was  led  to  adopt  this  axiom  from  the  fol- 
lowing considerations  :  that  even  if  there  were  no 
convulsions,  the  condition  of  urjemia  from  me- 
chanical pressure  on  the  renal  veins  was  a  very 
serious  one  for  both  mother  and  offspring.  The 
child  suffers  even  more  than  the  mother  from 
uremic  intoxication,  and  may  even  be  killed  by 
it  before  convulsions  come  on,  while  the  mother 
may  have  her  brain  more  or  less  seriously  injured 
by  the  circulation  through  it,  for  a  long  time,  of  the 
poisonous  fluid,  and  so  end  her  days  in  an  Insane 
Asylum.  This  occurred  in  a  case  which  I  reported 
in  the  same  paper,  and  in  which  I  have  ever  since 
regretted  not  having  induced  premature  labor. 


Ttlfe  CANADA  MEDICAL  RECORl). 


99 


I  thus  compared  the  relations  of  albuminuria, 
urxmia,  puciijeral  convulsions,  and  puerperal 
mania : 

A  moderate  degree  of  renal  congestion-  causes 
albumen  to  appear  in  the  urine. 

A  greater  amount  of  renal  congestion  causes 
tlie  albumen  in  the  urine  to  increase  and  the  nor- 
mal quantity  of  urea  in  the  urine  to  diminish,  and 
at  liie  same  time  tlie  urea  being  retained  in  the 
blood  and  bathing  the  nerve  centres  causes  head- 
ache, disordered  vision,  &c. 

A  still  greater  amount  of  urea  in  the  blood  and 
of  albumen  in  the  urine  causes  poisoning,  and  at 
the  same  lime  starvation  of  the  nerve  centres,  and 
so  that  irritation  is  set  up  and  convulsions  ensue. 
And  if  this  condition  continues  for  a  considerable 
time,  the  nerve  cells  are  seriously  altered  in  nature, 
so  that  even  when  the  cause  is  removed  they  can 
with  difficulty  or  not  at  all  recover  their  normal 
functional  activity. 

As  there  is  no  longer  the  slightest  doubt  as  to  the 
mechanical  nature  of  the  disease,  and  as  it  is  so 
easily,  safely,  and  speedily  remedied,  I  heartily 
agree  with  Dr.  McKeough  when  he  urges  the 
induction  of  premature  labor  in  the  albuminuria 
of  pregnancy. 

Dr.  E.  S.  McKee,  in  the  course  of  an  able  arti- 
cle in  the  Feb.  number  of  the  Cincinnati  Med. 
Jour.,  says :  "  There  is  a  growing  tendency  among 
careful  obstetricians  to  limit  vaginal  examinations 
of  the  woman  in  labor  as  much  as  possible.  Yet 
we  must  know  the  position  of  the  child  and  the 
state  of  the  labor.  To  be  able  to  tell  this  with 
accuracy,  it  is  needful  that  we  cultivate  more 
thoroughly  the  external  means  of  the  diagnosis  of 
pregnancy.  The  tadus  eruditus  should  be  prac- 
tised industriously.  A  great  opponent  to  the  fre- 
quent vaginal  examinations  is  Prof  Crede  of  Leip- 
sic.  This  gentleman  claims  that  women  in  labor 
and  the  lying-in-state  are  diseased  only  through 
infection  from  without.  He  who  does  not  exam- 
ine a  woman  cannot  infect  her,  is  a  statement  of 
Crede' s.  The  solutions  of  continuity,  which  are 
seldom  or  never  absent  in  the  course  of  child-birth, 
are  generally  made  by  some  artificial  assistance  to 
parturition.  The  most  careful  digital  examinations 
may  result  in  wounds,  and  we  should  dispense 
with  them  altogether  or  restrict  them  to  the  fewest 
number  possible.  For  weeks  in  succession  at  the 
lying-in  hospital  at  Leipsic,  the  digital  examina- 
tion is  omitted  in  all  normal  cases,  especially  if 
there  is  much  sickness  among  the  patients.     This 


omission  results  not  in  trouble,  but  most  satisfac- 
torily. What  we  need  is  more  thorough  know- 
ledge on  this  important  subject  of  external  diagno- 
sis in  pregnancy,  a  knowledge  gained  only  by  expe- 
rience, then  we  will  use  the  internal  method  only 
when  necessary.  The  surest  prophyllaxis  against 
infection  consists  in  total  abstinence  from  vaginal 
examinations. 

A  good  deal  of  discussion  has  taken  place  lately 
at  the  various  societies  as  to  the  danger  of  anti- 
septic midwifery,  especially  where  bichloride  of 
mercury  is  the  agent  used.  And  the  same  ques- 
tion may  be  raised  in  employing  sublimaite  solu- 
tion in  gynecological  practice.  I  have  had  one 
case  of  slight  mercurial  poisoning  in  a  midwifery 
case,  but  it  was  due  to  the  neglect  of  two  precau- 
tions which  should  always  be  observed  :  ist,  never 
to  guess  the  quantity  of  corrosive  sublimate  you 
are  putting  into  tlie  water,  and  2nd,  to  allow  the 
patient  to  sit  on  a  chamber  or  otherwise  empty 
her  vagina  shortly  afterwards.  But  out  of  an 
immense  number  of  irritations  with  sublimate  at 
my  office  (from  i  in  20C0  to  i  in  5000)  I  have 
never  seen  any  unpleasant  results,  and  Apostoli's 
experience  has  been  the  same  in  many  thousand 
cases.  But  this  immunity  is  due  to  the  simple 
precaution  of  pressing  down  the  perineum  and 
emptying  the  vagina  after  every  irrigation. 

Monti eal,  21st  March,  18S8. 

Saciefij  J^paceedttn^S. 

MEDICO     CHIRURGICAL     SOCIETY     OF 

MONTREAL. 

Stated  Meeting,  Deccmler  gfli ,  18S7. 

Jas.  Perrigo,  M.D.,  President,  in  thk  Chair. 

PATHOLOGICAL   SPECIMENS: 

Development  of  Bone  from  Periosteum. — Dr. 
Bell  presented  a  section  of  the  shaft  of  the  femur 
illustrating  the  reproduction  of  bone  from  the 
periosteum.  The  specimen  was  secured  from  a 
patient  whose  thigh  had  been  amputated  ten  days 
after  receiving  a  compound  comminuted  fracture 
of  the  lower  end  of  the  femur  and  the  head  of  the 
tibia,  opening  the  knee-joint.  Extensive  sloughing 
had  occurred,  and  at  the  time  of  the  operation  the 
patient  was  saprcemicixom.  the  absorption  of  putrid 
material  from  the  sloughing  tissues.  Twenty-five 
days  later  it  was  found  to  be  necessary  to  remove 
two  and  a  half  inches  of  the  end  of  the  bone  owing 
to  sloughing  of  the  flaps.  At  the  primary  amputa- 
tion the  periosteum  had  been  stripped  from  the 


100 


tHE   CANADA   MEDICAL   RECORD. 


bone  to  the  extent  of  nearly  an  inch  above  the 
point  at  which  it  was  removed.  The  bone  removed 
at  the  secondary  operation  showed  an  undoubted 
development  of  bone  in  the  periosteum  thus 
detaclied. 

Dr.  Shepherd  said  that  this  case  was  most 
interesting  in  connection  with  the  views  recently 
gived  by  Dr.  MacEwen  of  Glasgow  in  the  October 
and  November  numbers  of  the  Annals  of  Sur- 
gery. That  authority  held  that  periosteum  does 
not  initiate  the  reproduction  of  bone.  In  Dr. 
Bell's  case  the  periosteum  had  certainly  developed 
bone.  He  had  no  doubt  of  the  correctness  of  Dr. 
MacEwen's  views  when  he  states  that  the  perios- 
teum is  not  the  chief  factor  in  the  reproduction  of 
bone,  this  function  being  performed  by  the  soft 
tissues  in  the  bone  itself. 

Dr.  Mills  thought  that  the  .Society  was  much 
indebted  to  Dr.  Bell  for  having  brought  to  its 
notice  a  specimen  that  might  readily  liave  been 
overlooked,  and  which  illustrates  one  of  the  great 
laws  of  reproduction  of  lost  tissue  in  the  adult,  in 
a  structure  but  imperfectly  understood  as  yet. 
There  were  other  methods  of  ascertaining  the  laws 
of  the  organism  than  by  laboratory  experiments. 
Disease  was  one  of  nature's  own  experiments ; 
and  medical  practitioners  might  supplement  the 
work  of  the  physiological  and  pathological  labor- 
atories by  the  results  of  their  clinical  observations. 
The  views  most  likely  to  be  correct  and  lasting 
were  that  resultant  of  the  comparison  of  facts 
derived  from  many  different  fields  of  observation. 
It  was,  moreover,  to  be  remembered  that  however 
carefully  conducted  our  laboratory  experiments, 
there  was  always  some  disturbance  of  nature's 
processes,  a  principle  often  forgotten  by  over- 
confident investigators. 

Purulent  Meningitis. — Dr.  Johnston  reported 
a  case  which  had  been  under  the  care  of  Dr.  Mol- 
son,  and  in  which  he  had  performed  an  autopsy. 
Patient  was  a  healthy  woman,  who,  whilst  in  the 
sixth  month  of  pregnancy,  fell  and  struck  her  head. 
She  developed  soon  after  brain  symptoms,  devia- 
tion of  the  eyes,  flexion  of  the  neck  to  one  side, 
and  active  delirium.  She  was  admitted  to  the 
General  Hospital,  miscarried,  and  some  days  after 
died.  At  the  autopsy,  the  ovarian  veins  were 
distended  but  patent,  the  renal  veins  free.  There 
was  severe  parenchymatous  nephritis  with  slight 
interstitial  nephritis.  Spleen  and  liver  enlarged 
and  soft.  Uterus  enlarged,  cavity  dilated,  placen- 
tal site  free  from  inflammxtion.     On  the  right  side 


there  was  purulent  meningitis  of  the  inner  surface 
of  the  pia  mater  extending  to  the  base  in  the  mid- 
dle and  anterior  fossse  of  the  skull.  There  was 
thrombosis  of  the  right  lateral  sinus  and  inferior 
petrosal  sinus.  No  fracture  of  the  base  of  the 
skull  was  found,  but  there  was  purulent  otitis  me- 
dia of  the  right  side  with  pus  in  the  mastoid  cells. 
The  tympanic  cavity  was  covered  with  granula- 
tions. In  this  case  there  was  no  history  of  ear 
trouble.  Dr.  Johnston  had  no  doubt  that  the  otitis 
was  the  cause  of  the  meningitis,  and  that  the  fall  a 
short  time  previously  had  very  little  to  do  with  the 
fatal  result  of  the  case. 

Rupture  of  (he  Heart. — Dr.  H.  L.  Reddy  exhi- 
bited a  heart  showing  rupture  of  the  left  ventricle, 
and  related  the  following  history  : — S.,  aged  68, 
day  watchman  by  occupation,  enjoyed  good  health 
for  the  thirty  years  preceding  his  death.  Good 
family  and  personal  history.  Was  a  tall,  well-built 
man,  but  not  obese.  On  Monday  last  he  left  his 
house  at  5  a.m.  to  go  to  work.  When  going  down 
the  steps  of  his  house  he  was  seized  with  a  severe 
pain  in  chest;  he  managed  to  walk  about  a  quar- 
ter of  a  mile,  when  he  was  forced  to  return  and  go 
to  bed.  In  my  absence  Dr.  Spendlove  kindly  saw 
him  for  me,  and  has  given  me  the  following  note : 
"  Patient  complained  of  severe  pain  below  the  low- 
er third  of  the  sternum  and  extending  two  inches 
to  the  left  of  the  sternum  and  three  or  four  to  the 
right ;  pain  down  both  arms  to  the  fingers,  and  a 
sensation  of  tingling  in  the  finger-tips,  general 
malaise,  and  a  feeling  as  if  a  heavy  weight  was  on 
the  chest ;  slight  dyspnoea ;  no  cough  ;  lungs  nor- 
mal ;  pulse  slow  and  full  but  intermitting  once  in 
four  beats ;  heart-sounds  slightly  indistinct,  no 
murmurs  to  be  heard  ;  vomitted  once  after  taking 
a  cup  of  tea.  Dr.  S.  gave  him  a  small  dose  of 
nitro-glycerine,  which  apparently  had  the  effect  of 
removing  the  intermittence."  I  saw  the  patient 
about  12.30  P.M.  ;  he  complained  of  severe  pain  in 
the  epigastrium,  and  was  greatly  troubled  with 
eructation  ;  pulse  was  then  normal,  and  there  was 
no  symptom  pointing  to  the  heart  as  the  cause  of 
the  trouble.  I  ordered  him  \  gr.  of  morphia, 
which  relieved  him  greatly,  and  in  four  hours 
another  \  gr.,  which  relieved  him  entirely.  The 
patient,  after  the  second  dose  of  morphia,  seemed 
quite  well,  and  enjoyed  his  broth  diet.  On  the 
afternoon  of  the  8th,  or  four  days  after  the  first 
attack,  whilst  reading  the  newspaper,  he  threw 
back  his  head  and  died  instantly. 

At  the  autopsy  Dr.  Johnston  found  the  follow 


THE   CANADA    MEDICAL   RECORD. 


101 


iiig  conditions:  Pericardium  moderately  distended 
by  blood,  on  oiiening,  blood  and  clot  to  amount 
of  10  oz.  found  witliin  the  sac,  the  clot  forming  a 
com[)lete  mould  about  the  heart.  A  small  lacera- 
tion, half  an  inch  long,  situated  in  anterior  wall  of 
left  ventricle,  one  inch  to  left  of  septum,  surround- 
ed by  an  area  of  ecchymosis.  On  opening  ven- 
tricles, left  nearly  empty.  Endocardium  appears 
normal,  but  at  spot  of  rupture,  on  separating 
trabecular,  an  area  of  softening  can  be  seen,  and 
bristle  readily  passed  through  the  laceration.  On 
transverse  incision  above  laceration,  a  thrombosed 
vessel  seen  surrounded  by  soft  yellow  area  of 
necrotic  muscle.  Subpericardial  fat  in  excess,  but 
heart  muscle  not  fatty.  On  microscopic  examina- 
tion, no  extreme  atheroma  of  coronary  or  systemic 
arteries. 

Dr.  MacDonnell  thought  that  the  thrombosis 
of  the  vessels  in  the  wall  of  the  ventricle  caused 
the  symptoms  which  preceded  death,  but  that  the 
rupture  itself  occurred  later. 

Mucous  Polypi. — Dr.  Johnston  exhibited  some 
microscopic  specimens  of  mucous  polypi  from 
the  nose.  In  eight  or  nine  cases  the  condition 
was  seen  in  its  early  stage  to  be  strictly  an  adeno- 
ma of  the  nasal  mucous  glands.  In  later  stages 
in  the  epithelial  cells  cause  a  disappearance 
more  or  less  complete  of  the  cell  outlines,  leaving 
only  areolar  tissue  infiltiated  with  mucous  fluid. 
This  secondary  change  probably  the  reason  why 
these  growths  are  commonly  but  wrongly  called 
myxomata  of  the  nose  and  confused  with  true 
myxomata,  which  are  tumors  of  quite  a  different 
nature,  originating  in  connective  tissue. 

Dr.  J.  J.  Gardner  exhibited  a  horizontal 
section  of  an  absolutely  normal  human  eye  through 
the  macula  lulea.  Specimen  was  hardened  in 
Miiller's  fluid,  cut  under  alcohol  imbedded  in 
celluloidin  and  stained,  first  with  hrematoxylon 
and  after  with  eosin.  Under  the  microscope  the 
yellow  spot  shows  well  the  thinning  of  all  the 
layers  of  the  retina,  with  entire  absence  of  the 
rods,  leaving  the  cones  very  distinctly  seen. 

Sul-cUaphragmatic  Abscess. — Dr.  Shepherd 
reported  a  case  which  had  come  under  his 
observation  some  months  ago  : 

John  R.,  aged  60,  carter,  was  admitted  into  the 
Montreal  General  Hospital,  under  Dr.  Wilkins, 
on  the  14th  of  April,  1887,  complaining  of  a 
painful  swelling  in  his  right  side.  More  than  a 
year  ago  he  had,  after  exposure,  become  thoroughly 
ehijled,  and  had  suffered  from  very  acute  pain  in 


the  region  of  the  stomach ;  he  was  able  to  be 
about  again  in  a  day  or  two,  but  never  felt  rjuite 
well.  The  severe  pain  returned  in  a  couple  of 
weeks  in  the  right  hypochondriac  region,  and  was 
increased  by  inspiration  and  movement  of  the 
body.  At  this  time  he  became  jaundiced.  He 
remained  in  bed  for  a  week ;  after  this  the  pain 
left  him,  and  he  got  up  and  went  about,  but  was 
unable  to  do  any  work.  In  the  middle  of  April, 
1886,  he  had  another  severe  attack  of  pain  in  the 
right  hypochondrium,  and  this  time  he  remained 
in  bed  till  July,  1S86.  He  now  first  noticed  a 
swelling  in  his  right  side,  immediately  below  the 
margin  of  the  costal  cartilages.  Since  July,  1886, 
although  he  was  never  confined  to  bed,  he  always 
suffered  from  pain,  and  the  swelling  in  his  right 
side  gradually  increased.  At  the  beginning  of 
April,  i887j  the  swelling  became  more  painful  and 
rapidly  increased  in  size ;  he  entered  the  Gen- 
eral Hospital.  During  the  whole  period  of  his 
illness  he  never  had  any  rigors  nor  any  marked 
shortness  of  breath. 

When  examined  on  entrance  into  hospital, 
April  14,1887,  the  following  note  was  made  by  Dr. 
Wilkins  :  "  Well  developed  man,  not  emaciated 
or  ansemic  ;  skin  cool  and  moist ;  no  hectic  flush  ; 
no  jaundice  ;  temperature  98.5  °  ,  respirations  and 
pulse   normal;    appetite    good,   sleep  well,    and 


always   lies     on 


his 


jht    side.     In   the   right 


hyiiochondriac  region  is  a  large,  smooth,  globular, 
fluctuating  swelling  extending  below  the  costal 
margin  to  within  half  an  inch  of  the  umbilicus, 
and  laterally  to  near  the  median  line ;  lower 
border  of  the  swelling  is  convex  and  yields  to 
pressure  ;  right  side  of  chest  from  third  rib  down- 
wards is  expanded,  the  intercostal  spaces  widened 
and  bulging,  and  a  dull  note  on  percussion  in 
front  and  in  the  axillary  from  the  third  rib  down- 
wards and  from  the  middle  of  scapula  behind. 
Breathing  sounds  are  completely  absent  over  this 
area.  In  upper  part  of  right  lung  breathing  is 
feeble  and  somewhat  tubular  in  character.  Left 
hmg  and  heart  normal.  Urine  normal.  It  is 
impossible  to  make  out  the  liver  dulness  or  to  feel 
the  lower  border  of  that  organ." 

On  the  i8th  of  April  Dr.  Wilkins  aspirated  the 
fluctuating  swelling  in  its  most  convex  portion 
below  the  ribs,  and  drew  oft"  25  ounces  of  creamy 
sweet-smelling  pus.  This  was  examined  micro- 
scopically for  booklets  of  echinococci,  but  without 
result.  Nothing  but  blcod,  pus  and  neurJtic 
tissue  was  found.    After  the   aspiration,  patient 


102 


THE   CANADA   MEDICAL   RECORD. 


felt  much  more  comfortable^  could  sleep    on  his 
right  side,  and  had  no  pain  or  nausea.     He  was 
transferred  to  the   surgical   wards,    and  on   April 
23rd  Dr.  Shepherd,  under  ether,  made  a  vertical 
incision  some  four   inches   long  in  a  line  with  the 
nipple,  and  commencing  immediately   below  the 
costal  margin  on-  the  right   side  ;    the   parts  were 
carefully     incised,    and    it    was   found    that   the 
wall    of  the    abscess    cavity     was    adherent    to 
the     abdominal     parietes,      and    consisted     of 
a    thick   mass    of    infiamraatory     tissue.     When 
the    abscess  cavity  was   opened  there  was  a  gush 
of  fluid,  and  afterwards  each  inspiration  caused  the 
pus  to  flow  more  freely  ;  to  facilitate  the  exit  of  pus 
a  large  rubber  tube  was  introduced,  which  acted 
as  a  siphon ;  in  this  way  some   80  ounces  of  pus 
were  drawn  off.     The  patient  now  showed  signs  of 
collapse,  breathing  shallow,  pulse  extremely  feeble, 
so  the  evacuation  of  pus  was  discontinued.     On 
exjjloring  the  abscess  cavity    with  the  finger  the 
diapragni    could      be    felt   above,    reaching    as 
high  as  the  third  rib,  but  owing  to  the  size  of  the 
cavity  its  lateral  and    posterior  limits   could   not 
be  made  out ;  its  lower  limit  consisted  of  a  dense 
mass  of  inllammatory   tissue,   through  which  the 
liver  could  not  be  felt ;  a  probe  introduced  could 
be  felt  posteriorly  between    the  fourth  and  fifth 
ribs.     The  cavity    apparently   now  contained   as 
much  pus    as  had    been  already   evacuated,  but 
owing  to  the  condition  of  the  patient  it  was  deci- 
ded it  would  be  more  prudent  to  allow  it  to  drain 
away  gradually    through   a    rubber    tube  ;  so  the 
wound  was  sutured,  a  large  drainage-tube  left  in, 
and   a   dressing  of  sublimated   jute  and  washed 
gauze  applied.     Patient,  on  getting  to  bed,  under 
the  influence  of  heat  and  stimulants  soon   rallied. 
During  the  next  three  days  there  was  a  large   dis- 
charge of  pus,  and  the  dressings  had  to  be  changed 
daily.     Temperature   never  rose  above  99^,  and 
from  the  day  of  his  operation   patient  improved, 
the  abscess  cavity  rapidly  diminishing  in  size.     By 
tho  istof  June  the  discharge  of  pus  had  almost 
ceased,    the  abdominal  organs  had  resumed  their 
normal  position,   and  liver   dulness  was    normal, 
but   breath    sounds  over   right  lung   still  feeble. 
Patient  rapidly  gained  flesh,  and  when  discharged 
from  hospital  in  August  there  was  a  small  sinus  at 
the  site   of  the  wound  which  discharged  a  little 
serum.     For  the    last    three    months  patient  had 
been  at  work,  and  looks,  and  says  he  feels,  well. 
The  sinus  has  not  yet  quite  closed.     The   breath 
sounds  could  be  heard  over  the  whole  ri<?ht  luntr, 


but  at  the  lower  part,  both  in  front  and  behind, 
still  rather  feeble. 

Dr.  Shepherd  said  that  there  was  no  doubt  in 
his  mind  about  this  being  a  case  of  abscess  which 
originated  between  the  diaphragm  and  the  liver. 
The  remarkable  point  about  the  case  was  the 
absence  of  history  of  fever  or  rigors,  the  slow  and 
comparatively  painless  growth,  and  absence  of 
jaundice.  These  conditions  are  those  which  gen- 
erally indicate  echinococcus  disease  :  so  at  first, 
until  a  microscopical  e-xamination  gave  a  negative 
result,  the  case  was  diagnosed.  The  symptoms 
were  not  acute  enough  for  liver  abscess,  but  when 
no  hocklets  or  other  evidences  of  echinococcus 
were  found  it  was  thought  probable  that  it  was 
such  a  case.  He  had  intended  making  a  counter 
opening  posteriorly  to  facilitate  drainage,  but  the 
collapsed  condition  of  the  patient,  after  the  evacua- 
tion of  so  large  an  amount  of  pus,  warned  him  to 
complete  the  operation  as  soon  as  possible  and  to 
apply  restoratives.  The  result  was  quite  as  satis- 
factory as  it  would  have  been  had  an  opening  been 
made  posteriorly  as  intended,  a  dependent  open- 
ing when  abscesses  above  the  diaphragm  being 
much  more  important  than  when  they  are  below  it, 
on  account  of  pressure  of  the  abdominal  walls  on 
the  contents  of  the  abdomen  always  tending  to  ob- 
literate any  cavity  that  may  exist.  In  this  case  it 
was  remarkable  how  soon  such  -an  enormous 
cavity  disappeared. 

Dr.  Roddick  thought  that  it  was  not  improba- 
ble that  the  case  originally  had  been  one  of 
empyema  ;  that  the  pus  had  ulcerated  through  the 
diaphragm,  and  got  between  that  structure  and  the 
liver. 

Dr.  Geo.  Ross  said  that  the  explanation  offered 
by  the  last  speaker  was  an  ingenious  one,  but  not 
practicable.  The  anatomical  structure  of  the  parts 
did  not  give  any  likelihood  to  the  supposition. 
The  case  had  probably  been  originally  one  of 
subdiaphragmatic  peritonitis  which  had  become 
localized.  We  may  have  a  pleurisy  following  a 
subdiaphragmatic  inflammation  without  perforation 
of  the  diaphragm,  but  that  such  a  small  opening 
as  v.-ould  naturally  result  from  an  ulcerating  em- 
pyema could  completely  drain  the  pleural  cavity, 
and  collect  below  the  diaphragm,  was  not  proba- 
ble. Any  empyema  would  surely  come  forward 
more  readily  than  downward. 

Dr.  MacDonnell  related  a  case  of  peri-ca:cal 
abscess,  in  which  pus  found  its  way  up  behind  the 
peritoneum,  between  the  liver  and  diaphragm,  and 


THE   CANADA.    MEDICAL   RECOIl©, 


103 


biirrdwiiig  tliroiigh  tlie  latter,  formed  an  abscess 
in  the  lung,  and  was  coughed  up  by  the  patient. 

Dr.  Wii.KiNS  said  that  when  he  first  saw  the 
case  the  probability  of  its  being  an  empyema  oc- 
curred to  him,  but  he,  for  various  reasons, 
discarded  this  idea.  From  the  early  history, 
jaundice,  etc.,  he  was  inclined  to  regard  the  case 
as  one  of  abscess  of  the  liver  ;  but  against  this  was 
a  total  absence  of  a  history  of  fevers,  rigors,  or 
sweating.  He  had  now  no  doubt  that  the  case 
was  one  of  abscess  between  the  liver  and  dia- 
phragm. One  feature  about  the  case  was  the  appar- 
ently slight  amount  of  pain  which  pressure  on  the 
tumor  caused. 

Dr.  Shkpherd,  in  reply  to  Dr.  Roddick,  said 
that  not  one  symptom  in  the  early  history  pointed 
to  an  affection  of  the  pleura;  the  pain  was  always 
below  the  costal  cartilages  of  the  right  side,  and 
there  never  was  any  cough  or  difficulty  of 
breathing.  At  the  time  of  the  operation  there  was 
no  pus  in  the  plural  cavity.  Fluid  always  finds 
its  way  in  the  direction  where  there  is  the  least  re- 
sistance, and  this  is  certainly  not  the  direction  of 
the  diaphragm.  In  his  experience  the  pus  in  em- 
pyema always  pointed  in  the  neighborhood  of  the 
nipple,  and  when  it  pointed  elsewhere  it  did  so 
by  burrowing  beneath  the  tissues  external  to  the 
lung  wall  of  the  thorax,  after  perforating  an  inter- 
costal space. 

Four  Cases  of  Literal  Litliotomi/. — Dr.  FENWick 
said:  I  desire,  Mr.  President,  to  lay  before  the 
Society  four  specimens  of  vesical  calculi  recently 
removed  by  lateral  operation. 

The  first  is  a  mulberry  calculus  removed  in 
August  of  the  last  year  from  a  young  fisherman 
from  Newfoundland,  aged  22  years,  who  had  no- 
ticed the  usual  symptoms  of  stone  for  the  past  five 
or  six  years.  For  the  past  year  he  had  been  quite 
unfit  for  his  usual  avocations,  and  at  length  deci- 
ded on  seeking  relief  by  coming  to  Montreal.  The 
voyage  from  Newfoundland  was  unsually  rough, 
and  he  stated  that  the  pitching  of  the  vessel  was 
very  distressing.  The  usual  operation  of  lateral 
lithotomy  was  performed.  The  patient  made  a 
good  recovery;  the  urine  ceased  to  flow  from  the 
wound  on  the  14th  day,  and  he  returned  home 
ten  days  later. 

The  second  specimen  was  removed  by  lateral 
lithotomy  from  a  Scotch  farmer,  aged  57,  who  had 
suffered  from  difficulty  of  micturition  for  the  past 
year  and  a  half.  He  had  also  noticed  occasional 
spasm,  persistent  pain  at  the  point  of  the  penis, 


and  frequency  in  passing  urine;  he  could  not  retain 
his  water  longer  than  two  hours  at  any  time,  and 
more  frequently  it  would  be  passed  every  hour. 
He  presented  an  anxious,  care-worn  appearance, 
was  a  strong,  robust  man,  and   otherwise   well- 
nourished  and   healthy-looking.      His  physician 
had  suspected  stricture,  and  had  failed  in  an  at- 
tempt to  pass  a  No.  4  catheter  into   the    bladder. 
This,  he  slated,  had  been  followed  by  hemorrhage, 
the  only  time,  indeed,  in  which  he  had  lost  blood. 
An  ordinary  sound  was  passed  into   the  bladder 
and  a  stone  at  once  struck.     The  prostate  gland 
was  not  enlarged,  and  the  urine  was  found  to   be 
normal  and  otherwise  healthy.     I  may  state  that 
this  man's  brother,  a  year  or  two  before,  had  been 
successfully  operated  on  for  stone  by  Dr.  Roddick. 
Lateral   lithotomy  was   performed   on  the    27th 
September  last,  and  the  two  calculi  shown  were  re- 
moved; their  united  weight  is  243  grs.  The  patient 
progressed  favorably.     On  the  tenth  day  after  the 
operation  he  complained  of  some  bladder  irritation 
so  that  I  determined  to   pass  and  leave  in  a  soft 
rubber  catheter.     This  was  done  with   a  view  of 
hastening  the  closure  of  the  wound   in  the   per- 
ineum.    The  pressure  of  the  catheter,   however, 
could  not  be  endured;  it  was  removed  on  the  second 
day  after  its  introduction.  The  urine  ceased  com- 
ing by  the  wound  on  [the  fourteenth  day.     The 
wound  made  rapid  progress  towards  improvement 
and  closed  on  the  seventeenth  day  after  the  opera- 
tion, and  he  was  allowed  to  return  home  on  the 
twenty-sixth  day  from  the  date  of  operation. 

The  third  specimen  submitted  was  removed 
from  an  old  gentleman,  aged  69  years,  by  lateral 
lithotomy.  It  is  almost  pure  lithic  acid,  and  one 
of  the  largest  specimens  of  the  kind  in  my  collec- 
tion, its  weight  was  625  grs.  The  operation,  which 
was  performed  on  the  ist  November  last,  was  at- 
tended w-ith  some  difficulty  owing  to  the  high  posi- 
tion of  the  bladder,  due  apparently  to  an  enlar- 
ged prostate  gland.  The  bladder  was,  however, 
readily  incised,  but  on  attempting  to  enter  with 
the  finger  I  found  that  the  point  of  my  finger  did 
not  reach  further  than  the  commencement  of  the 
prostate.  Fearing,  if  I  used  any  force,  that  the 
bladder  would  be  pushed  beyond  my  reach,  I  re- 
quested my  friend  Dr.  Roddick,  who  has  a  much 
longer  index  finger  than  I  have,  to  complete  the 
operation,  this  he  did  with  some  difliculty;  no 
further  cutting  was  necessary  as  the  opening  in 
the  prostate  was  large  enough  for  the  purpose.  The 
bladder  was  then    carefully  washed  out,  and    a 


104 


THE   CANADA   MEDICAL   RECORD, 


large-sized  giim-elastic  tube  introduced  through 
the  wound  and  tied  in.  Tliis  was  removed  by  the 
patient  himself  the  morning  after  the  operation, 
and  to  this  I  attributed  the  subsequent  distur- 
bance wliich  delayed  the  recovery.  Erysipelas 
attacked  the  wound  on  the  fifth  day,  the  edges  of 
the  incision  presented  a  sloughy  aspect,  and  the 
erysipelatous  blush  extended  over  the  buttocks  and 
up  the  back  as  high  as  the  shoulders  ;  septic  sore 
throat  followed.  The  entire  fauces  and  hard  and 
soft  palate  were  covered  with  diphtheritic  mem- 
brane. The  muriate  tincture  of  iron  with  quinine 
was  prescribed  in  full  doses,  and  he  was  supported 
with  beef-juice,  milk  and  champagne.  At  the 
same  time  the  throat  was  sponged  over  with  a 
solution  of  salicylic  acid  3  i  to  §  i  glycerine  every 
two  hours.  This  treatment  was  persevered  in,  and 
about  the  fifteenth  day  after  the  operation  the 
symptoms  began  to  improve.  The  urine  was 
highly  ammoniacal,  and  as  he  was  constantly  wet, 
which  added  to  his  distress,  a  soft  rubber  catheter 
was  introduced  into  the  bladder  so  as  to  drain 
througli  the  natural  passage.  This  was  kept  up  for 
several  days.  He  was,  however,  somewhat 
difticult  to  manage,  as  he  would  himself  remove 
the  instnuneut,  but  always  ])ermitted  it  to  be  rein- 
troduced. This  was  followed  by  marked  improve- 
ment. The  erysipelas  subsided  about  the  twenty- 
second  day  and  the  wound  became  more  healthy 
in  appearance.  The  catheter  was  retained  at  in- 
tervals up  to  the  30th  ult.  The  patient  is  now 
making  a  slow  recovery  ;  the  urine  ceased  coming 
through  the  wound  on  the  5th  of  December  and 
the  wound  itself  is  all  but  closed.* 

The  fourth  specimen  is  mulberry  calculus,  re- 
moved from  the  bladder  by  the  lateral  operation  on 
the  22nd  of  November,  1887.  The  patient  is  a 
healthy-looking  lad  of  18  years.  I  was  informed 
by  his  mother  that  he  had  suffered  from  bladder 
irritation  off  and  on  since  the  age  of  five  years. 
During  the  past  twelve  months  lie  had  observed 
that  he  experienced  pain  in  liding  over  a  rough 
road  ;  there  was  a  continued  irritation,  frequency 
of  micturition,  and  pain  at  the  point  of  penis.  He 
had  never  passed  blood.  No  examination  for 
stone  had  ever  been  made  until  recently,  when 
the  gentleman  whom  he  consulted  had  passed  a 
sound  and  readily  found  the  stone.  He  advised 
him  to  come  to  Montreal,  and  he  was  admitted  to 


*  He  progressed  slowly,  but  steadily,  and  early  in  January 
returned  to  his  home  in  the  country.  Since  llicn  I  have 
heard  of  his  steady  amendment, 


the  Montreal  General  Hospital  on  the  i6th  Novem- 
ber, 1S87.  The  day  following  an  examination  was 
made  while  the  patient  was  under  ether.  A  short 
beaked  sound  was  passed  and  a  stone  struck  ;  it 
ajipeared  hard,  had  a  clear'i'ing,  was  evidently  of 
good  size,  and  was  rough  on  the  surface.  Litho- 
tomy was  advised.  As  the  examination  had  been 
attended  with  slight  bleeding  and  increased 
bladder  irritation,  it  was  decided  to  defer  the 
operation  for  a  day  or  two.  On  Tuesday,  22nd  of 
November,  the  operation  of  lateral  lithotomy  was 
performed.  Some  difficulty  was  experienced  in 
delivering  the  stone.  The  patient  progressed 
favorably.  A  sponge  wrung  out  of  a  very  weak 
solution  of  sulphuric  acid  was  placed  in  his  bed 
against  the  wound,  on  the  seventh  day  from  the 
date  of  operation  he  first  e.xjjerienced  a  desire  to 
pass  urine,  but  not  over  half  an  ounce  was  passed 
by  the  natural  passage.  This  gradually  increased 
in  amount  each  day.  On  the  thirteentii  day  the 
urine  was  passed  in  full  stream  and  very  little  by 
the  wound,  on  one  the  sixteenth  day  the  urine 
ceased  to  come  through  the  wound  and  two  days 
subsequent  the  wound  closed.  The  patient  was 
allowed  up,  and  he  returned  home  on  the  24th 
Deccember,  1887.  The  weight  of  the  stone  was 
411    grs. 

Cirrhtisis  0/ the  liver. — Dr,  R.  L.  McDonnei,l 
related  a  case  of  recovery  in  cirrhosis  of  the  liver, 
where  ascites  had  been  present  to  a  very  great  ex- 
tent. The  patient,  a  woman  aged  35,  married, 
but  childless,  was  admitted  to  the  Montreal  Gen- 
eral Hospital  in  August,  1885,  '*^'''i  ^  large  quan- 
tity of  fluid  in  the  abdomen.  She  had  suffered 
during  the  past  year  from  dyspeptic  symptoms 
with  morning  vomiting.  There  was  a  history  of 
s]iirit  drinking.  Prior  to  admission,  was  tapped 
to  the  extent  of  200  ounces.  There  was  tender- 
ness over  the  hepatic  region.  The  liver  was 
small,  measuring  three  inches  in  the  right  mam- 
mary line.  Slie  remained  in  hospital  for  ten 
mouths,  being  tapped  at  first  every  two  or  three 
days,  but  subsequently  at  longer  intervals,  the 
amount  withdrawn  being  at  first  about  180  to  200 
ounces,  but  at  the  time  of  leaving  hospital  but 
16  to  20  ounces  could  be  obtained.  She  was 
tapped  sixty  times  during  that  year,  and  taking 
150  ounces  as  an  average,  altogether  8,500  to 
9,000  ounces  were  removed.  The  woman  has 
gained  health  and  strength,  and  is  now  apparently 
well  and  attending  to  her  household  duties.  The 
liver  is  of  the  same  size,   the  belly  empty,  and 


tnE  CANAbA  liEDlOAL  ftfiCORO. 


105 


dyspeptic  symptoms  have  disai)pcared.  The 
total  amount  of  fluid  removed  in  a  year  is  large, 
considering  the  i)atient's  weight  (125  lbs.)  and 
size.  Much  larger  quantities  have  been  taken, 
but  the  case  is  instructive  as  illustrating  the  benfcfit 
to  be  derived  from  |)aracentesis  in  cirrhosis. 

JJerinoiii  Ooarkin  Cyst  i"  o.  Pregnitnl  Womnn. — 
Dr.  Wm.  Garunkk   alliuled  to  a  case  he  related 
to  the  Society  with  exhibition  of  the  specimen  last 
winter.     The  case  in  question  was  one  of  ovario- 
tomy for  dermoid  cyst,  with  twisted   pedicle  and 
most  alarming  symptoms  of   peritonitis.     At  the 
operation  there  was  found  universal  adhesion  of 
the  cyst ;   it  was  necessary  to   remove  the  second 
ovaiy  for  commencing  disease.     Washing  out  ol 
the  cavity  was    freely  practised,  and  a  drainage 
tube  was  used  for  five  days.     It  lay   against  the 
posterior   wall  of  the   uterus  for  five  days.     The 
uterus   was    somewhat    large   and    vascular,    but 
pregnancy  was  not  seriously  thought  of,  yet  in  a 
few  weeks  the  woman  was  found  to  be  undoubtedly 
pregnant.     He  now  had  to  report  that  a  few  weeks 
ago  slie  had  been  confined  at  full  term  by  her 
ordinary    medical    attendant,    Dr.    Molson,    of  a 
large,  healthy,  living  child,  and  had  made  an  easy 
and  rapid  recovery.     This  was  the  second  ovario- 
tomy Dr.  Gardner  had  done  during  pregnancy. 
jK      The  first  case  was  also  confmed  at  full  term,  both 
■^  mother  and  child  being  alive  and  well.     Consider- 
^^■ing  the  dangers  of  pregnancy  with  ovarian  tumor 
^^B  when  uninterfered  with,  such  cases  surely  furnish 
^^B  a  strong  argument  in  favor  of  prompt  performance 
^^B  of  ovariotomy  even  when  at  the  time  of  diagnosis 
^^■there   are  no  alarming  symptoms.      Both  of  Dr. 
^^B  Gardner's  cases  were,  however,  done  for  urgent 
^^■symptoms. 

^^  The  JJ(iii(jcrs  and  Accidents  of  Local  Treatment 
in  I'lieqieial  Cases. — Dr.  J.  C.  Cameron  then 
read  a  paper  on  this  subject,  as  follows  :  — 

Dr.  Matthews  Duncan  has  somewhere  remarked 
that  the  subject  of  antisei^ics  in  midwifery  is  by 
far  the  most  important  obstetrical  question  of  the 
day,  being  of  even  greater  moment  to  the  public 
than  the  prevention  of  epidemics,  for  while  epide- 
mics come  only  at  intervals,  puerperal  seplicajmia 
is  a  constant  menace  to  the  lives  of  a  most  valu- 
able portion  of  the  community.  Antiseptics  may 
justly  be  said  to  have  revolutionized  the  practice 
of  midwifery,  so  that  results  impossible  anywhere 
a  few  years  ago  are  now  e\erywhere  obtainable. 
Antiseptic  midwifery  in  some  form  or  other  is 
practised  almost   universally  ;  but  unfortunately, 


general  use  is  apt  to  run  speedily  into  abuse,  and 
the  antise])tic  system  is  no  exception  to  the  rule. 
Uterine  and  vaginal  douches,  when  ])roi)erly  ad- 
ministered in  suitable  cases  and  at  suiiable  times, 
are  invaluable,  but  otherwise  they  may  prove  dan- 
gerous. To  point  out  some  of  the  dangers  and 
show  how  they  may  be  avoided  is  the  object  of 
this  pai)er. 

The  oi)inion  seems  to  be  prevalent  ami  ;il;  i'.:e 
profession  ili.it,  while  the  intra-uterinc  douche  is 
genera//}'  sak',  the  vaginal  douche  is  perfed/y  so. 
No  particulai  skill  is  considered  necessary.  Im- 
pressed with  its  harmlessness,  some  recommend 
the  antiseptic  vaginal  douche  as  a  i)rophylactic 
against  infection  during  the  puerperal  state,  and 
advise  its  use  in  all  cases.  No'  unfrequciuly  we 
find  ihe  operation  entrusted  to  the  nurse  or  some 
inconijietent  person,  without  direction  or  supervi- 
sion, as  if  douching  was  a  trivial  matter  out  of  the 
province  of  the  physician  or  perhaps  beneath  his 
dignity.  With  sucli  doctrines  and  practice  I  can- 
not agree,  for  in  my  opinion  prophylactic  douch- 
ing during  the  puerperal  state  is  not  only  unnecces- 
sary,  but  frequently  the  cause  of  serious  harm. 
Though  believing  in  thorough  antisei)sis  during 
labor  and  the  puerperal  period,  and  admitting  the 
value  of  vaginal  and  uterine  douching  in  certain 
conditions,  I  am  nevertheless  convinced  that  the 
douche  is  not  perfectly  harmless,  and  that  it  should 
be  used  only  when  clearly  indicated,  and  then  with 
caution. 

Liability  to  absorption  through  tears,  fissures, 
abrasions  or  other  traumatisms  constitutes  the 
chief  danger  of  the  v.aginal  douche.  The  contrac- 
tion of  the  constrictor  muscles  narrows  the  orifice 
of  the  vagina  and  fiivors  sacculation  of  its  canal ; 
consequently  part  of  the  infection  is  apt  to  be  re- 
tained, perhaps  for  a  considerable  time.  Indeed 
absorption  is  more  liable  to  take  place  through 
the  vagina  than  through  the  uterus,  because  the 
latter  usually  contracts  firmly  and  empties  its 
cavity,  especially  if  the  injections  be  hot. 

For  various  reasons  the  intrauterine  douche  is 
more  dangerous  than  the  vaginal,  especially  if  the 
current  be  too  strong  or  the  outflow  insufficient. 
Fluid  may  be  forced  through  the  Fallopian  tubes 
into  the  abdominal  cavity,  causing  acute  peritonitis 
or  even  death,  as  in  Yoht's  case ;  or  a  thrombus 
may  be  dislodged  from  the  placental  site  and  hem- 
orrhage take  place  ;or  air  may  find  its  way  direct- 
ly through  the  uterine  sinuses  into  the  veins;  or 
some  of  the  injection  tluid    may  enter  the  veins. 


lOfl 


fHE   CANADA  MfeOlCAL  KfeCOfeD. 


In  Stadfeldt's  case,  symptoms  of  poisoning  appear- 
ed, while  a  large  sublimate  douche  (i  to  5000)  was 
being  administered,  proving  that  the  mercuric  sol- 
ution entered  the  circulation  directly.  The  ute- 
rine sinuses,  firmly  attached  to  the  muscular  wall 
of  the  uterus,  are  closed  during  muscular  contrac- 
tion, but  gape  open  during  relnxaiion;  therefore, 
in  relaxed  conditions  of  the  uterus,  fluid  or  air 
may  readily  penetrate  into  the  veins.  I  have  seen 
sudden  death  produced  in  this  way  during  an  in- 
tra-uterine  injection  of  perchloride  of  iron  for  post- 
partum hemorrhage. 

l"he  fluids  most  commonly  used  for  injection 
are  plain  water  or  solutions  of  permanganate  of 
potash,  carbolic  acid  or  corrosive  sublimate. 
Plain  hot  water  is  the  safest,  and  is  quite  sufficient 
when  debris  is  to  be  w  ashed  away  and  a  simple 
mechanical  effect  is  the  only  one  desired.  But  in 
septic  cases  where  germicide  action  is  also  required 
corrosive  sublimate  is  by  far  the  most  effective, 
but  at  the  same  time  it  is  the  most  dangerous. 
Death  has  occurred  in  sixty  hours  from  the  effects 
of  an  intra-uterine  sublimate  douche  (i  x  2000). 
Patients  suffering  from  anaemia  or  kidney  troubles 
are  very  susceptible  to  the  action  of  mercury  ;  so, 
too,  are  those  who  have  recently  been  under  mer- 
curial treatment,  or  in  whom  there  is  marked  atony 
of  the  uterus  or  extensive  traumatisms  of  the  genital 
tract.  It  may  be  t.aken  as  a  general  rule  that 
sublimate  injections  are  contra-indicated  in  all 
such  cases,  or  should  at  least  be  given  with  the 
greatest  caution. 

Frequently  an  intrauterine  douche  is  foUov.-cd 
by  a  chill  and  rapid  rise  of  temperature  (104° 
or  over),  accompanied  sometimes  by  colic  and 
abdominal  tenderness.  As  a  rule,  these  symp- 
toms are  of  nervous  origin,  though  exceptionally 
they  may  be  due  to  absorption.  In  men,  the  pas- 
sage of  a  catheter  or  soinid  is  occasionally  follow- 
ed by  a  sharp  rigor  and  high  f«ver;  surgeons  call 
this  urethral  fever,  and  attribute  it  to  nervous  in- 
fluences. Similar  synii)toms  may  be  caused  by 
the  passage  of  a  uterine  sound  or  by  artificial 
dilation  of  the  cervix,  without  any  evidence  of 
inflammatory  mischief;  nervous  influences  are 
undoubtedly  the  cause.  So,  in  like  manner,  the 
passage  of  a  foreign  body  (irrigation-nozzle)  into 
the  uterus,  and  the  distension  of  the  uterine  cavity 
with  fluid,  especially  if  the  outflow  be  insufficient, 
may  produce  similar  nervous  symptoms  sometimes 
of  an  alarming  nature. 


What  precautions  are  to  be  taken  for  the  avoid- 
ance of  these  dangers  and  accidents? 

1.  The  patient  should  always  be  placed  across 
the  bed  in  the  dorsal  position,  with  hips  well 
raised  and  thighs  everted.  The  operator  has 
then  better  control  over  the  direction  and  force  of 
the  injection  as  well  as  over  the  outflow.  In 
intra-uterine  douching,  the  anterior  lip  can  be 
more  easily  seized  and  the  uterine  cavity  straight- 
ened, if  the  patient  is  lying  in  the  dorsal  position. 

2.  The  vaginal  or  uterine  nozzle  should  be 
inflexible  (glass  or  hard  rubber),  without  a  cen- 
tral orifice  in  the  bulb  (to  avoid  injecting  fluid 
through  the  Fallopian  tubes  or  dislodging  thrombi 
from  the  placental  site).  The  openings  in  the 
bulb  should  be  directed  slightly  backwards,  so 
that  the  injection  stream  may  flow  away  from  the 
fundus,  not  towards  it. 

3.  A  sufficient  outflow  should  be  secured. 
The  vaginal  orifice  should  be  kept  open.  Before 
an  intra-uterine  douche  is  give,  the  anterior  lip 
should  be  seized  with  a  vulsellum  or  tenaculum 
and  drawn  gently  downwards  till  the  uterine 
cavity  is  straightened.  The  nozzle  can  then  be 
more  easily  introduced,  and  a  good  outflow  is 
secured.  After  the  operation  it  should  always  be 
ascertained  that  there  is  no  pouching  of  the 
vagina  or  retention  of  fluid. 

4.  The  quantity  of  fluid  injected  should  be 
small ;  from  one  to  two  litres  is  quite  sufficient. 
Large  and  long-continued  injections  are  not  more 
effectual,  while  they  greatly  increase  the  risks. 

5.  Antiseptic  injections  should  be  weak,  unless 
powerful  germicide  action  is  required  in  acute 
septic  cases.  For  an  ordinary  vaginal  douche  a 
sublimate  solution  of  i  x  7000  or  i  x  5000  is 
quite  strong  enough.  The  strong  solutions  (i  x 
2000  or  I  X  1000,  or  even  i  x  500)  should  be 
used  only  in  urgent  septic  cases,  and  then  with 
the  greatest  caution.  After  a  sublimate  injection, 
a  pint  or  two  of  plain  hot  water  should  be  riui 
through  to  wash  away  any  retained  sublimate, 
thus  lessening  the  risks  of  absorption. 

6.  The  injection  should  always  be  used  hot 
(108  °-ii2  °  F.)  Hot  water  is  a  powerful  stim- 
ulant, causing  the  uterus  to  contract  firmly,  thus 
closing  up  the  sinuses  and  tubes,  and  expelling 
the  injection  fluid  fiom  its  cavity. 

7.  To  prevent  nervous  chill  and  rise  of  tem- 
perature, a  glass  of  brandy  or  some  diffusible 
stimulant  should  be  given  fifteen  minutes  before 


THE   CANADA    MKDICAL   RECORD, 


107 


operating.  The  stimulant  acts  primarly  by  bra- 
cing u])  the  vascular  system,  and  secondarily  by 
increasing  (he  resisting  power  of  the  nervous 
system.  If  this  precaution  be  t,il<(,n,  and  the 
injection  be  given  rapidly  and  wiihout  midue 
exposure  or  chilling  of  the  surface,  rigors  and 
fever  will  rarely  follow.  In  very  nervous,  ex- 
citable patients,  or  where  there  is  likely  to  be 
liain,  ether  may  be  advisable. 

During  the  more  severe  methods  of  intra  uterine 
treatment,  such  as  curetting  or  brushing  (ecou- 
villonage  of  Doleris),  the  jjlacental  site  is  apt  to 
be  disturbed  ;  some  of  the  little  |)lugs  may  be 
scraped  or  brushed  away  from  the  mouths  of 
vessels,  [)crmitting  the  entrance  of  air,  fluid  or 
sei)tic  matter.  Curetting  or  Ijrushing  should  be 
followed  at  once  by  a  small  douche  of  very  hot 
water  given  very  slowly  and  carefully  ;  a  supposi- 
tory of  iodoform  should  then  be  passed  into  the 
uterine  cavity  and  the  vagina  loosely  packed  with 
a  strip  of  iodoform  gauze. 

Dr.  BLACKAnER  said  he  would  like  to  ask  the 
reader  of  the  paper  under  what  circimistances  he 
now  advised  curetting,  and  whether  he  would 
perform  this  operation  whenever  there  were  any 
septic  symptoms  present.  He  thought  that  injec- 
tions should  not  be  too  hot,  for  he  had  seen 
serious  symptoms  follow  the  employment  of  very 
h.ot  injections  ;  peritonitis  even  had  resulted  from 
the  injection  of  plain  hot  water. 

Dr.  Wm.  Gardner  related  an  instance  illustra- 
ting the  dangers  of  vaginal  injections  with 
improper  syringes.  The  case  was  that  of  a  lady 
whom  he  attended  during  the  past  summer  for  a 
violent  attack  of  pelvic  peritonitis.  She  had  been 
for  some  inonths  suffering  from  pelvic  symptoms, 
and  on  one  occasion  proceeded  to  take  a  vaginal 
injection  with  the  ordinary  syringe  ;  but  having 
mislaid  the  vaginal  pipe,  she  used  the  rectal  pipe 
with  a  single  aperture  at  the  end.  The  vagina 
was  lax  and  the  perineum  and  cervix  lacerated. 
She  had  no  sooner  begun  than  she  was  seized 
with  violent  pelvic  and  abdominal  pain  with  symp- 
toms of  collapse,  speedily  followed  by  vomiting, 
fever,  and  all  the  other  symptoms.  She  was  in 
bed  for  four  or  five  weeks,  and  was  for  a  time  in 
great  danger.  There  can  scarcely  be  a  doubt  that 
the  water  was  forced  directly  into  the  uterine 
cavity  through  the  open  cervix. 

Dr.  Roddick  said  he  was  cognizant  of  not  a 
few  cases  where  serious  results  had  followed  the 
use    of  bichloride    of   mercury    injections.     He 


thought  Condy's  Fluid  a  safer  antiseptic.  But 
best  of  all  is  hydronaijhthal  ;  it  has  germicidal 
qualities  nearly  equal  to  bichloride  of  mercury,  but 
no  odor  or  irritating  qualities,  and  there  is  no 
danger  of  poisoning. 

Dr.  MiM.s  thought  that  the  untoward  results 
sometimes  following  vaginal  and  uterine  injections 
were  to  be  explained  through  the  impressions 
directly  made  on  the  nervous  system  as  well  as 
by  absorption  of  the  fluid  used.  'J'his  being  the 
case,  the  good  effects  of  the  stimulant,  given  as 
Dr.  Cameron  recommended,  prior  to  theiniection 
were  probably  owing  to  itsacing  by  lessening  the 
susceptibility  of  the  nerve  centres  to  any  sort  of 
afferent  imjjressions.  He  doubted  whether  the 
effect  on  the  circulation  was  not  rather  favorable 
th.m  otherwise  to  absorption.  Dr.  M.  wished  to 
know  whether  there  was  any  exact  evidence  bear- 
ing out  the  belief  that  fluids  were  more  readily 
absorbed  from  the  vagina  than  the  uterus  after 
parturition.  It  is  scarcely  what  would  be  ex- 
pected. 

Dr.  Cameron,  in  reply,  stated  that  the  value 
of  curetting,  in  suitable  cases,  is  unquestionable, 
viz.,  where  portions  of  the  placenta  are  retained  ; 
the  brushing  out  of  the  uterus  would  not,  in  all 
cases,  replace  curetting.  The  danger  of  absorp- 
tion is  greater  through  the  vagina  than  the  uterus, 
as  the  former  is  always  more  or  less  abraded,  and 
also  because  the  injected  fluid,  owing  to  the  greater 
tendency  of  the  vagina  to  sacculate,  remains 
longer  in  contact  with  the  absorbing  surface.  He 
had  written  this  paper  as  a  protest  against  the 
indiscriminate  and  careless  use  of  injections  in 
the  puerperal  state. 

BaPk-S^ondence. 

LETTER  FROM  NEW  YORK. 
The  disadvantages  under  which  a  correspondent 
labors,  when  he  attempts  to  write  a  letter  upon 
general  topics  connected  with  medicine,  is  that  he 
is  certain,  in  the  case  of  a  very  large  medical 
centre  like  New  York,  to  give  a  one-sided  view  or 
review  of  his  subject.  Perhaps  the  fact  that  my 
time  here  has  been  chiefly  devoted  to  the  consid- 
eration of  certain  special  branches  may  however 
make  it  more  easy  to  speak  with  authority  about 
them.  To  begin  with,  it  seldom  strikes  a  visitor 
to  this  city  that  in  extent,  population  and  wealth 
(consequently   in  variety  and  amount  of  disease 


108 


THE   CANADA   MEDICAL    RECORD. 


and  the  special  means  adopted  to  relieve  it)  New 
York  may  lay  claim  to  being  the  second  city  in 
the  world.  Because  New  York,  Brooklyn,  Jersey 
City,  Hoboken,  Long  Island  City,  and  the  sub- 
urbs of  these,  with  over  3,000,000  of  population, 
are  practically  one  and  the  same,  and  the  clinical 
material  included  within  their  limits  is  quite  as 
available  for  teaching  purposes  as  is  that  within  a 
circle  having  20  miles  radii  and  its  centre  Charing 
Cross.  And  since  the  magnificent  Vanderbilt 
donation  to  the  Medical  Department  of  Columbia 
College,  and  other  generous  gifts  of  like  kind, 
this  vast  amount  and  variety  of  disease  is  being 
more  and  more  put  to  good  use  for  the  teaching 
of  medicine. 

The  post  graduate  courses  Jiere  may  be  des- 
cribed as  excellent.  I  will  not  say  that  they  offer 
as  good  inducements  to  the  students  as  the 
German  courses,  but  I  must  say  liuit  a  man  may 
study  to  unusual  advantage  any  or  all  of  tlie 
branches  into  which  medicine  and  surgery  are 
commonly  divided.  It  is  a  matter  of  taste  which 
of  the  two  schools  one  cliooses,  probably  certain 
branches  are  more  effectually  taught  in  one  than 
in  the  other.  Taken  as  a  whole,  I  prefer  the 
Polyclinic  on  East  34th  Street.  The  arrange- 
ments for  the  practical  study  of  the  Eye  and  Ear 
are  second  to  none  anywhere,  the  courses  on  the 
Throat  and  Nose  are  complete ;  the  man  who 
does  not  profit  by  them  has  himself  to  blame. 
The  teachers  are  anxious  to  impart  instruction,  and 
every  facility  is  offered  to  the  student.  Not  only 
are  certain  daily  or  tri  weekly  lessons  given  in 
manipulative  work,  but  for  each  branch  cards  are 
issued,  giving  a  list  of  hosjiitals  and  teachers  con- 
nected with  the  schools  where  the  student  may 
woik  up  tlie  branch  from  '' early  mom  till  dewv 
eve,"  if  he  be  so  inclined.  The  New  York  Post 
Graduate  School  and  Hospital  on  Kast  20th  street 
is  also  well  worth  a  visit.  The  students  here  are 
not  quite  as  numerous  as  at  the  Polyclinic,  a  fact 
somewhat  in  favor  of  the  Post  Graduate  School, 
in  my  judgment  at  least.  I  would  like  to  support 
the  proposition  that  one  is  much  more  likely  to 
make  progress  in  study  (particularly  where  skill 
in  the  handling  of  certain  instruments  of  precision 
is  desired)  with  a  few  patients  and  few  students, 
than  in  a  clinic  crowded  with  teachers,  students, 
and  patients. 

To  begin  wiili,  it  is  essential  that  one  (every 
beginner  at  least)  should  have  the  same  teacher, 
because  no   two   men   impart  instruction  in  the 


same  manner.  Then  in  crowded  classes  one  does 
not  readily  obtain  that  contact  between  teaclier 
and  pupil  which  is  so  desirable  where  hand-to- 
hand  instruction  is  involved.  Finally  it  is  in 
crowded  clinics  more  difficult  to  follow  uj)  indiv- 
idual cases  from  time  to  time. 

After  wandering  around  and  taking  notes  of  the 
various  teaching  advantages  available  for  the 
special  branches  [  was  interested  in,  I  decided  to 
spend  my  mornings  with  another  searcher  after 
practical  knowledge,  as  office  assistant  to  a  well 
known  oculist  and  aiiiist  here,  Dr.  Mittendorf, 
Assistant  Professor  in  Bcllevue.  My  afternoons, 
with  the  exception  of  occasional  visits  to  other  Eye, 
Ear  and  Throat  clinics  in  the  city,  were  devoted 
to  the  courses  given  by  the  surgeons  attending  the 
New  York  Eye  and  luir  Infirmary.  Those  who 
are  tamiliar  wiili  the  four  "head  "  specialties  will 
recognize  the  n;iines  of  iVs.  Bull,  1-oring,  Noyes, 
Derby,  and  Cocks,  on  the  Eye;  Rujip  on  the 
Ear  ;  and  Asch — one  of  the  most  friendly  of 
teachers  and  most  genial  of  men — on  the  Ihroal 
and  Nose.  The  com]ietition  between  the  post 
graduate  schools  and  less  ambitious  special  courses, 
like  that  of  the  Eye  and  Ear  Infirmaiy,  is  a  veiy 
healthy  and  a  very  profitable  one  to  the  student. 
Sevenly-five  per  cent,  of  the  teachers  have  studied 
in  the  various  continental  schools  and  are  well 
read  men.  They  all  frankly  state  their  belief  that 
shortly  the  graduated  student  will  have  advantages 
here  not  to  be  surpa.ssed  by  those  of  Vienna  or 
Berlin, — advantages  arising  out  of  the  necessity 
for  having  an  intimate  knowledge  of  German, — • 
the  Yiermese  English  courses  to  the  contrary, 
notwithstanding—  on  the  one  hand,  and  out  of  the 
l)eifecting  v{  the  teaching  system  here  on  the 
other.  I  should  like  to  say  something  later  on 
that  subject  while  breathing  the  atmosphere  of 
a  foreign  city.  Similarly.  I  would  advise  any  one 
wlio  proposes  to  spend  some  time  here  in  post 
graduate  study: — Take  a  week  or  ten  days  in 
looking  around.  You  can  study  what  you  will, 
where  you  will,  and,  last  but  not  least,  at  almost 
whatever  cost  you  will,  if  you  will  only  hunt  it  uji. 

One  would  imagine  from  the  way  in  whii  h 
quinine  is  given  by  professional  drug  distributors, 
and  the  facile  manner  in  which  it  is  consumed  by 
the  laity,  that  malarial  germs  were  laying  siege  to 
tlie  lity.  And  yet  I  can  find  no  evidence  of  its 
existence  to  any  extent.  The  dozens  of  doctors 
and  patients  whom  I  have  questioned  on  the  sub- 
ject furnish  no  signs  of  its  especial  prevalence.     I 


THE   CANADA    MEDICAL    RECORD. 


109 


suspect  that  the  Yankee  public  have  lired  of  the 

{;ood  old  word  "cold"  as  an  etiological  explana- 
tion, and  for  a  lime  at  least  have  adopted  a  more 
classical  term. 

21ic  Dispensary  and  Hos|)ital  evil  has  jierhaps 
not  l.)ecoine  so  pressing  as  it  is  in  London,  but  it 
thrusts  itself  upon  one's  observation  everywhere- 
People — well  dressed  people — present  themselves 
daily  at  the  charitable  institutions,  and  obtain  re- 
lief which  they  ought  to  have  paid  some  hard-work- 
ing doctor  for.  'I'he  necessity  on  the  part  of  teach- 
ing institutions  for  clinical  material,  the  want  of 
unanimity  ui)on  this  subject  among  members  oftlie 
profession,  and  the  cupidity  of  the  iiatieiits  them- 
selves, here  as  elsewhere,  combine  to  prostitute  the 
proper  use  of  these  charities.  A  side  issue  lately 
arose  out  of  this  matter.  It  was  found  (and  I 
know  that  it  is  not  an  unconnnon  thing  to  do  here, 
even  among  some  of  the  so  called  better  class  of 
practitioners)  that  a  certain  .Utendant  upon  one 
of  the  largest  hospitals  was  in  the  habit  of  divert- 
ing such  of  their  patients  who  were  worth  any- 
thing to  his  own  private  office,  and  getting  out  of 
them  what  he  could  in  the  way  of  fees.  I  do  not 
j)ropose  to  discuss  tlie  morality  or  the  medical 
ethics  of  the  affair,  but  I  think  that  the  action  of 
the  medical  board  in  calling  for  his  resignation 
was,  on  the  whole,  commendable. 

Intubation  of  the  larynx,  especially  as  a  substi- 
tute for  tracheotomy,  is  still  under  trial.  It  may 
safely  be  said  that  even  if  no  better  results  areob- 
tainable  from  it  than  from  tracheotomy  for  the 
cure  of  croup  and  diphtheria,  it  will  always  be 
valuable  as  a  relief  measure.  Parents  who  refuse 
to  permit  a  "  bloody  operation  "  will  allow  intuba- 
tions to  lie  performed.  I  have  seen  O'Dwyer's 
latest  modification  of  his  introducer,  tubes  and 
extractor,  and  they  are  marvels  of  mechanical  in- 
genuity. The  introduction  and  extraction  of 
O'Dwyer's  tubes,  under  the  circumstances  which 
commonly  call  for  their  use,  is  no  easy  mat- 
ter. "Let  them  who  think  it  is  just  try  it,"  said 
an  instructor  to  his  class  in  laryngology  the  other 
day. 

.  A  phase  in  the  attempt,  old  as  the  hills,  to  cure 
epilepsy  by  operative  procedure  has  presented  it- 
self here  in  the  field  of  ophthalmology.  Dr.  Stevens, 
an  oculist  in  large  practice,  is  the  author  of  a  work 
on  nervous  diseases,  in  which  he  claims  to  have 
cured  a  large  number  of  epileptic  and  allied  cases 
by  operations  upon  the  ocular  muscles.  Every- 
body knows  that  muscular  insufficiencies,  as  well  as 


disturbances  of  the  normal   relation  of  one  set  of 

eye  musi'les  to  another,  will  bring  about  dizziness, 
nausea,  and  other  siiiijcctive  symptoms.  Dr. 
.Stevens  claims  that  they  also  give  rise  to  much 
more  serious  neinotic  troubles,  who.se  relief  lies  on 
tlie  connection  of  sueh  muscular  deficiencies  and 
insufficieiu:ies.  The  matter  must  be  regarded  as 
yet  sub  jiidice,  but  when  one  remembers  in  how 
many  parallel  instances  similar  extravagant  claims 
have  been  made,  it  is  best  to  maintain  for  the 
present  an  altitude  of  intelligent  scepticism. 

Lately,  in  the. Academy  of  Medicine,  Dr.  Kralz- 
shmar  read  a  very  interesting  paper  on  Dettweiler's 
treatment  of  [ihthisis,  and  entered  a  (ilea  for  the 
erection  of  his  ])avillion  hospital  convenient  to 
large  cities  like  New  A'ork,  wlu're  unfortunates 
miglit  make  a  stand  against  this  terrible  disease, 

To-niglit  1  am  going  to  attend  the  dinner  given 
by  that  most  delightful  of  all  the  New  Voik  social 
and  literary  gatherings,  "  The  Twilight  Club." 
The  subject  for  discussion, — "  How  woidd  you 
spend  a  million  dollars  for  the  jniblic  good?" 
suggests  the  Royal  \'ietoria  Hospital  in  Montieal. 
AVhat  a  grand  position  for  a  consuinplive  hospital 
on  the  Dettweiler  princi[ile  !  About  one  eighth 
of  the  population  in  temiicrate  climates  dies  of 
phthisis  in  some  of  its  forms,  and  notwithstanding 
all  the  workers  from  ^sculapius  to  Koch  we  get 
now  no  better  results  from  treatment  than  came 
to  St  John  I.ongorany  other  empiric, — ancient  or 
modern.  Enforced  fresh  air  breathing  in  all 
weathers,  full  and  generous  feeding,  the  most  rigid 
hygienic  observances — all  these  could  be  carried 
out  on  the  southerly  slope  of  Moimt  Royal,  as  it 
hardly  can  be  within  the  limits  of  any  other  city 
on  this  continent;  and,  in  my  hundile  opinion,  it 
would  do  more  good  and  be,  consequently,  a  more 
lasting  monument  to  the  munificence  of  its 
founders  than  it  can  ever  hope  (from  its  remote, 
inaccessible  and  inconvenient  position)  to  accom- 
plish as  a  General  Hospital. 

About  Dettweiler's  plans  it  may  be  said  that 
while  his  theory  is  old  and  commonplace,  the 
means  to  the  end  he  would  reach  are  at  least 
practical,  somewhat  novel,  and  infinitely  more 
effective  than  any  kind  of  drug  treatment.  Of  all 
the  plans  which  in  common  willi  my  fellow  prac- 
titioners I  have  tried  for  the  relief  of  phthisis,  I 
render  thanks  that  I  have  always  been  a  follower 
of  the  searchings  of  that  medical  free  lance.  Dr. 
Eelix  Oswald's,  and  I  always  regretted  that  a  severe 
Canadian  climate  prevented  my  carrying  out  his 


110 


THE   CANADA   MEDICAL    RECORD, 


ideas  with  the  majority  of  people  who  possess  a 
sm^ill  stock,  either  of  money,  courage  or  common 
sense.  Detiweiler  proposes  to  treat  this  majority 
irrespective  of  their  possessions. 

I  ha\e  met  many  Canadian  medical  men  here, 
both  local  practitioners  and  post  graduate  stu- 
dents. Dr.  H.  N.  \'ineberg,  well  known  to  Mon- 
irealers.  is  Dr.  Hunter's  assistant  in  Gynecology 
at  the  Polyclinic,  and  holds  as  well  the  position  of 
Assistant  Physician  in  the  New  York  Hospital. 
1  have  to  acknowledge  many  courtesies  received 
at  his  hands.  Dr.  Frank  Ferguson,  originally 
from  the  Lower  Piovinces,  has  worked  his  way  up 
10  the  chair  of  Pathology  in  Long  Island  College, 
and  is  also  Assistant  Pathologist  at  ihe  New  York 
Hospital.  Dr.  P'erguson  is  still  a  lo)  al  Canadian, 
as  frcquenkrs  of  the  Canadian  Club  can  testify. 

Dr.  (Miappell  of  'I'oronto  "  has  fallen  upon  his 
feet,"  and  is  in  |)artnership  with  Dr.  A.  H.  Smith. 
Dr.  Woodrough  of  London,  Ont.,  Dr.  Snow,  Dr. 
Robinson,  and  a  dozen  others  are  also  here. 


C.  A.  W. 


659  Le.\inglon  Avenue, 

New  York,  Feb.  20,  1888. 


J^/io^QicM  af  Science. 


FFKDING    PHTHISLS. 

Ev  Solomon  Soi.is-cohen,    a.m.,  m.d., 
Philadelphia. 

Physicians  of  the  present  day,  regarding  phthsis 
as  a  fever,  are  taking  the  hint  from  Graves' 
celebrated  maxim,  and  feeding  it.  Not  that  it  has 
waited  for  the  present  day,  or  even  decade,  to 
demonstrate  the  value,  or  rather  the  imperative 
necessity,  of  a  supporting  treatment  of  the  disease 
whose  prominent  clinical  feature  is  so  aptly 
expressed  in  many  languages — consumption, 
schwindsucht  pif/ilsis.  Not  that  the  principal 
i'eaiures  of  our  hygienic  and  dietetic  regulations 
may  not  be  found  in  the  writings  of  the  older 
authors,*  and  how  far  back  we  hardly  venture  to 
fix  the  limit ;  but  that  the  subordination  of  medi- 
cation and  the  desire  for  medication  to  alimenta- 
tion and  concomitant  measures,  is  distinctly 
modern  as  a  generally  adopted  practice. 

However  much  others  may  have  contributed  to 
this  result,  and  however  iudepjndently  tlie  practice 
has  been  elaborated,  no  o  ic  can  consider  the 
subject  of  alimentation  in  phthisis  without  render- 

*Of  modern  .iiitlmrs,  llie  be-t  expositiun  of  tlie  hygienic 
treatment  of  cons  iniption  is  tlie  essay  of  Dr.  !>•  W. 
K  cliavclson,  inU:.liili.:il  m  1856,  ami  lepiincedin  7/ic  AscL'- 
piUni,  April,  1S85,  No.    2,    Vol.  11. 


ing  at  least  a  passing  tribute  to  the  value  of 
Debove's  method  of  forced  feeding.  His  striking 
results  emphasized  the  lessons  of  experience,  en- 
couraged us  to  disregard  loss  of  appetite,  or  even 
complete  anorexia,  proved  that  powers  of  digestion 
and  a-isiniilation  did  not  decrease /i;/"/ /'<?.««,  and 
indeed  were  not  to  be  arbitrarily  limited  by  any 
other  method  than  actual  experiment  ;  and  his 
systematic  use  of  meat  powders  gave  us  a  hint  as 
to  the  best  method  of  pre[)aration  of  food,  the  merit 
of  which  is  no  less  that  American  chemists  have 
since  much  im[>roved  u))on  it. 

Our  resort  to  the  tube  of  Del)ove  may  be  lim- 
ited to  cases  in  which  physical  or  phychial  disa- 
bility prevents  superalimentation  by  less  distress- 
ing methods.  The  word  is  used  advisedly.  Often 
as  the  writer  has  preformed .;'^rt7'(Ti,''^,  and  he  flatters 
himself  not  with  any  great  degree  of  awkwardness 
it  Iias  in  almost  every  instance  proved  a  source  of 
distress  to  patient  and  [ihysician  ;  though  it  must 
be  interpolated  that  the  refined  disgust  of  the 
omnipresent  car|jing  friend,  relative,  nurse  or  other 
bus\l)ody,  has  always  far  exceeded  that  of  the 
sufferer. 

However,  in  most  instances,  by  judicious  per- 
suasion, explanation  or  insistence,  it  will  be  pos- 
sible to  induce  patients  to  take  a  sufficiency  of 
aliment  in   the  ordinary  way. 

It  is  again  to  Debove  that  we  must  give  credit 
for  having  demonstrated  what  is  meant  by  suffici- 
ency of  aliment,  namely,  the  extreme  limit  of 
assimilability.  We  have  not  only  to  provide  for 
current  needs,  to  repairdaily  excess  of  combustion 
but  to  make  up  as  far  as  possible  for  previous 
unrepaired  waste. 

W'e  have  thus  to  determine  in  each  case,  and  to 
prescribe  with  the  same  precision  as  in  the  case  of 
drugs,  thequantity  and  quality  of  food,  and  the  times 
of  feeding.  As  the  results  of  experience,  general  rules 
will  gradually  formulate  themselves  in  the  mind  of 
the  ])iactitioncr  ;  and  confirmation  or  modification 
will  result  from  the  progress  of  physiological  che- 
mistry. The  opinion  most  widely  prevailing  at 
the  present  time  assigns  the  first  rank  as  an  ali- 
ment in  phthisis  to  flesh,  and  more  especially  to 
beef.  The  results  obtained  by  certain  individuals, 
who  devote  themselves  to  the  treatment  of  disease 
by  an  exclusive  diet  of  beef  prepared  in  a  certain 
and  most  excellent  manner,  conjoined  with  lava- 
tory potations  of  hot  water  to  prepare  the  digestive 
canal  for  the  reception  and  disposition  of  the  ali- 
ment, cannot  be  ignored,  whatever  we  may  think 
of  the  theories  or  methods  of  the  practitioners  in 
question.  Without  confining  themselves  to  beef, 
scientific  physicians  are  justified  in  giving  it  the 
first  rank. 

It  should  be  taken  at  least  twice  daily,  three 
times  if  possible.  It  may  be  eaten  raw,  as  it 
comes  from  the  butcher,  or  it  may  be  chopped 
finely,  seasoned  to  taste,  and  made  into  little 
cakes,  which  are  eaten  raw  or  slightly  browned  on 
the  grid-iron.  It  may  be  taken  in  the  form  of  rare 
beefsteak  broiled   in  its   own    fat,    or  as  very  rare 


tllE   CANADA   MEDICAL   RECORt). 


Ill 


roast  beef.  Otlicr  metliods  of  cooking  are  to  be 
prohibited.  The  iiieat  is  to  be  as  juicy  as  possible 
and  fibrous  ])ortions  are  to  be  removed. 

Very  often  one  can  be  satisfied  with  tlie  use 
of  butcher's  meat,  raw  or  cooked  as  above. 
Si)melimcs,  however,  wlicther  from  partial  failure 
of  digestive  powers  or  other  condition  neiessitating 
reduction  in  bulk  widioiit  loss  of  nutritive  mate- 
rial, or  suggesting  conversation  of  the  energy  that 
would  be  expended  in  digestion,  it  becomes 
necessary  to  resort  to  special  methods  of 
prejjaiation.  'I'he  meat  powders  prepared  by 
various  pharmacists,  more  especially  for  forced 
feeding,  here  render  valuable  aid.  By  cutting 
boiled  beef  into  fine  pieces,  drying  by  means  of  a 
water  bath,  and  grinding  in  a  coffee  mill  with  the 
teeth  set  closely,  an  excellent  meat  powder  may  be 
made  in  the  kitchen.     (Uiijardin-13eaumetz.) 

The  preparation  from  which  the  writer  has  seen 
the  greatest  benefit,  and  which  he  is  most  frequently 
in  tiie  habit  of  inescrilung,  is  Beef  Peptonoids. 
Whether  from  improvement  in  the  process  of  man- 
ufacture, rendering  it  more  palatable,  or  from  de- 
crease in  the  fastidiousness  of  patients,  there  has 
not  recently  been  the  same  difficulty  in  getting 
patients  to  persevere  in  the  use  of  it  that  was 
experienced  in  former  years. 

The  methods  of  administration  may  be  varied 
almost  indefinitely.  It  may  be  added  to  soups 
and  broths,  to  milk  jiunch,  egg-nog,  etc.,  taken  in 
warm  or  cold  water,  or  made  into  paste  with  milk 
or  water  and  spread  upon  bread.  Beginning  with 
a  teaspoonful  three  or  four  times  a  day,  the  amount 
is  to  be  increased  as  soon  as  the  preferable  method 
of  administration  is  determined  upon,  to  a  table- 
spoonful  or  more.  ■  It  is  jireferably  given  among 
the  supplementary  articles  of  diet  between 
meals. 

Next  to  beef  in  the  dietary,  the  writer  would 
place  milk,  sufticient  care  being  exercised  to  ob- 
tain a  good,  pure  article,  and  to  keep  it  proi^erly. 
The  "  half  Alderney''  milk,  supplied  by  a  well- 
known  dairyman  in  Philadelphia,  is  usually  better 
than  either  the  pure  Jersey  milk  or  that  from  ordi- 
nary cattle. 

'I'he  manner  of  drinking  milk  is  not  unimport- 
ant. Ice-cold,  gulped  hastily,  the  chances  are  all 
in  favor  of  its  promptly  coagulating  and  failing  to  di- 
gest, perhaps  to  be  vomited,  perhaiis  to  cause  con- 
siderable discomfort  in  various  ways,  ^\'hile  with 
some  patients  it  is  best  taken  cold  and  with  some 
quite  hot — a  matter  (or  which  experience  seems 
to  be  the  only  guide — in  the  majority  of  instances 
it  should  be  slightly  warmed  (say  to  loo  deg.  F.) 
and  si|)ped  slowly,  so  as  to  thoroughly  incorpo- 
rate it  with  sal  iva.  Ten  minutes  may  well  be  given 
to  a  tumblerful  of  milk,  and  in  this  way  the  fancied 
"disagreement"  of  which  many  persons  complain 
may  be  avoided.  If  necessary,  lime  water  may 
be  added  or  peptonized  milk  employed.  When 
these  expedients  fail  koumyss  may  be  tried,  and 
failure  here  may  indicate  the  necessity  of  greater 
attention  to  the  condition  of  the  gastro-intestinal 


mucous  membrane  :  not  necessarily  medication, 
however.  Potations  of  hot  water  (flavored,  if 
necessary),  "a;rated,"  acidulated  or  "mineralized" 
in  some  cases,  from  half  a  i)int  to  a  pint,  one 
hour  before  meals,  or  /«7'(?,i,v  with  simple  alkaline 
solutions  may  answer.  When  disinfection  of  the 
alimentary  canal  seems  indicated,  creasote,  iodo- 
form and  the  sulphur  compounds  are  among 
the  [jieferable  agents. 

From  one  to  two  (piarts  of  milk  daily,  in  divided 
doses,  should  be  given,  if  jiossible,  partly  with 
meals,  partly  between  meals  ;  as  a  vehicle  often 
for  Beef  Peptonoids,  etc.,  and  sometimes  for 
alcohol. 

Alcohol,  despite  all  that  is  said,  forcibly  and 
truly,  against  its  indiscriminate  employment,  is  in 
reality  a  food  in  phthisis.  We  may  or  we  may 
not  be  able  to  follow  the  molecular  changes  and 
cellular  reactions  from  the  moment  of  its  introduc- 
tion to  that  of  its  elimination  ;  but  whether  or  not 
jihysiologic.al  chemistry  has  said  its  last  word  upon 
this  subject,  that  intelligent  empiricism  upon  which 
clinicians  must  continue  to  dejiend  has  demonstra- 
ted the  value  of  alcohol  in  wasting  diseases,  and 
more  especially  in  those  associated  with  elevation 
of  temperature. 

It  need  not  be  given  in  excessive  doses.  A 
tablespoonful  of  srood  brandy  or  good  whiskey 
night  and  morning,  in  the  form  of  milk 
punch — or  better  cream  punch — with  a 
glass  of  good  Burgundy  wine  at  dinner,  \\\]\ 
ordinarily  suffice,  though  much  larger  quantities 
may  be  given  at  times  with  much  advantage.  The 
elder  Flint  records  instances  in  which  a  pint  of 
whiskey  daily  was  taken  for  a  long  time,  with 
apparently  very  good  effect.  The  writer  knows 
of  similar  cases.  It  is  only  fair  to  add  that 
cod-liver  oil  was  also  used  freely  in  all  these  cases. 
Sometimes  malt  liquors  may  seem  to  be  prefer- 
able ;  and,  if  decidedly  more  agreeable,  the  patient's 
taste  may  be  considered  ;  a  good  wine  of  coca, 
used  intermittently,  is  often  useful.  For  prudential 
reasons,  alcohol  may  be  disguised  as  an  extract 
of  malt— and  here  the  power  of  die  diastase  of  the 
malt  in  aiding  digestion  is  often  of  service 
—or  it  may  be  made  into  a  prescription,  as  in  the 
formula  of  Jaccoud,  of  glycerine,  mint  water  and 
rum. 

The  combination  of  alcohol  with  milk,  malt, 
cod-liver  oil  or  glycerine  is  theoretically  preferable 
to  (Fothergill)  and  in  experience  more  advanta- 
geous than  Its  separate  ingestion. 

Returning  to  the  consideration  of  meats,  the 
value  of  an  occasional  variation  of  our  beel  diet 
must  be  recognized — in  the  way  of  a  digression, 
however,  rather  than  of  a  total  or  lasting  departure. 
Mutton— preferably  broiled  chops— poultry  and 
game,  carefully  cooked,  and  whenever  possible 
rather  underdone,  may  be  employed  from  time  to 
time.  The  "  dark  meat"  is  preferable  to  the 
"  white  meat"  in  the  case  of  poultry.  Sweetbreads 
are  often  tempting  to  a  failing  appetite,  and  may 
assist  digestion.     While  the  skill  of  the  cook  may 


112 


THE   CANADA   MEDICAL   RECORD. 


well  be  called  upon  to  supplement  the  knowl- 
edge of  the  physician,  yet  elaborate  dishes  of  all 
kinds,  high  seasoning  of  all  kinds,  and,  in  plain 
English,  messes  of  all  kinds — even  among  our 
hiiinbler  jjatients,  the  "Irish  stew'' — are  to  be 
rigorously  inlerdicled.  Even  soujis  should  be  as 
simple  as  possible.  Kggs,  when  ]ialalable,  despite 
fears  of "  biliousness,"  form  a  useful  addition  to 
the  dietary.  A  raw  egg  may  be  sucked  from  the 
shell,  ar.d  will  thus  often  relieve  an  irritable  con- 
dition of  the  pharynx.  It  may  be  beaten  up  with 
milk,  or  milk  and  whiskey.  If  the  egg  be  cooked 
it  may  be  poached  or  soft  boiled.  Omelette, 
scrambled  eggs  and  fried  eggs  are,  as  a  rule,  to  be 
avoided.  Hard-boiled  eggs  are  sometimes  well 
digested,  but  in  most  instances  are  not  Fish, 
when  relished,  may  form  one  of  ihe  au.xiliary  arti- 
cles of  diet.  As  to  variety,  the  taste  of  the  patient 
may  be  consulted.  As  to  preparation,  frying 
should  be  strictly  prohibited.  Broiling,  boiling, 
and  baking  are  permissible.  Of  shell  fish,  when 
the  patient  desires  it,  and  there  is  no  other  objec- 
tion, oysters  and  cl.inis  m.ay  be  permitted.  All 
others  should  be  |>rohibited.  Many  |)hthisical  pa- 
tients, however,  are  unable  to  take  even  an  oyster 
without  considerable  discomfort. 

The  green  vegetables — lettuce,  celery,  spinach, 
watercress,  etc.,  are  to  be  freely  partaken  of. 
The  leguminousgroup,  especially  green  peas,  made 
into  soup,  boiled  with  milk  or  otherwise  prepared, 
are  of  benefit.  Starchy  and  farinaceous  foods  are, 
as  a  rule,  to  be  avoided,  though  they  need  not  in 
all  cases  beabsoluiely  interdicted.  They  must,  in 
any  event,  be  suliortlinated  to  nitrogenous  aliments, 
and  the  (juantit)'  taken  be  minimized.  The  espe- 
cially indigestible  and  fermentable  articles,  such  as 
potatoes  and  turnips,  are  Ijest  avoided  altogether. 
Even  the  amount  of  bread  consumed  should  be 
limited,  and,  if]iossiblc,  that  made  from  thewhole 
wheat,  or  the  gluten  bread,  or  one  of  the  similar 
prejiarations  manufactured  for  diabetics,  employ- 
ed. Pastry  and  sweets  are  not  to  be  thought  of 
save  to  be  rejected. 

While  the  diet  is  tluis  to  be  largely  nitrogenous, 
a  sufficient  proportion  of  carbo-hydrates  must  enter 
into  it.  Eats  and  oils,  preferably  from  the  animal 
kingdom,  will  supply  this.  Cream  has  already 
been  mentioned.  lUitter  should  be  freely  used. 
"  Butter  and  bread"  is  ton-place  "  bread  and  but- 
ter" in  the  consumptive's  diet-list.  Oil-dressings 
of  salads,  etc.,  are  useful  in  the  same  connections. 
Cod-liver  oil  may  be  given,  though  it  is  doubtful 
whether  the  large  quantities  sometimes  ordered 
are  assimilated.  A  tablesjioonful  three  times  a 
day  probably  represents  the  extreme  limit,  and 
half  that  quantity  m.ay  often  suffice,  in  many 
cases,  the  patient  will  do  just  as  well  without  any. 
When  the  pure  oil  can  be  taken,  either  floated  on 
whiskey  or  in  any  other  way  i)referred  by  the  pa- 
tient, it  is  best  given  in  that  form.  Emulsions 
extemporized  by  the  physician  are  in  general 
better  that  the  pro|)rielary  ones.  Ether,  say 
Hoffman's  anodyne,    may  be  introduced  into  the 


emulsion,  or  given  separately  imimediately  follow- 
ing the  dose  of  oil,  and  will  not  only  assist  in  its  so- 
lution,but  stimulate  the  pancreatic  secretion  which 
]irepares  it  for  absorption.  The  combination  of 
pancreatic  [ireparations  with  cod-liver  oil  is 
rational  ;  that  with  pepsin  isLased  upon  ratiocina- 
tion or    experience  that  the    wiiter  cannot  follow. 

When  sufficient  fatly  matters  cannot  be  taken 
in  any  of  the  ways  indicated,  oleaginous  inunctions 
may  be  resorted  to.  If  the  oil  used  for  anointing 
has  an  unpleasant  odor,  one  of  the  essential  oils, 
such  as  oil  of  gaultheria,  or  oil  of  bergamot,  may 
be  employed  to  disguise  it.  Inunctions  with  lano- 
lin may  be  doubly  utilized  as  a  means  of  introduc- 
ing iodoform  or  other  desired   medicinal    agents. 

The  fre(]uency  of  meals  is  a  point  of  much 
importance  in  the  alimentation  of  phthisical  pa- 
tients. Rarely  more  than  three  hours,  ne\er  more 
than  four  hours,  except  during  sleep,  should  be 
allowed    to    elapse   without   the   taking  of  (bod. 

The  .'Xnierican  custom  of  three  set  meals  daily 
need  not  be  altered,  but  in  the  intervals  between 
meals,  and  just  before  going  to  bed,  some  of  the 
lighter  aliments,  milk,  soup  or  biodi,  milk-punch 
or  egg-nf)g,  etc.,  should  be  taken,  and  as  already 
stated,  with  the  addition,  if  possible  of  Beef 
Peptonoids.  When  the  Peptonoids  powder 
is  not  ])alalable  or  not  available  for  any. 
reason,  the  Liquid  Peptonoids  may  be  sub 
stitnted  and  in  some  cases,  being  entirely 
])re-digested,  is  preferable.  In  addition  to  the 
glass  of  punch,  or  of  plain  milk  or  cream,  taken 
at  bed  time,  a  glass  of  milk  or  cream,  with  or 
without  alcohol,  or  a  glass  of  wine  or  spirits,  some- 
times advantageously  reinforced  by  half  an  ounce 
of  Liquid  Pejitonoids,  should  be  at  hand  to  be 
taken  in  case  of  waking  during  the  night  or  early 
morning.  Liquid  Pejitonoids  with  coca  is  a  good 
preparation  for  this  purpose  ;  for  coca,  like  strong 
coffee  under  similar  circumstances,  facilitates  the 
return  of  sleep.  When  a  suflicient  quantity  of 
food  is  not  taken  in  the  six  times  suggested,  the 
frequency  may  be  increased.  While  our  object  is 
distinctly  "  cramming,"  it  is  not  well  to  so  over- 
burden the  digestive  apparatus  as  to  give  rise  to 
positive  discomfort. 

'J'ho  duty  of  the  ])hysician,  who  feeds  his  cases  of 
phthisis,  is  not  finished  when  he  has  prescribed 
the  diet,  even  in  all  its  details;  or  when,  in  case 
of  failure  by  natural  methods,  he  has  resorted  to 
giiv,!^!^v,  inunction  or  rectal  feeding.  He  must 
])repare  the  stomach  and  intestines  to  welcome 
the  nutritive  materials  furnished,  and  to  prepare 
them  for  al)sori)tion.  He  must  endeavor  to  re- 
move obstacles  to  jiroper  elaboration  and 
assimilation  and  to  stimulate  and  assist  these 
functions,  not  forgetting  the  respiration,  which 
in  Arbuthnot's  expressive  phrase,  "is  the 
second  digestion,"  or  the  circulation  which  is  to 
cause  the  oxygen-carrying  corpuscles  and  the 
nutrient  lymph  to  penetrate  into  all  the  tissues. 
He  must  further  watch,  and  if  necessary  assist 
the  process  of  elimination,   so  that  broken  down, 


THE   CANADA   MEDICAL   RECORD. 


113 


useless,  and  sometimes  toxic,  materials  may  be 
speedily  removed  to  make  away  for  that  which 
will  i)ettcr  and  more  vigourously  assist  in  tissue- 
building  and  force-iirodLiction. 

'i'his  subject,  including  as  it  tloes  the  considera- 
tion of  general  and  sjiecial  hygirne,  as  well  as 
mechanical,  chemical  and  medicinal  aids  to 
digestion,  rcsju'ration,  circulation  and  excretion, 
sim])le  and  comi)lex,  must  be  indicated  ;  but  it 
cannot  be  properly  studied  in  a  paper  which  has 
already  overrun  its  limits. 

Yet  one  more  word  must  be  added,  even  at  the 
risk  of  occupying  too  much  space.  Experience  has 
demonstrated  tlie  utter  futility  of  all  measures 
ilesigned  to  destroy  the  bacillus  tuberculosis.  A 
moment's  retlection  must  convince  us  that  even 
could  we  destroy  every  bacillus  in  the  lungs,  we 
would  gain  uotliing  ;  for  the  patient  has  only  to 
o])en  his  mouth,  to  be  invaded  by  a  new  host.  So 
that  whether  we  follow  the  ojiinion  oftlie  majority, 
and  assign  to  this  microbe  supreme  fetiological 
importance,  or  whether  we  arc  content  to  remain  a 
minority  which  can  at  least  boast  among  its  num- 
bers the  most  cultured  and  jjhilosophical  mind 
among  medical  men  of  the  century,  the  experience 
of  every  physician  and  of  every  patient  is  in  accord 
upon  the  all-imi)orlant  point  that  the  secret  of 
treatment  is  not  microbicide,  but  Nutrition. — 
Dietetic  Gazette. 


*THE  CAUSE  AND  TREATMENT  OF   IN- 
FANTILE ECZEMA. 

By  JOUN    V.    SUOEMAKER,    A.M.,  M.D.,  PuiLADELrUI A, 
I'A. 

Infantile  eczema  is  one  of  the  most  common 
diseases  of  early  life.  It  is  always  a  distressing  and 
frequently  an  olistinate  affection,  remaining  for 
weeks  or  months;  but,  as  a  rule,  it  is  much  more 
amenable  to  treatment  than  eczema  in  adults.  It 
may  occur  at  any  period  during  infancy,  but  it  is 
most  frequently  observed  during  the  first  six 
months  of  infantile  life,  at  the  time  of  weaning, 
and  during  the  process  of  dentition. 

It  may  appear  in  a  variety  of  forms.  In  some 
cases  it  is  characterized  by  the  development  of  a 
veritable  number  of  erythematous  spots, or  blocthes 
upon  the  face,  scalp,  and  other  portions  of  the 
body.  In  others  the  eruption  is  purely  jjapular; 
in  still  others  it  consists  solely  of  vesicles  situated 
upon  a  reddened  inflamed  base,  or  both  lesions  may 
be  intermingled.  The  pustular  variety  is  charac- 
terized by  the  formation  of  pustules  of  various  sizes, 
either  alone  or  comingled  with  vesicles,  papules  and 
vesico-papules.  The  disease  may  involve  any  or 
all  portions  of  the  integument,  but  it  most  frequent- 
ly attacks  the  face,  scalp,  neck,  chest,  buttocks, 
and  the  upper  and  lower  extremities.  It  pursues 
a  variable  course.  The  papular  and  erythema- 
tous forms   usually  disappear   by    resolution,  but 


•  Read  in  llic  Section  of  Diseases  of  Women  .ind  Chil- 
dren, .^t  tlie  Tliirty-Eigluh  Anniu-il  Meeting  of  the  Ameri- 
can Mcdiwl  Association,  June,  18S7, 


they  may  pass  imperceptibly  into  the  chronic 
squamous  stage  of  the  disease.  The  surface  then 
presents  a  dull  red  infiltrated  appearance,  and  is 
covered  with  a  number  of  mimUe  epidermic 
scales. 

The  vesicular  and  pustular  varieties  rarely  tem- 
jxrate  in  resolution.  As  a  rule,  the  vesicles  and 
pustules  burst  within  a  few  days  after  their  devel- 
opment, exj)Osing  a  raw  weeping,  bleeding  sur- 
face, from  which  a  sero  jnirulent  fluid  exudes,  and 
dries  into  large,  firm,  yellowish  crusts.  When  the 
scalp  is  tiie  seat  of  the  eruption,  the  hairs  are 
matted  together  by  the  exudation,  and  the  entire 
scalp  becomes  covered  with  yellowish  masses, 
forming  the  condition  known  as  crustalactea.  As 
the  disease  progresses  the  irritation  increases,  so 
that  the  inclination  to  scratch  the  parts  becomes 
almost  irresistable,  and  patients  tear  the  surface 
with  their  finger-nails  even  while  asleep.  This,  of 
courses,  increases  the  exudation  and  enlarges  the 
diseased  area.  After  an  interval  ot  several  weeks 
the  morbid  action  may  cease,  spontaneous  repair 
take  place,  and  these  crusts  drop  off,  disclosing  a 
healthy  but  somewhat  reddened  surface.  Usually 
however,  unless  appropriate  treatment  be  institu- 
ted, the  disease  passes  into  the  chronic  stage,  and 
remains  for  months  or  years  with  occasional 
periods  of  amelioration  and  exacerbation. 

Infantile  eczema  is  due  practically  to  one  of 
four  causes:  i.  Insufficient  or  improper  food.  2. 
Imperfect  assimilation.  3.  Deficient  excretion, 
j  4.  External  irritation. 

Insufficient  or  Improper  Food .-"W^xi  is  one  of  the 
most  frequent  existing  causes  of  the  disease.  If 
the  mother's  milk  is  scanty  in  quantity,  or  poor  in 
quality,  or  altered  in  character  by  pregnancy, 
passion,  menstruation,  anxiety  or  disease,  the 
nutrition  of  the  child  will  suffer,  and  eczema tous 
or  other  eruptions  speedily  appear.  If  the  child 
is  handfed,  and  given  unsuitable  and  indigestible 
articles  of  food,  or,  if  the  cow's  milk  upon  which  it 
is  nourished  is  so  diluted  with  water  as  to  be 
deprived  of  its  value,  the  same  result  will  follow. 

Imperfect  Assimilation.  —  This  is  another 
potent  factor  in  the  production  of  the  disease. 
The  food  may  be  perfect  in  all  respects,  but  if 
owing  to  disturbances  of  the  digestive  tract  a 
considerable  portion  of  it  is  either  rejected  by 
vomiting,  or  hurried  out  through  the  intestinal 
canal  before  digestion  and  assimilation  are 
complete,  the  blood  will  become  thin,  the  nervous 
system  will  suffer,  and  various  cutaneous  eruptions 
apjjear. 

Deficient  Excretion. — Deficient  excretion  is 
not  as  frequently  chargeable  with  the  development 
of  infantile  eczema,  as  it  is  with  many  other  cuta- 
neous disorders,  but  many  stubborn  cases  spon- 
taneously disappear  when  the  normal  functions  of 
the  various  excretory  organs  are  re-established. 

External  Irritation. — This  is  frequently  the 
unsuspected  cause  of  numerous  cases  of  infantile 
eczema,  Among  the  common  sources  o\  in  itation 
may  be  mentioned   woollen  or  flaiincl  clothing, 


114 


THE   CANADA   MEDICAL    RECORD. 


light  clothing,  dyed  clothing,  wet  diapers, 
scratching,  and  the  too  frequent  washing  of  the 
body  and  scalp  with  soap  and  water.  The  erup- 
tion is  often  aggravated  by  the  use  of  quack 
preparations,  or  ointments  recommended  by 
obliging  friends  and  neighbors. 

Treatment. — The  general  principles  upon  which 
the  successful  treatment  of  infantile  eczema  must 
be  based  are,  to  improve  the  nutrition  of  the 
])atient,  correct  any  disorder  of  digestion  or  excre- 
tion that  may  exist,  and  protect  the  affected  sur- 
face from  further  irritation,  and  endeavor  to 
restore  it  to  its  normal  condition.  The  measures 
to  be  employed  in  each  case  will  vary  with  the 
cause  of  the  disease,  and  the  extent,  variety  and 
stage  of  the  eruption.  In  some  cases  attention  to 
diet  and  hygiene  will  be  sufficient  to  effect  a  cure. 
In  other  cases,  local  or  constitutional  medicine 
will  be  required,  while  in  obstinate  cases  both  local 
and  constitutional  remedies  must  be  employed. 
In  mild  cases  of  the  erythematous  or  papular 
variety,  in  which  the  deficient  character  of  the 
food  supply  is  plainly  apparent,  immediate  impro- 
vement can  often  be  obtained  by  simply  giving  a 
sufficient  quantity  of  appropriate  nourishment. 
There  are  several  ways  of  accomplishing  this.  If 
the  mother  is  nursing  the  child,  and  her  milk  is 
scanty  or  impoverished,  she  should  be  placed  upon 
tonics  and  a  liberal  diet,  and  directed  to  give  the 
child  a  definite  quantity  of  cow's  milk  in  addition 
to  her  own  at  stated  intervals  throughout  the  day. 
I  have  notes  of  several  cases  in  which  a  rapid  and 
decided  improvement  in  the  character  and  the 
amount  of  motlier's  milk,  and  a  disappearance  of 
the  eruption  from  her  child  followed  a  liberal  diet, 
conjoined  with  the  use  of  this  formulae  : 

B .     Tiiict .   ignatios 

Tinct.  sei-pentaricB 

Tinct.  cinhconoe 
M.     Sig.     Teaspoonliil 
bedtiaie. 

If,  unfortunately,  the  infant  cannot  be  nursed  by 
its  mother,  the  best  substitute  for  its  natural  food 
is  pure,  undiluted  crow's  milk,  unmi.xed  with  any 
other  substance  whatever.  More  than  thirty 
years  ago  Dr.  N.  S.  Davis  declared  before  this 
Association,  that  the  practice  of  diluting  the  cow's 
milk  given  to  infants  was  the  direct  cause  of  incal- 
culable suffering  and  innumerable  deaths.  Care- 
ful observation  has  convinced  me  of  the  truth  of 
Dr.  Davis'  assertion.  Time  and  again  have  I 
been  called  in  to  see  infants  of  ten  weeks 
who  were  crying  continually,  pining  away,  and  in 
addition  were  coveied  with  various  forms  of  ecze- 
malous  eruptions.  On  inquiring  what  th^ little 
patients  were  fed  upon,  answers  were  oiie  part 
milk  and  three  parts  water,  one  part  milk,  one 
part  flour,  and  five  or  six  parts  water.  In  one 
case  the  unfortunate  child  was  being  slowly  and 
unknowingly  starved  to  death  upon  one  part  milk 
and  eight  parts  water.  My  orders  in  every  case 
were  at  once  to  give  each  child  plenty  of  pure, 
unadulterated    cow's  milk   and  nothing  else  for 


lo  drops 
6    diachms 
I  ounce 
in   water  before    meals     and  at 


food.  For  some  I  directed  2  grains  of  pepsin  to 
be  given  in  addition  with  each  feeding.  No  others 
medicine  was  employed  or  required,  and  in  every 
case  the  eruption  spontaneously  disappeared  in 
from  a  few  days  to  two  weeks. 

In  other  cases  it  will  be  found  tiiat  the  trouble 
is  due  to  the  child  being  givtn  potatoes,  pies,  pas- 
try, pork  and  all  sorts  of  table  fcod,  preparatory 
to  being  weaned,  or  to  assist  it  to  cut  its  teeth. 
The  child's  stomach  is  unable  to  digest  such  food, 
its  gastro-intestinal  canal  is  disordered,  and 
various  eruptions  appears  that  are  charged  to 
dentition.  Dentition  is  a  perfectly  natural  process, 
and  in  the  overwhelming  majority  of  cases  is 
accomplished  without  any  reflex  or  direct  distur- 
bance of  the  system.  The  cases  of  eczema 
attributed  to  it  are  numerous,  but  they  are  really 
due  to  errors  of  feeding  and  disorders  of  diges- 
tion. 

Cases  of  infantile  eczema,  due  to  imperfect 
digestion  and  mal-assimilation,  require  to  be 
studied  carefully.  Those  in  which  there  is  a 
deficiency  in  the  gastric  juice,  are  benefitted  by 
the  administration  at  each  feeding  of  from  J^  to  2 
grains  of  pure  pepsin,  or  from  2  to  5  grains  of 
lactopeptine.  Nux  vomica  in  doses  of  from  one- 
quarter  to  two  minims  of  the  tincture  three  times 
a  day  is  also  valuable.  Minute  doses  of  the 
chloride  of  iron,  or  of  hydrochloric  acid,  some- 
times yield  better  results  than  either  pepsin  or 
nux  vomica.  If  diarrhoea  exist,  small  doses  of 
opium  or  Dover's  powders,  with  an  astringent 
tonic,  like  cinchona  or  geranium,  will  be  of  the 
utmost  value.  In  some  cases  a  change  of  air,  as 
to  the  seashore  or  the  mountains,  will  be  the  most 
effective  remedy.  Cod  liver  oil  will  be  found  of 
especial  value  in  all  patients  that  are  debilitated, 
ansmic,  or  that  present  any  evidences  of  the 
scrofulous  diathesis.  It  may  be  given  in  half- 
drachm  doses  three  times  a  day,  or  used  as  an 
inunction  every  morning.  In  many  cases  no  other 
treatment  will  be  necessary.  The  syrup  of  the 
iodide  of  iron  is  also  valuable.  The  dose  will  vary 
from  five  to  twenty  drops,  according  to  the  age  of 
the  patient.  It  may  be  given  in  any  convenient 
medium  or  in  combination  with  cod  liver  oil. 

Quinine  is  also  an  effective  remedy,  especially 
in  malarious  districts  and  in  cases  in  which  the 
eruption  manifests  itself  during  the  spring  and 
autumn  months.  It  may  be  given  in  the  syrup  of 
yerba  santa,  in  doses  of  from  Vn  grain  to  3  grains 
once  or  twice  a  day.  Very  often  in  cases  aris- 
ing from  gastro-intestinal  irritation  or  complicated 
by  constipation,  marked  and  rapid  improvement 
can  be  obtained  from  the  use  of  minute  doses  of 
calomel,  alone  or  combined  with  a  small  quantity 
of  jalap  resin. 

R.     Hydrag.  Chlor.  mitis.  i    grain 

Resinje  jalapse  i    grain 

Sacchari  albje  10  grains 
M.  Make  6  powders. 

Sig.     One  powder  every  other  day. 


THE   CANADA    MEDICAL   RECORD. 


115 


Podop\Ilin  and  leptandiin  will  also  be  found 
serviceable,  t-'astoroii  is  a  time-honored  and  an 
effective  remedy,  b'mall  doses  of  synipol  rhujjarb 
orcarbonate  ol  magnesia  are  frequently  beneficial. 
In  acute  cases  accomijanied  by  fever  and  an  in- 
crease of  the  circulation,  aconite  is  |)otent  for  good. 
It  will  be  noticed  that  I  have  said  nothing  as  to  the 
use  of  arsenic  in  the  treatment  of  the  various 
forms  of  infantile  eczema.  The  omission  was  in- 
tentional. Arsenic  is  sometiines  requisite  in  the 
treatment  of  obstinate  forms  of  eczema  in  adults, 
but  in  the  eczema  of  childhood  it  is  not  only  un- 
necessary,but  frequently  injurious.  For  many  years 
I  have  not  employed  arsenic  in  cases  of  infantile 
eczema  which  have  come  under  niy  observation. 
I  would  advise  thatarsenic  be  avoided  in  the  treat- 
ment of  infantile  eczema,  as  its  use  is  often  pro- 
ductive of  more  injury  than  any  benefit  it  may 
l)roduce  on  the  disease. 

Local  Treatment. — In   cases  in  which  the  itch- 
ing is  a  marked  symptom,  various  soothing  and 
antipruritic  lotions  and  ointments  may  be  employ- 
ed.     Those  which  I  most  frequently  order  are: 
R.     Acid  carbolic!  2     grains 

Hydrag.  chlor.  mitis  10  grains 

Ung.  zinci  oxide  benz  i     oimce 

M.  Ft.   migt. 
R.     Creasoti  3    minims 

Aquoe  3    ounces 

M.  Ft.  loto 
R.     Chloral  hydrat  5    grains 

Aqua;  menth.  pip  2  ounces 

M.  Ft.  loto. 
Applications  of  cold  w^ater,  ice-water,  lead-water 
and  laudanum,  or  a  saturated  solution   of  bicar- 
bonate of  soda,  will  also    be  found  grateful  and 
calmative. 

When  the  eruption  has  become  subacute  and 
chronic,'  and  the  integument  is  covered  with 
crusts,  it  would  be  folly  to  expect  any  improve- 
ment until  the  diseased  surface  is  exposed  to  view-. 
The  affected  region  should  be  covered  with  a  starch 
poultice,  or  saturated  with  oil  to  loosen  the  crusts 
and  scales,  which  must  be  carefully  picked  off. 
Various  stimulating  ointments  may  then  be  applied 
to  the  exposed,  denuded  surface,  but  care  must 
be  taken  to  avoid  increasing  the  irritation  and  in- 
flammation. The  medicaments  employed  should 
be  such  as  will  constringe  the  capillaries  and  reduce 
the  congestion,  while  they  at  the  same  time  form  a 
protective  covering  for  the  raw  and  oozing  corium. 
The  subnitrate  and  the  oleate  of  bismuth  and  the 
oleate  of  zinc,  either  in  powder  or  ointment  form, 
are  excellent  applications  for  this  purpose.  The 
ordinary  benzoated  oxide  of  zinc  ointment  alone, 
with  5  grains  of  camphor  to  the  ounce,  is  also  ser- 
viceable. The  following  ointment  will  be  found 
valuable  : 

R.     Pulv.  opii  3  grains 

Acidi  tannici  Y-z  ounce 

Plumbi  carbonatis  i  drachm 

_  Oleianthemidis  5    drops 

■  Adipis  I    ounce 


Another  excellent  procedure  is  to  brush  a  25  per 
cent,  solution  of  the  fluid  extract  of  geranium  over 
the  surface  after  the  scales  have  been  removed. 
Diachylon  ointment,  weak  tar  ointment,  cucumber 
ointment,  weak  salicylic  acid  ointment,  and  the 
ointment  of  the  carbonate  of  lead,  may  also  be  em- 
ployed with  benefit.  Harsh  and  irritating  applica- 
tions must  be  studiously  avoided, as  they  are  certain 
to  protract  the  disease.  Cases  due  to  external  irrita- 
tion usually  require  nothing  more  than  the  removal 
of  the  initant  and  the  application  of  a  soothing  oint- 
ment or  lotion  to  the  pari  affected.  Tight,  dyed, 
woollen  or  flannel  clothing  should  be  replaced  by 
articles  of  wear  composed  of  some  less  offending 
material.  If  wet  diapers  are  at  fault  they  should 
be  removed  as  soon  as  soiled,  the  parts  gently 
mopped  dry  with  a  soft  cloth,  and  then  dusted 
with  zinc  o.xide,  bismuth  subnitrate,  or  lead  car- 
bonate, or  painted  with  a  dilute  solution  of  ger- 
anium maculaliun.  If  the  eruption  is  due  to  the 
scratching  and  irritation  consequent  upon  the  pre- 
sence of  lice,  the  hair  should  be  cut  short,  and 
any  of  the  following  ointments  rubbed  well  into 
the  scalp. 

R.     Hydrag  chlor.mitis  10  grains 

Acidi  carbolici  3    grains 

Ungt.  zinci  oxidi  i     oimce 

R.     Napthlithol  10   grains 

Ungt.  zinci  oxidi  i    ounce 

R.     Sulphuris  sublimate  2    scruples 

Pulv.  marantse  i    drachm 

Ungt.  aquae  rosse  i    ounce 

Cases  that  are  the  result  of  too  free  use  of  soap 
and  water  will  usually  spontaneously  subside  upcn 
the  suspension  of  the  practice.  An  infant's  body 
should  be  bathed  every  day  in  tepid  or  warm  water, 
but  soap  should  not  be  applied  to  its  delicate  skin 
more  than  two  or  three  times  a  week. 


WHEN  AND  HOW  TO  USE  MYDRIATICS 
IN  THE  EYE.* 

By  Edward  Jackson,  A.M.,  M.D., 
Adjunct  Professor  of  Diseases  of  the  Eye  in  the  Philadel- 
phia Polyclinic. 

Nowhere  in  the  medical  application  of  drugs  is 
clear  and  definite  knowledge  more  important  than 
in  the  use  of  mydriatics  in  the  eye,  and  in  very 
few  directions  has  so  much  clear  and  definite 
knowledge  been  accumulated. 

Besides  their  therapeutic  applications  to  this 
organ,  mydriatics  are  even  more  frequently  used 
for  diagnostic  purposes.  Before  making  such  use 
of  a  mydriatic,  one  should  always  consider  the 
possible  presence  of  contra-indications.  In  an 
eye  apparently  normal  the  most  important  of  these 
is  an  incipient  or  latent  glaucoma.  Glaucoma  is 
an  affection  always  tending  toward  functional 
destruction  of  the'eye,  only  to  be  finally  checked 


•Read  before  the  Medical  Society  of  the  Sta'eo'  Ptm-yl- 
vania,  at  Bedford  Springs,  June  30th,  1887. 


116 


THE  CANADA  MEDICAL  RECORD. 


in  the  great  majority  of  cases  by  severe  operative 
procedure,  and  often  uncontrollable  even  by  the 
most  radical  measures.  To  hasten  or  bring  about 
an  acute  manifestation  of  such  a  disease  in  an  eye 
liitherto  apparently  free  from  it,  must  always  be 
to  the  surgeon  an  occasion  of  deep  annoyance 
and  regret.  And  well-attested  cases  show  that 
each  mydriatic,  with  the  possible  exception  of 
cocaine,  is  liable  to  produce  such  acute  manifes- 
tations in  the  course  of  this  disease.  To  use  a 
mydriatic  in  an  eye  suffering  from  an  acute  out- 
break of  primary  glaucoma,  as,  I  regret  to  say,  I 
have  known  to  be  done,  is  to  be  guilty  of  practice 
comparable  to  the  feeding  of  a  typhoid  fever 
patient  on  violent  purgatives  or  practicing  free 
venesections  on  one  in  collapse.  I  will  not  here 
reherse  the  symptoms  af  glaucoma  ;  but  remem- 
ber, that  it  is  a  disease  of  middle  and  advanced 
life,  that  it  oftens  presents  a  pericorneal  zone  of 
hy|5er£emia,  and  may  otherwise  closely  simulate 
some  of  the  conditions  in  which  mydriatics  are 
most  strongly  indicated. 

A  second  contraindication  to  its  use  is  the 
interference  with  vision  which  a  mydriatic  occa- 
sions. The  importance  of  this  is  to  be  weighed 
with  the  circumstances  of  each  individual  case, 
and  such  a  mydriatic  should  be  chosen,  and  it 
should  be  so  ai)])lied,  that  the  inconvenience  may 
be  reduced  to  the  minimum.  But  it  is  always  to 
be  remembered  that  when  a  patient  comes  to  a 
physician,  he  has  generally  made  up  his  mind  that 
his  trouble  is  serious  enough  to  warrant  some 
expenditure  of  time  and  money  to  get  relief,  and 
that  to  get  the  clearest  possible  conception  of  his 
case  is  the  first  duty  the  physician  owes  his  patient. 

Of  contraindications  in  eyes  manifestly  diseas- 
ed may  be  mentioned,  besides  glaucoma,  ulcers 
perforating  the  cornea  at  or  near  its  periphery, 
where  myotics  will  ofien  be  more  useful. 

Diagnostically,  mydriatics  are  used  to  dilate 
the  pupil,  to  determine  the  condition  of  the  iris 
or  the  structures  back  of  it,  or  to  paralyze  the 
accommodation.  In  normal  eyes,  to  fully  dilate 
the  pupil  requires  very  much  less  of  the  drug  than 
to  paralyze  the  accommodation.  Simply  to  dilate 
the  normal  pupil,  a  single  drop  of  either  of  the 
fjllowing  solutions  will  suffice: — 
Cocaine  hydrochlorate,  gr.  j,  water,  mxxv, 

or  about  i  to    25  ; 
Homatropine  hydrobromate,  gr.  j,  water,  f  3  j, 

or  about  i  to  500  ; 
Atropine  sulphate,  gr.  j,  water,  f  §   v, 

or  about  1  to  2500; 
Duboisine  sulphate,  gr.  j,  water,  f  3   x, 

or  about  i  to  5000  ; 
or  daturine,  hyoscyamine,  or  hyoscine  salts  used, 
of  the  same  strength  as  duboisine. 

Of  the  above  the  homatropine  solution  will  ren- 
der the  pupil  rather  the  most  rigid,  and  its  effects 
will  pass  off  in  from  twenty  to  fifty  hours.  But 
cocain  cis  the  most  generally  valuable  dilator  of  the 
pupil.  The  dilatation  it  produces  lasts  but  ten 
pr  twenty  hours,  is  never  so  great  in  strong  as  in 


feeble  light,  so  that  there  is  less  annoyance  from 
exposure  to  the  light ;  it  produces  proportionately 
the  smallest  impairment  of  accommodation,  inter- 
fering least  with  near  vision  ;  and  the  dilatation  it 
produces  can  be  promptly  overcome  by  the  use  of 
eserine,  making  it  especialTy  valuable  after  middle 
life,  when  there  is  a  chance  of  the  occurrence  of 
glaucoma.  And  it  is  after  middle  life  that  a  dila- 
tor of  the  pupil  is  most  frequently  needed ;  for  as 
age  advances  the  pupil  normally  grows  smaller, 
and  at  the  same  time  there  is  an  increasing  liabil- 
ity to  those  degenerative  changes  in  tlie  posterio- 
media  and  coats  of  the  eye  that  require  a  some- 
what dilated  pupil  for  their  thorough  study.  But 
this  drug  has  yet  another  advantage.  In  spite  of 
the  readiness  with  which  it  yields  to  myotics,  in 
spite  of  its  inability  to  entirely  prevent  the  reac- 
tion to  bright  light,  tested  in  a  weak  or  moderate 
light,  cocaine  produces  a  7vider  dilatation  of  the 
pupil  than  any  other  mydriatic.  And  this  supe- 
rior power  of  cocaine  is  especially  manifest  in  old 
people,  whose  pupils  often  do  not  dilate  well  un- 
der other  mydriatics. 

Paralysis  of  accommodation  is  produced  both 
as  a  diagnostic  and  as  a  therapeutic  measure.  It 
is  not,  as  a  rule,  called  for  after  fifty,  although 
some  cases  do  occur  after  that  age  in  which  such 
an  action  of  a  mydriatic  is  absolutely  necessary. 
The  difficulty  of  producing  complete  paralysis  of 
accommodation  does  not  greatly  diminish  with 
the  approach  of  the  age  at  which  the  power  of 
acconnnodation  is  lost.  The  strength  of  solution 
required  is  not  materially  less  at  forty-five  than  at 
fifteen.  And  this  is  not  surprising  when  we  remem- 
ber that  accommodative  power  is  lost  primar- 
ily by  increased  resistence  in  the  lens,  rather  than 
diminished  power  in  the  ciliary  muscle.  Yet  early 
childhood,  probably  because  of  interference 
with  the  absorption  of  the  drug  and  extreme  activ- 
ity of  excretion,  presents  special  difficulty  in 
securing  complete  abeyance  of  the  function  of  the 
ciliary  muscle. 

To    completely   paralyze    the    accommodation 
usually  requires  from  two  to  five  instillations  of  a 
drop  of  either  of  the  following  solutions: — 
Homatropine  hydrobromate,  gr.  x,  water  f  ?  j, 

or  about  i  to  50  ; 
Atropine  sulphate,  gr.  iv,  water  f  3  j, 

or  about  i  to  120 ; 
Duboisine  sulphate,  gr.  ij,  water  t  3  ; 

or  about  i  to  240; 
or  daturine,  hyoscyamine,  or  hyoscine  in  the  same 
strength  as  duboisine.  Homatropine  should  be 
instilled  at  intervals  of  from  five  to  fifteen  minutes; 
with  the  other  mydriatics,  to  avoid  constitutional 
effects,  the  intervals  must  be  much  longer.  Cocaine 
in  any  strength  cannot,  in  most  cases,  completely 
control  the  accommodation. 

Of  the  above,  for  diagnostic  purposes,  homatro- 
pine is  greatly  to  be  preferred.  It  reduces  to  a 
minimum  the  period  of  disability  for  eye  work, 
recovery  from  it  being  nearly  complete  in  from 
jhirtj-six   to  forty-eight  hours  against  five  or  six 


'TBE   CANADA   MEDICAL   RECORD. 


117 


(l.iys  lor  tluhciisiiu'  or  ten  or  iwelve  days  for  atro- 
l>ine.  'J'liL'ii,  too,  lioiiiatropiiie  catiscs  no  notice- 
able and  distressing  syniiitonis,  like  tlie  dryness  of 
the  throat,  Hushing  of  the  surface,  incoordination  of 
motion,  or  even  delirium,  which  arc  liable  to  fol- 
low the  use  of  the  other  mydriatics.  Although,  as 
1  have  elsewhere  pointed  out  {Medial/ ^€701,  July 
-'4  ,i8S6),  this  drug  does  usually  to  some  extent 
mlhience  the  action  of  the  heart. 

Wlicn  IIS  (I  thcriipcntic  measure  the' power  of 
acivmmodallon  in  parulijr.ed,  siirh  panilysis  should 
always  he  made  comphte.  Strain  of  accommoda- 
tion occurs  when  the  power  of  the  ciliary  muscle  is 
insiifiicient  for  the  performance  required  of  it.  In 
such  a  condition  nothing  could  be  more  irrational 
than  to  lessen  still  further  ts  power  while  still 
requiring  it  to  do  some  work,  as  inevitably  hap- 
pens when  an  eye  is  placed  jiartially  under  the 
inlluence  of  a  mydriatic.  When  in  doubt  as  to 
the  propriety  of  a  certain  measure,  it  seems  natural 
not  to  push  it  very  vigorously.  So  physicians,  un- 
certain as  to  whether  or  not  a  mydriatic  should  be 
used,  say  in  a  case  of  strain  of  the  accommodation 
or  in  commencing  convergent  squint,  are  rather 
apt  to  use  a  weak  solution  of  the  drug,  or  make  the 
application  at  long  intervals  ;  thinking,  by  such  a 
tentative  employment  of  the  remedy,  to  discover 
if  indeed  it  is  likely  to  give  relief.  I  have  even 
seen  in  cases  of  headache  belladonna  given  by  the 
mouth  (causing  paresis  of  accommodation),  with 
a  vague  notion  that  it  was  especially  indicated  by 
the  eye  symptoms.  Now,  as  the  mydriatic  used 
in  these  meffective  ways  can  only  weaken  still 
further  the  already  relatively  weak  ciliary  muscle, 
the  result  must  be  still  greater  suffering  on  the 
part  of  the  patient,  and  still  greater  confusion  on 
the  part  of  the  doctor.  If  you  use  a  mydriatic  to 
relieve  strain  of  accommodation,  use  it  so  that  com- 
plete paralysis  of  accommodation  will  be  secured 
as  soon  as  possible,  for  only  then  does  accommo- 
dative effort  cease.  Homatropine  is  inferior  to 
atropine  or  duboisine  where  the  influence  over  the 
accommodation  is  to  be  long  maintained  ;  for  after 
each  instillation  of  the  former,  recovery  of  ciliary 
power  will  begin  within  two  or  three  hours,  and 
the  instillations  must  be  repeated  at  least  that 
often,  to  prevent  the  alternation  of  periods  of  rest. 
With  the  other  mydriatic  sjlut'o.is  recominended 
for  this  purpose,  at  least  eight  to  twelve  hours 
elapse  before  there  is  any  noticeable  lessening  of 
the  influence  of  the  drug,  so  that  three  instillations 
a  day  will  be  sufficient  to  unifonnly  sustain  their 
action.  Again,  the  period  after  the  use  of  the 
drug  is  suspended,  when  the  eye  is  but  partially 
mrder  its  influence,  is  one  of  especial  danger.  Even 
with  careful,  intelligent  patients,  much  of  the  ben- 
efit that  would  otherwise  accrue  from  prolonged 
mydriasis  is  often  lost  at  this  time. 

As  a  therapeutic  measure,  dilatation  of  the  pupil 
is  resorted  to  in  cataract,  mainly  involving  the 
centre  of  the  lens ;  and  in  breaking  up  posterior, 
or  central  anterior,  iritic  adhesions.  For  the  for- 
mer purpose  one  of  the  weaker  solutions  of  atro- 


jjine,  duboisine,  etc.,  applied  once,  every  one,  two, 
or  three  days,  is  sufficient ;  cocaine  not  being  well 
suited  to  this  ])urpose  on  account  of  the  evanes- 
cence of  its  action,  and  its  inability  to  maintain 
dilatation  against  a  strong  light. 

To  maintain  dilatation  of  the  pupil  against  a  con- 
gested or  inflamed  iris,  or  to  tinak  up  iritic  adhe- 
sions, use  the  strongest  nii/driatir  solutions  that 
need  ever  be  applied  to  the  eye.  For  such  purpo- 
ses one  may  employ  the  following,  or  even  strong- 
er solutions  : — 

Atropine  sidpiiate,  gr.j.  water  f  f  j,  or  i  to  6o  ; 
Duboisine  sulpliate,  gr.  j,  "     ffij,         or  i  to  120, 

Here  we  wish  to  develoi)  the  maximum  effect 
of  the  drug  upon  the  iris,  and  the  instillations 
should  be  repeated  at  short  intervals,  say  every 
half-hour  or  hour,  until  the  pupil  becomes  fully 
dilated,  or  the  symptoms  of  mydriatic  intoxication 
become  so  pronounced  that  the  use  of  the  drug 
can  be  pressed  no  futher. 

To  get  the  maximum  effect  on  the  eye  with  the 
least  absorption  of  the  drug  into  the  general  system, 
as  little  of  it  as  possible  must  be  permitted  to  enter 
the  tear  passages,  and  find  its  way  to  the  mucous 
surfaces  of  the  nose  and  throat.  To  hinder  such 
escape  of  the  solution,  the  nasal  extremities  of  the 
lids,  including  the  canaliculi,  may,  as  is  often 
recommended,  be  firmly  pressed  against  the  nasal 
process  of  the  superior  maxilla.  But  1  think  it  is 
much  more  effective  to  evert  the  lachrymal  puncta, 
and  keep  in  contact  with  the  adjoining  surface  a 
bit  of  absorbent  cotton.  To  aid  in  securing  the 
same  object,  it  is  important  to  use  a  very  strong 
solution  of  the  drug,  and  place  but  a  single  small 
drop  upon  the  cornea  at  once.  1  use  a  dropper 
with  a  small  end,  that  will  give  less  than  a  half- 
minim  of  water  to  the  drop.  When  larger 
amounts  of  fluid  are  instilled  a  greater  proportion 
runs  off  with  the  tears.  When  both  eyes 
are  affected  with  iritis,  it  is  sometimes  wise  to  con- 
centrate the  mydriatic  attack  upon  one  of  them 
one  day,  and  upon  the  other  the  next ;  in  order  to 
gel  the  full  force  of  the  drug  in  tearing  loose  adhe- 
sions. The  power  of  atropine  or  duboisine  in  this 
direction  may  be  scmiewhat  supplemented  by  the 
simultaneous  use  of  cocaine  ;  though  on  account 
of  its  effect  on  the  cornea  I  would  not  continue 
the  applications  of  cocaine  more  than  a  few  hours, 
nor  repeat  them  before  the  second  or  third  day. 

All  the  mydriatics  mentioned,  except  cocaine, 
seem  to  exert  a  direct  influence  over  the  nutritive 
processes  of  inflammation,  which  gives  them 
great  value  in  the  treatment  of  many  inflammatory 
affections  of  the  eye.  I  will  not  now  attempt  to 
cover  this  field  of  their  application,  both  because 
it  is  so  extensive  and  because  I  do  not  feel  that  I 
can  here  speak  so  definitely.  It  may,  however,  be 
mentioned  that,  subject  to  the  contraindication  of 
glaucoma,  and  aside  from  their  influence  on  iritic 
adhesions,  the  most  obvious  indication  for  the  use 
of  a  mydriatic  in  an  inflammatory  disease  of  the 


lis 


THE   CANADA  MEDICAL   RECORD. 


eye  is  the  presence  of  a  pericorneal  zone  of  redness, 
either  partial  or  complete.  In  proportion  as  the 
intlammation  is  plastic  in  character  will  be  the  ben- 
efit derived.  And  for  its  direct  influence  on  the 
nutrition  of  the  part,  the  largest  amount  of  the 
mydriatic  does  not  always  give  the  best  result. 

It  may  seem  that  I  have  busied  myself  with  the 
discussion  of  very  small  details  ;  but  ignorance  of 
details  nullifies  the  value  of  more  pretentious 
knowledge,  and  nowhere  more  frequently  than  in 
the  ajjplication  of  mydriatics  to  the  eye. 

215  South  nth  Street. 


SUPPURATIVE  PERITONITIS;  OPENING, 
WASHING,  AND  SPONGING  THE  PER- 
ITONEUM ;  RECOVERY. 
At  the  meeting  of  the  Clinical  Society  of  Lon- 
don, on  October  28,  Mr.  Richard  Barwell  read 
notes  of  this  case.  The  man,  set.  42,  accustomed 
to  drink  a  good  deal,  was  admitted  into  Charing 
Cross  Hospital  June  24,  1887.  Six  days  previous- 
ly he  fell  and  struck  the  left  lower  part  of  the 
abdomen,  but  seemed  very  little  hurt.  Five  days 
afterwards  he,  in  stooping,  felt  severe  pain  in  the 
lower  part  of  the  abdomen;  he  vomited  and  pass- 
ed a  little  very  dark-colored  urine.  (Absence  or 
presence  ofblood  could  not  be  verified.)  He  went 
to  bed,  his  abdomen  swelled,  he  passed  very  little 
urine  ;  vomited  after,  and  sometimes  without,  tak- 
ing Ibod.  On  admission  he  was  placed  in  a  warm 
bath  ;  while  in  it  he  passed  what  may,  he  thinks, 
have  amounted  to  a  wine-glassful  of  urine.  At  2 
p.m.  Mr.  Barwell  found  him  v;ith  pinched,  anxious 
countenance,  pulse  small,  hard,  and  quick,  and 
temperature  100.4°,  dry  skin,  tongue  somewhat 
coated,  vomiting,  abdomen  slightly  tender,  save  in 
left  iliac  region,  much  swollen,  very  tympanitic 
quite  down  to  the  pubes;  tapping  it  produced  a 
peculiar  thrill  not  like  that  of  flatulence.  A  No. 
1 2  catheter  brought  away  no  urine,  even  though 
pressed  far  back,  but  the  instrument  when  with- 
drawn was  full  of  urine  deeply  stained  with  blood. 
June  25.  On  three  occasions  10  ounces  of  urine 
had  been  passed,  at  first  with  blood,  the  last  sam- 
ple free  of  blood,  but  slightly  albuminous,  specific 
gravity  1022  ;  temperature  89°  ;  pulse  130  ;  abdo- 
men more  distended.  It  being  evident  that  the 
man  had  a  bad  type  of  acute  peritonitis,  Mr.  Bar- 
well  ojiened  the  abdomen  in  the  middle  line  below 
the  umbilicus.  A  large  quantity  of  gas,  not  of  fe- 
culent odor,  escaped.  No  rupture  of  any  viscus 
was  found,  but  in  its  lower  part  the  peritoneum 
contained  a  quantity  of  thick  pus.  There  were 
no  adhesions  ;  parts  of  the  intestines  were  conges- 
ted, and  the  membrane  was  somewhat  thickened. 
Three  sponges  passed  into  the  lower  part  of  the 
cavity  were  withdrawn  covered  with  tenacious 
flocculent  pus.  A  smooth-nozzled  glass  funnel 
was  then  deeply  introduced,  and  the  part  of  the 
cavity  washed  out  with  10  pints  of  distilled  water, 
temperature  99"^,  bringing  away  quantities  of  pus 
and  flocculi.     After  sponging,    a  second  smaller 


washing  and  sponging  was  directed  to  the  upper 
part.     The  abdomen  was  then  sewn  close  without 
any  drain.     The  whole  operation,  including  the 
anaesthetic  and  dressing,  lajSted  anhour.     June  26. 
During  the  night  and  d.ay  the  patient  frequently 
vomited  a  brown  fluid  with  darker  concreta ;  pulse 
rather  fuller,   no;  abdomen    scarcely  distended, 
and  tender  only  in  immediate  neighborhood  of  the 
wound.     He  was  lying  flat,  save  for  a  small  pillow 
under  the  knees  ;  said  he  was  quite  well,  and  want- 
ed to  go  home.     July  28.     The  vomiting  slowly 
decreased  durina;  the  night ;  the  bowels  acted  rather 
copiously  four    tunes.     The  vomiting  ceased  and 
all  symptoms  passed  rapidly  away.     The  rest  of 
the  history  was  that  of  rapid  convalescence,  the 
man  being  very  importunate  in  requesting  to  be 
discharged.     In  his  remarks  Mr.  Barwell,  referring 
to  a  paper  by  Mr.  Hancock,  claimed  for  Charing 
Cross  Hospital  the  first  conception  of  the  idea  of 
opening  the  peritoneum  for  acute    peritonitis(ia«- 
(■£•/,  1848,  "Meetingof  Medical  Society").  Healso 
pointed  out  that  this  operation  had  been  performed 
fourteen  times,  though  the  operator  had  not  always 
known  what  was  the  precise  nature  of  the  case  and 
the  circumstances  had  been  very  various,  ulcers  or 
rupture  of  some  part  of  the  intestinal  tract,  or  of 
an  ovarian  cyst.     He  emphasized  the  impossibility 
of  draining  the  lower  part  of  the  peritoneum  through 
a  wound  in  the  front  of  the  abdomen,  and  advised 
that  no  drainage-tube  should  be  inserted  immedi- 
ately after  operation,  but  that  if  distention  recurred 
to  remove  the  lower    stiches  and  permit  escape. 
The  presence  of  a  tube,  which  could  not  in  that 
position  act  as  a  drain,  might  be  injurious  rather 
than  beneficial.     In  the  female,  drainage  J>er  va- 
ginain  would  probably  be  the  most  valuable  treat- 
ment as  the  best  wash,  since  disinfectant  lotions, 
strong  enough  to  act  as  germicides,  could  not  be 
brought  into  contact  with  any  large  surface  of  the 
peritoneum  witiiout  injurious  effects,  local,  syste- 
mic, or  both. — British  Medical  Journal,  Novem- 
ber 5,  1887. 


THE  TREATMENT  OF  OPHTHALMIA 
NEONATORUM. 

Mules,  of  the  Manchester  Eye  Hospital,  in  a 
Prize  Essay  published  in  the  Medical  Chronicle 
for  January,  188S,  describes  the  following  treat- 
ment : 

The  mother  or  nurse  should  first  wash  the  eyes 
in  warm  water  to  remove  the  secretion  and  free 
the  lids.  The  surgeon  should  be  seated  in  a  con- 
venient chair,  with  a  folded  towel  across  his  knees 
and  with  medical  appliances  within  reach  of  his 
hand.  These  aj^pliances  are:  (i)  A  plentiful 
supply  of  pieces  of  clean  rag ;  (2)  solutions  of 
argenii.  nit.,  5  grs.  to  oz.,  and  10  grs.  to  i  oz. ; 
(3)  vessel  of  clean  water;  (4)  two  camel's-hair 
pencils  to  apply  the  solutions  and  wash  the 
excess  of  fluid  away  ;  (5)  a  botde  of  eserine,  5  grs. 
to  I  oz.,  and  dropper ;  (6)  lid  elevators.  He 
then  receives    the  head  between    his   knees,  yet 


THE   CANADA   MEDICAL   RKCORD. 


119 


supported  by  the  towel.  The  nurse,  tucking  the 
child's  legs  under  her  left  arm,  supports  the  body 
on  her  raised  knee,  holds  the  child's  hands  with 
one  hand,  and  has  the  other  at  liberty  to  assist  the 
surgeon.  The  surgeon  first  proceeds  to  exam- 
ine the  condition  of  the  cornea  by  gently 
raising  the  upper  lid  with  his  finger — if  there  is 
any  diiiiculiy  in  this  manteuvre  he  uses  an  elevator. 
A  bent  han-pin  ollen  answers  admirably.  He 
next  everts  the  lids,  wipes  them  diy,  paints  them 
will)  the  silver  sohuion  of  the  recpiired  strength, 
taking  sjiecial  care  to  get  the  baJi  folds  of  ihc 
conjunctiva,  and  washing  off  the  excess  of  sohuion 
wiih  clean  water,  carelully  replaces  the  lid  by 
drawing  them  downward  and  away  from  the  globe. 
'J'his  process  is  repeated  by  the  surgeon  every 
morning  until  the  disease  is  arrested,  his  object 
being  to  produce  a  slight  eschar,  which  either 
destroys  the  micro-organisms  or  prevents  their 
nnilti[>Iication.  The  effect  lasts  about  twelve 
hours.  In  severe  cases  the  solutions  can  be  re- 
aii|)lied  at  night.  However  careful  a  surgeon  may 
be  his  efforis  are  of  little  avail  unless  he  is  ably 
seconded  by  the  nurse.  Her  duties  are — to 
prevent  the  re-collection  of  pus,  by  constantly 
opening  the  lids  and  wiping  the  matter  away  with 
clean  rags;  to  wash  the  conjnnctivai  with  a  weak 
alum  or  boracic  acid  solu  ijn,  3  grs.  to  i  oz. ;  to 
anoint  the  lid  margin  witli  cerate  to  prevent  ad- 
herence, and  to  combat  the  feverish  restlessness  by 
fresh  air  and  careful  attention  to  diet. 

The  Canada  Medical  Record. 

A  Monthly  Jotirnal  of  Medicine  and  burgery- 
EDITORS  : 

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

Editoz-  auil  Proprietor. 

R.  A.  KENNEDY,  M.A.,  M.D.,  Managing  EOitor. 
ASSISTANT  EDITOR: 
GEORGE  E,  ARMSTRONG,  CM.,  M.D. 

SUBSCRZPTION    TWO    DOLLARS    PEU   AN.NDM. 

All  communications  and Kichanqps  muat  be  aiJressed  to 
the  Bditors,l)rawer356,  Post  Office,  Montreal. 

MONTREAL,  FEBRUARY,  18SS. 

A  NEW  TREATMENT  FOR  BOILS  AND 
CARBUNCLES. 
The  ordinary  methods  of  treating  boils  and  car- 
buncles by  a  "  free,  bold  incision  "  often  leads  to 
good  results,  but  the  anticipation  of  this  cutting  is 
always  such  a  terror  to  patients  that  surgeons  would 
most  gladly  use  a  milder  treatment,  if  certain  that 
cure  would  follow.  M.  Verneuil,  with  an  expe- 
rience of  half  a  century,  has  noticed  with  interest 
the  different  phases  through  which  die  treatment  of 
these  painful  maladies  has  passed.     Following  in 


the  footsteps  of  his  teachers,  he  freely  used  the 
knife,  to  give  it  up  only  when  the  thermo  cautery 
came  into  use.  Cauterization,  with  subsequent 
api)licationofcarbolated  dressings,  gave  him  such 
good  results  thai  his  rule  was  to  use  the  knife  only 
exceptionally,  in  the  gravest  cases,  and  then  to  use 
it  unsiKiringly.  In  1883  lie  observed  a  case  which 
made  him  reflect  and  change  his  mode  of  treat- 
ment. Since  that  time  he  lias  confined  his  treat- 
ment absolutely  to  the  apidication  of  carbolated 
powders,  and  these  for  all  kinds  of  boils  and  car- 
buncles, large,  small,  diabetic,  ]iainful  or  indolent, 
closed  or  open,  and  covered  with  gangrene.  For 
the  small  and  medium-si/.ed  carbuncles,  this 
method  of  treatment  has  been  very  successful,  with- 
out pain  or  extension  of  the  inllammation. 


THE  CANCER-BACILLUS,  AND  THE  SAR- 
COMA-BACILLUS. 

The  New  Yorjc  Medical  Record  of  February  25th 
says  : 

Dr.  Carl  Francke,  assistant  to  professor  Von 
Ziemssen  at  the  Clinical  Institute,  at  Munich, 
reports  to  the  Munich  Society  of  Morphology  and 
Physiology  that  he  has  confirmed  the  discovery  of 
Scheuerlen  regarding  the  bacillus  of  cancer.  He 
has  also  discovered,  himself,  a  bacillus  of  sarcoma 
(^Munch.  Med.  Wochenschr). 

Dr.  Francke's  experiments  began  last  November, 
and  he  had  already  seen  and  demonstrated  the 
bacillus  of  sarcoma  when  Scheuerlen's  discovery 
was  announced.  Francke  has  examined  nine  can- 
cers since  then,  and  in  all  has  observed  the  car- 
cinoma-bacillus and  its  spores  essentially  as  des- 
cribed by  Scheuerlen. 

His  observation  on  the  sarcoma-bacillus  were 
based  on  the  examination  of  three  cases.  In  each 
instance  he  found  a  bacillus  which  resembled  the 
cancer-bacillus  very  closely  only  it  was  thinner 
and  longer.  The  cancer-bacillus  are,  on  the  aver- 
age, 2  micro-millimetres  long,  and  0.4  micro-milli- 
metre broad,  while  the  .sarcoma  bacillus  measures 
3  to  4  by  0.4  micro-millimetres.  The  sarcomo- 
spores  also  resemble  those  of  carcinoma,  except 
that  they  are  a  little  larger  and  Iiave  a  sharply 
I  contoured  pole.  The  two  organisms  develop  alike 
in  culiure-media,  producing  a  reddish-brown  pig- 
ment. Inoculations  of  the  pure  cultures  of  the 
sarcom.a-bacillus  have  produced  no  result  as  yet, 
but  Francke  thinks  that  four  weeks  is  too  short  a 
time  for  sarcoma  to  develop,  and  he  will  make 
another  report  later. 


120 


THE   CANADA   MEDICAL  RECOKD. 


PERSONAL. 
Dr.  McCIure,  Medical  Superintendent  of  the 
Montreal   General    Hospital,  has    tendered    his 
resignation,  to  take  effect  on  the  ist  of  May. 

Dr.  Geralde  Howard,  son  of  Dr.  R.  P.  Howard, 
Dean  of  the  Faculty  of  Medicine,  McGill  Uni- 
versity, is  to  be  married  on  the  8th  of  March  to 
tlie  adopted  daughter  of  Sir  Donald  Smith  of 
Montreal.  Dr.  Geralde  Howard's  many  friends 
will  congratulate  him  on  obtaining  as  his  partner 
in  life  a  lady  so  highly  esteemed  by  all  who  have 
the  pleasure  of  her  acquaintance. 

Dr.  C.  A.  Wood  (CM.,  M.D.,  Bishop's  Col- 
lege 1877),  who  so  ably  filled  for  several  years 
the  Chair  of  Pathology  in  the  Medical  Faculty  of 
his  Alma  Mater  on  the  completion  of  his  course 
for  this  session,  tendered  his  resignation,  which 
has  been  accepted  with  deep  regret.  Dr.  Wood 
had  gained  a  most  extensive  but  a  very  laborious 
practice,  and  it  was  telling  seriously  on  his  health. 
It  was  therefore  necessary  for  him  to  cease  his 
work  for  a  time.  He  early  last  month  proceeded 
to  New  York,  where  in  attendance  at  the  Poly- 
clinics, he  devoted  his  time  in  special  investiga- 
tion. On  the  22nd  of  this  month,  Dr.  Wood 
sailed  from  New  York,  accompanied  by  his  wife, 
for  Hamburgh  from  whence  he  will  proceed  to 
Berlin.  It  is  his  intention  to  remain  abroad  two 
years,  during  which  time  he  will  devote  himself 
to  special  work,  which  he  will  follow  in  the  future. 
His  friends  have  every  reason  to  believe  that  he 
will  return  to  Montreal,  and  practice  his  specialty. 
Dr.  Wood  was  admittedly  one  of  Montreal's 
brightest  medical  men,  so  that  his  departure  was 
witnessed  with  regret,  and  his  return  will  be 
hailed  with  enthusiasm.  In  this  issue  we  publish 
a  letter  by  Dr.  Wood  from  New  York,  and  our 
pages  will  often  be  enriched  with  communications 
from  Berlin. 


REVIEW. 

A  synopsis  of  the  Physiological  Action  of  Medi- 
cines, prepared  for  the  special  use  of  the  Students 
of  the  Medical  Department  of  the  University  of 
Pennsylvania.  By  Louis  Stare,  M.D.,  and  Jas. 
B.  Walker,  M.D.  Third  edition.  Philadel- 
phia.    P.  Blakiston,  Son  &  Co.,  1888. 

One  can  hardly  imagine  why  it  took  three 
authors  to  produce  this  little  book  of  seventy-two 
pages;     but  whatever  the  reason  they  have  suc- 


ceeded admirably.  In  a  very  small  compass  they 
have  compressed  a  vast  amount  of  information  on 
the  physiological  action  of  medicines,  and  have 
thus  rendered  medical  students  their  debtors.  We 
advise  every  student  to  purchase  a  copy. 


Nasal  Polypus,  ivith  Neuralgia ;  Hty  Fever  and 
Asthma  in  relation  to  Ethmoditis.  By  Edward 
Woakes,  M.D.,  London,  Senior  Aur.al  Surgeon, 
and  Lecturer  on  Diseases  of  the  Ear  at  London 
Hospital,  Surgeon  to  the  London  throat 
Hoipital,  with  illustrations,  Philadelphia,  P. 
Blakiston,  Son  &  Co.,  1888.     Price,  $1.25. 

We  have  examined  this  work  pretty  thoroughly, 
and  are  satisfied  that  it  is  a  very  important  addi- 
tion to  the  literature  of  the  subject.  He  elucidates 
an  entirely  new  theory  as  to  the  origin  of  Nasal 
Polypi,  if  facts  which  have  been  patent  to  his  eye 
can  be  designated  theory.  It  is  a  volume  vi'hich 
is  sure  to  attract  attention,  and  its  perusal  will 
whet  the  reader's  appetite  for  the  fuller  volume, 
which  is  in  course  of  preparation.  It  should  be 
very  carefully  studied  by  all  nasal  specialists. 


JOSEF  HOFMANN. 

This  is  the  name  of  the  marvelous  boy  pianist, 
who  has   been  creating   such   a  furore   in  New 
York  and    Boston,  and   other  places,  since  last 
summer.     His  exact  age  we  cannot  give,  but  it  is 
somewhat    in   the   neighborhood   of  eight   years, 
and  the  amount  of  work  he  has  performed  during 
the     last    nine     months    has    been     prodigious. 
Almost  daily,  and  almost  nightly  also,  he  has  per- 
formed before  large  audiences,  amid  great  excite- 
ment  and  corresponding  nerve   strain.     Playing 
the  most  difficult  compositions  of  the  great  masters, 
improvising  and   leading    orchestres,    there    has 
developed  in  him,  as  the  result  of  this  increased 
mental  activity,  a  condition  of  nervous  prostration, 
which  threatens  to  blight  a  most  wonderful  genius. 
According  to  the   New  York  Medical  Record,  a 
consultation  of  medical  men  has  taken  place,  and 
the  result  is  that  the  little  fellow  has  been  ordered 
complete  rest.     It  is  to  be  hoped  that   this  will 
have  the  desired  effect,  but  it  is  a  matter  of  sincere 
regret   that  the   little  fellow  has   been  as   it  were 
forced   to   the    very   brink   of  destruction.      No 
matter  what  the  character  of  the  strain,  it  should 
fall  but  gently  on  a  growing  child. 


THE  CANADA  MEDICAL  RECORD. 


Vol.  XVI. 


MONTREAL,    MARCH,    1888. 


No.  G. 


ORIGINAL  COMMUNICATIONS. 

Valedictory  a(Mri\SH  on  bdialf  of  the 
Kaculty  by  Dr.  proinKnol 121 

\'alcili<-t()ry  aiidri'Bs  oTi  brlialf  of  llio 
OratluaU'8  by  l>r.  'i'iionias 122 

SOCIETY  PKOCEEDINGS. 
Medico  Cliirurgioal  Society  of  Mont- 
real   124 

CLINCAL   NOTES. 

Typlioid  Fever 12S 

Noil  Epileptic  Convulsion 129 

Tape  Worm 120 

Persistent  Headaclie 12!' 

For  Tonsillitis  ami  riiaryiiBilis 129 

Krysipelas  Treated  Willi  .?abor:indi. , . .  i;jo 
Sodium    Chloride    as  a    rruphylactie 

against  Germs l.TO 

Morphine  Habit -,  1:10 

Shoulder  Dislocation l;((i 

Laparotomy  for  Gunshot  Wound 130 


COn^TEIsTTS. 

PEOGRESS  OF  SCIENCE. 

The  Treatment  of  Early  PlithiBis 

Pulmonary  CoiiHumption  as  Treated  in 


tbe  Pliiladelpbia  Polyclinic 

The  Management  of  tuo  Anterior  Lip 
oltlie  UttTus 

Tli6  Qiwstion  of  Kxtrac'ion  afier  Ver- 
sion.  

Fiecal  Anemia 

ChloaBma 

Strictures 

The  Vahie  of  Nitroglycerine  in  Tinni- 
tus Aurium ..*. .  

Crede'e  jVIethod  of  Phicontal  Expression 

Colored  Light  ill  the  Treatment  of  the 
Iiigano  

On  Scuih't  Fever  and  its  Treatment 

German  Hospitai 

Blepharitis 

Foetid  Fcia 

Keith  on  Ilyeterectoniy  in  Fibroma.  .. 


Tobacco  Heart  HO 

Mehuic'holia i4o 

SoapB  in  Skin  iJieeases HI 

I'yspepsia  Mixture HI 

Vngue  PaiuB HI 

Cyelitis  hi 

Fracture  of  tlie  Clavicle HI 

Hyoscyamine  for  Asthma 141 

Iritis 141 

Prognosis  in  Convuleious HI 

iiroiiiinc  in  Croup HI 

Flatulence  due  to  Fermentation HI 

EDITORIAL. 

Professional  Success HiJ 

Longevity  and  Medical  Men 112 

Doctors*  Billi 143 

The  Code  of  Ethics  of  the  American 
Medical  Association H3 

Personals u\ 


^n^inal  BomiminicaUoM. 

CONVOCATION  OF  THE  UNIVERSITY  OF 
BISHOP'S  COLLEGE  FOR  CONFERRING 
DEGREES  IN  THE  FACULTY  OF  MED- 
ICINE. MARCH  28th,    i888. 
Valedictory  Address  on  Behalf  of  The  Professors, 
BY  A.  Proudfoot,  M.D.,  Professor  ok 
Ophthalmology. 

Gentlemen  Graduates  : — It  is  my  privilege 
on  this  occasion  to  address  to  you  a  few  words, 
and  I  embrace  the  opportunity  with  pleasure. 

Gentlemen  : — You  have  to-day  reached  the  goal 
for  which  you  have  been  striving  for  four  long 
years';  the  days  of  your  apprenticeship  are  over, 
and  you  will  henceforth  be  at  liberty  to  put  into 
practice  the  knowledge  which  you  have  acquired. 

During  your  college  career,  it  has  been  the 
earnest  endeavor  of  each  of  your  professors,  to 
impart  to  you  as  thorough  a  knowledge  of  your 
profession  as  time  and  circumstances  would 
permit;  and  the  high  standing  which  some  of  you 
have  obtained  in  the  examinations  through  which 
you  have  just  past  is  an  evidence  that  their  efforts 
have  not  been  in  vain.  And  believe  me,  gentlemen, 
when  I  tell  you,  that  your  professors  will  follow 
your  future  course  through  life  with  an  anxious 
merest,  as  the  success  of  our  graduates  will 
determine  the   continued  success  of  our  college. 

It  has  been  said  that  to  begin  right  is  half  the 
battle.  I  wish  therefore  to  give  you  a  few  liints 
upon  the  subject  of  medical  ethics,  with  which  it 
is  the  duty  of  every  physician  to  familiarize  himself 
at  the  very  beginning  of  his  professional  career, 
and  never  under  any  circumstances   to   violate 


them  when  brought  in  contact  with  members  of 
the  regular  profession. 

A  physician  should  ever  be  ready  to  obey  the 
calls  of  the  sick,  and  his  mind  should  be  endued 
with  the  greatness  of  his  mission  and  the  respon- 
sibility he  ever  incurs  in  its  discharge.  He  should 
therefore  reflect  upon  the  importance  of  his  ofiice, 
remembering  that  the  ease,  health  and  perhaps 
the  lives  of  his  patients  are  dependent  upon  his 
attention,  fidelity  and  skill.  And  in  his  deportment 
he  should  study  to  unite  tenderness  with  firmness, 
and  condescension  with  authority,  so  as  to  inspire 
the  minds  of  his  patients  with  respect,  confidence 
and  gratitude. 

Every  case  committed  to  his  care  should  be 
treated  with  attention  and  humanity,  reasonable 
allowance  being  made  for  the  mental  weakness  and 
caprices  of  the  sick.  The  familiar  and  confiden- 
tial intercourse  to  which  the  physician  is  admitted 
in  his  professional  visits  should  be  used  with 
discretion;  and  the  strictest  regard  to  fidelity 
and  honor.  And  none  of  the  privacies  of  [Person- 
al or  domestic  life  should  ever  be  divulged,  even 
after  his  professional  services  have  ceased.  This 
rule,  however,  noes  not  apply  in  cases  of  smallpox, 
diphtheria,  scarlet  fever,  or  other  contagious  orin- 
fec  tious  diseases,  which  he  is  compelled  by  law  to 
report  to  the  Sanitary  Authorities. 

The  physician  should  visit  his-patients  frequent- 
ly, in  order  that  he  may  gain  a  perfect  knowledge 
of  their  diseases,  and  be  able  to  meet  promptly 
any  change  or  complication  that  may  arise ;  he 
will  thus  secure  the  confidence  of  his  patients. 
Too  frequent  visiting  should,  however,  be  avoided, 
as  they  may  lay  the  physician  open  to  the  suspicion 
of  interested  motives. 


122 


THE   CANADA  MEDICAL  RECORD. 


Whilst  a  physician  should  not  be  too  hasty  in 
fornning  a  gloomy  prognosis  or  in  magnifying  the 
importance  of  his  services,  it  is  his  imperative 
duty  to  warn  the  friends  when  danger  really  exists. 
And  as  it  is  the  special  mission  of  the  physician  to 
minister  hope  and  comfort  to  the  sick,  he  should 
avoid  most  scrupulously  every  word  or  act  which 
may  tend  to  discourage  or  depress  the  spirits  of 
his  patient.  Even  where  the  case  is  incurable, 
the  physician  should  not  abandon  his  patient, 
as  he  may  relieve  pain  and  other  symptoms,  and 
thus  contribute  to  his  comfort,  and  diminish  the 
distress  and  anxiety  of  his  friends. 

In  cases  of  real  doubt  or  difficulty  consultations 
should  be  asked  for,  as  they  strengthen  the  hands 
of  the  physician  in  attendance,  and  increase  the 
confidence  of  the  patient.  I  must  here  remind 
you  that  when  an  hour  has  been  fixed  for  a  con" 
s-ultation,  the  greatest  punctuality  must  be  obser- 
ved. But  circumstances  may  arise,  which  will 
prevent  a  physician  from  keeping  his  appointment, 
in  which  case  he  should,  if  possible,  notify  his 
confrere,  and  a  fresh  "appointment  can  be   made. 

In  consultations  the  attending  physician  must 
first  examine  his  patient,  after  which  the  consult, 
ing  physician  should  have  an  opportunity  of  doing 
so,  and  of  asking  such  questions  as  he  may  deem 
necessary  to  satisfy  himself,  as  to  the  true  nature 
of  the  case.  No  statement  or  discussion  should 
take  place  before  the  patient  or  his  friends  ;  but 
both  physicians  should  retire  to  a  separate  room, 
and  after  exchanging  views  upon  the  case,  the 
attending  physician  should  then  communicate  the 
result  of  their  deliberations  to  the  patient  and  his 
friends,  and  give  all  directions  for  the  further 
treatment  of  the  case. 

The  responsibility  must  then  be  equally  divided 
between  the  medical  attendants,  who  share  alike 
the  blame  of  failure  or  the  credit  of  success.  The 
consulting  physician  should  conscientiously  main- 
tain the  attending  physician  in  the  confidence 
and  good  opinion  of  the  family  into  which  he  is 
called,  as  any  attempt  on  his  part,  by  word  or 
deed,  to  ingratiate  himself  and  basely  supplant  the 
medical  attendant, Would  be  most  dishonest,  and 
unworthy  any  member  of  an  honorable  profession. 
And,  gentlemen,  there  is  no  profession  from  tlie 
members  of  which  there  is  required  a  higher 
standard  of  morality  than  the  medical.  Let 
therefore  your  habits  be  regulau;  do  not  devote 
too  much  time  to  pleasure,  politics  or  any  other 
pursuit  which  may  incapacitate  you  for  the  faith- 


ful performance  of  your  professional  duties.  And 
here  let  me  warn  you  against  the  far  too  prevalent 
habits  of  "  nipping  and  smoking."  It  is  incumbent 
upon  the  members  of  our  profession  to  be  temper- 
ate in  all  things,  with  eyes  clear,  hands  steady  and 
brain  unclouded,  r.^ady  to  act  on  any  emergency, 
where  the  life  of  a  fellow-creature  may  be  in 
danger. 

Can  you  imagine  anything  more  distasteful  to  a 
delicate  and  refined  lady  than  to  have  a  physi- 
cian ushered  into  her  presence,  whose  breath  is 
redolent  of  the  fumes  of  Old  Rye,  and  whose 
clothes  are  reeking  witli  the  odor  of  stale  tobacco? 
In  these  degenerate  days,  I  know  that  it  is  useless 
for  me  to  tell  you  not  to  smoke.  I  will  therefore 
content  myself  with  earnestly  advising  you  to  re- 
serve your  pipe  or  cigar  until  after  you  have 
made  your  daily  round  of  visits.  And,  gentlemen, 
one  word  more  and  I  have  finished. 

Do  not  get  discouraged  if  practice  does  not 
come  quickly,  and  be  led  to  make  the  fatal  mis- 
take of  having  flaming  advertisements  or  reports 
of  operations  and  cases  inserted  in  the  daily 
papers.  These  are  the  common  practices  of  the 
quack  or  empiric,  and  are  considered  discreditable 
to  members  of  the  regular  profession.  Your  time 
can  be  profitably  spent  in  making  careful  notes  of 
every  case  that  may  come  under  your  observation; 
from  the  daily  papers  you  can  post  yourself  upon 
the  news  of  the  day,  and  from  medical  journals, 
for  one  or  two  of  which  I  would  advise  you  to 
subscribe,  you  will  be  able  to  keep  yourselves 
uu  fait  in  all  matters  more  closely  connected 
with  your  profession. 

And  now,  gentlemen,  in  the  name  of  your  pro- 
fessors, I  bid  you  goodbye  and  Godspeed. 


VALEDICTORY   ADDRESS    ON    BEHALF 
OF  THE  GRADUATING  CLASS. 
By  Dr.  S.  A.  A.  Thomas. 
Worthy  Chancellor,  Dear  Professors,  Ladies 
AND  Gentlemen. 

I  regret  that  I  have  to  express  my  thoughts  in 
a  language  for  which  I  have  much  admiration, 
but  which,  owing  to  my  early  training,  I  speak 
but  imperfectly;  however,  trusting  to  your  generos- 
ity and  to  your  kindness,  I  have  accepted  the 
honor  of  addressing  you  this  day  in  behalf  of  the 
graduating  class,  although  this  could  have  been 
better  done  by  any  of  my  confreres. 

At  last  we  have  completed  our  4  years  of  stu- 
dent's life,  rather  of  college  life, — for  the  medical 


THE  CANADA  MEDICAL  RECOR©. 


123 


man,  in  order  to  keep  pace  with  the  times,  must 
remain  a  student  for  ever — and  have  had  confer- 
red upon  us  the  often  coveted  degree  of  C.  M., 
M.  D.  Such  is  the  reward  of  our  energy  and  per- 
severance. The  price  is  great,  the  value  thereof 
cannot  be  overestimated.  As  our  Alma  Mater 
has  thought  us  worthy  of  admission  into  the  ranks 
of  her  graduates,  let  us,  fellow-graduates,  prove 
^ourselves  worthy  sons  of  such  a  grand  University. 

Indeed, this  is  a  happy  day  for  us,for,within  these 
walls,  we  see  the  face  of  many  and  many  friends 
who  have  gathered  to  congratulate  us  and  to  rejoice 
with  us.  How  auspicious  the  future,  surely,  with  so 
many  freinds  to  stand  by  us,  we  cannot  help  but 
succeed  in  our  noble  profession.  We,  the  gra- 
duates, thank  3'GU,  ladies  and  gentlemen,  to  have 
come  in  such  a  great  number  to  witness  this  our 
happiest  day. 

Although  our  college  days  are  over,at  the  feet  of 
our  professors  we  have  learned  to  reverence  the 
medical  profession,  and  will  ever  endeavor  to  pro- 
mote its  welfare  at  all  times. 

But  as  this  is  aday  of  gladness  and  of  jubilation 
and  of  mutual  congratulations,  it  is  also  a  day  of 
sadness  and  of  sorrow.  To-day, we  press—doubtless, 
many  of  us — the  hand  of  some  good  and  faithful 
friends  whom  we  shall  never  see  again.  To-day, we 
have  to  bid  farewell  to  our  dear  professors,  with 
whom  we  have  been  so  intimately  connected 
during  the  past  4  years ;  ever  we  have  found  them 
sympathisers,  friends  and  true  gentlemen.  In  part- 
ing with  you,  dear  professors,  we  heartily  thank  you 
for  the  knowledge  you  have  imparted  unto  us,  for 
your  kindness  in  and  out  of  the  lecture  room ;  we 
gladly  bear  testimony  to  your  able  teaching,  and 
to  the  painstaking  care  you  ever  employed  to  fit  us 
to  answer  the  calls  of  suffering  humanity. 

We  recognize  your  efforts  to  promote  true 
medical  education, both  out  and  in  college.  True 
it  is  we,  the  class  of  88,  grumbled  a  great  deal  when 
you  made  the  examinations  in  ophthalmology  and 
in  diseases  of  children  compulsory,  but  to-day  we 
forgive  you,  for  we  know  that  it  was  your  enthu- 
siasm in  behalf  of  the  promotion  of  medical  educa- 
tion, your  aim  at  making  Bishop's  the  leading 
school,  that  caused  you  to  take  such  a  step. 

By  the  way,  ladies  and  gentlemen,  should  any  one 
of  you — I  trust,  that  you  may  never  need  to — have 
something  wrong  with  his  or  her  eye,  you  need 
not  call  in  a  specialist  if  you  are  in  the  vicinity  of 
a  Bishop's  graduate^  for  every  man  graduating  from 


our  Alma  Mater  ought  to  be  capable  to  perform 
the  most  difficult  operations. 

Our  college  life  has  not  been  an  unhappy  one  ; 
although  we  had  to  study  hard,  yet  we  had 
occasionally  our  recreations,  and  such  recreations 
as  medicos  alone  know  how  to  take. 

I  need  not,  ladies  and  gentlemen,  describe  to 
you  the  different  stages  through  which  we  passed 
during  the  last  few  days, — I  refer  to  the  examina- 
tions. I  would  not  for  a  great  deal  have  to 
undergo  the  same  strain  as  I  did  during  the  last 
week.  To  the  professor  the  day  of  examinations 
seems  to  be  a  wedding-day  ;  see  him  coming  in,  all 
smiles  and  radiant  with  joy.  To  the  candidate,  such 
a  day  is  more  like  a  funeral  than  anything  else, 
see  him  and  tell  me  if  I  am  mistaken ;  his  face 
anxious,  expression  doubtful,  countenance  some- 
what cathetic,  his  eye  sunken  and  lifeless,  pulse 
rapid  and  wiry,  at  times  there  is  dysphagia  and 
aphonia,  especially  when  sitting  before  examination 
papers,  and  the  questions  do  not,  at  first  sight,  ap- 
pear to  be  practical  or  of  vital  importance.  In 
short,  ladies  and  gentlemen,  the  candidate  looks 
more  like  a  revivalist,  a  brother  to  Sam  Jones  and 
Sam  Small.  Indeed  !  those  have  been  lonely  and 
long  hours  ;  but  to-day  we  look  back  with  joy  and 
satisfaction  over  our  trials. 

All  is  well  that  ends  well :  we  are  through  now, 
and  we  wish  our  fellow-students,  whom  we  leave 
behind  us,  every  success  in  their  coming  years  ; 
may  they  prove  themselves  an  honor  lo  our  Alma 
Mater. 

We  tliank  our  professor.  Dr.  Proudfoot,  for  the 
sound  and  practical  advice  contained  in  his  vale- 
dictory on  behalf  of  the  Faculty  ;  it  will  be  our  aim 
to  abide  by  it. 

In  all  probability,  this  is  the  last  time  we  meet  to- 
gether ;  the  calls  of  interest,  the  appeals  of  ambi- 
tion, the  demand  of  our  families  will  cause  our 
paths  in  life  lo  be  widely  divergent. 

Some  of  us  may  sleep  beneath  the  sands  of 
Africa  and  some  beneath  the  ice  of  Alaska  some 
may  find  a  resting  place  in  the  bosom  of  the 
ocean,  whilst  some  we  trust  will  remain  in  this 
dear  old  city  of  Montreal;  but  wherever  we  may 
go,  let  us  cherish  the  recollections  of  our  Alma 
Mater,  and  let  us  enshrine  our  student's  association 
with  the  flowers  of  everlasting  friendship  and 
true  devotion. 

In  saying  fare\yell,  we  wish  our  Professors  every 
success,  and  we  hope  and  trust  that  they  may  be 
long   spared  to   communicate    their   sound   and 


124 


TUE   CANADA   MEDICAL   RECORD. 


practical  teaching.  Farewell  to  our  former  fellow 
students,  whom  we  leave  behind ;  we  expect  much 
from  you,"  and  we  trust  that  we  shall  not  be 
disappointed  in  our  expectations  of  distinguishing 
yourselves  in  your  coming  examinations. 

Ladies  and  Gentlemen,  once  more  thank  you 
for  your  attendance  this  afternoon,  and  to  one  and 
all,  in  behalf  of  the  class  of  '88,  I  bid  a  hearty 
farewell. 


sSoddij  J^mcecdiiiM. 


MEDICO-CHIRURGICAL  SOCIETY  OF 

MONTREAL. 
Stated  Meeting,  Dec.  Qth,  1887  (continued). 

Removal  of  Eight  Calculi. — Dr.  Roddick  exhib- 
ited eight  large  calculi  which  he  had  removed  from 
an  old  gentleman  last  summer  by  the  lateral  opera- 
tion. The  stones  weighed  2\  ozs.  At  the  time 
of  the  operation  the  patient  was  in  very  bad 
health  and  there  was  much  pus  in  the  urine.  He 
died  some  two  days  after  the  operation  of  uremia. 
Although  no  post-mortem  was  allowed,  there  is 
little  doubt  that  the  kidneys  were  very  seriously 
affected.  In  this  case  the  supra-pubic  operation 
was  contemplated,  but  the  lateral  was  preferred  on 
account  of  tlie  small  capacity  of  the  bladder,  which 
would  only  hold  2\  oz.  of  water. 


Stated  Meeting,  Decanhcr  23)t?,   18S7. 

James  Perrigo,  M.D.,  President,   in  the 
Chair. 

PATHOLOGICAL    SPECIiVlENS. 

Tuberculous  Knee-Joint. — Dr.  Bell  exhibited  a 
leg  recently  amputated  at  the  junction  of  the  middle 
and  upper  thirds,  for  tuberculosis  of  the  knee- 
joint.  A  longitudinal  section  was  made  to  show 
the  condition  of  the  joint.  Dr.  B.  gave  the  foL 
lowing  history : 

P.  F.,  aged  30,  a  pale,  emaciated  man,  was 
admitted  to  hospital  on  the  iQtli  of  December 
with  the  following  history :  He  began  to  suffer 
from  a  painful  and  swollen  knee  twelve  years  ago, 
which  is  vaguely  attributed  to  injury.  The  knee 
has  grown  steadily  worse  up  to  the  present,  inca- 
pacitating him  for  work  for  the  greater  part  of  the 
time.  For  about  four  years  he  has  been  con- 
o  his  bed  with  it.     Two   years  ago   he  was 


treated  by  a  quack,  who  blistered  the  leg  in  large 
patches  above  and  below  the  knee,  and  then  ap. 
plied  salt  pork  to  the  abraded  surfaces.  These  sores 
never  healed,  and  an  attack -of  erysipelas,  which 
occurred  a  few  months  ago,  caused  extensive  bur- 
rowing of  pus  both  in  the  thigh  and  calf  On 
admission,  the  patient's  general  condition  and  the 
condition  of  the  soft  parts  in  the  leg  and  lower 
third  of  the  thigh  were  very  unpromising  indeed. 
On  this  account  the  idea  of  excising  the  knee- 
joint  was  abandoned,  and  the  thigh  amputated  at 
the  junction  of  the  upper  and  middle  thirds  (it 
being  impossible  to  secure  sufficient  healthy  tissue 
for  flaps  at  a  lower  point).  The  progress  of  the 
patient  was  uninterrupted  after  amputation,  and 
he  was  discharged  at  the  end  of  three  weeks  with 
a  small  sinus  still  open  at  the  inner  angle  of  the 
flap.  The  knee-joint,  when  sawn  through  from 
above  downwards,  although  showing  extensive 
and  widely  distributed  disease,  was  yet  in  a  con- 
dition suitable  for  resection,  had  the  patient's  gen. 
eral  health  been  better  and  the  soft  parts  in  the 
leg  and  thigh  less  extensively  destroyed. 

Dr.  Roddick  thought  that  as  far  as  the  condi- 
tion of  the  joint  itself  was  concerned,  it  was  a  typi- 
tcal  case  for  excision,  but  the  condition  of  the  sof 
parts  necessitated  amputation. 

Dr.  Shepherd  saw  the  case  three  months 
before;  did  not  think  there  was  pus  in  the  joint 
at  that  time,  and  was  struck  at  the  time  of  the 
operation  with  the  amount  of  sujipuration  in  the 
soft  parts  about  the  joint.  He  thought  the  ampu- 
tation might  with  safety  have  been  made  a  little 
lower. 

Tubing  in  Diphtheria. — Dr.  Johnston  showed 
the  respiratory  organs  in  a  case  of  diphtheria 
which  had  proved  fatal  two  days  after  the  perfor- 
mance of  intubation,  the  tube  being  shown  in  situ. 
The  lungs  were  for  the  most  part  in  a  state  of  acute 
emphysema,  but  showed  a  few  small  patches  of 
collapse  with  commencing  pneumonia.  The  tube 
was  seen  in  sitri,  and  was  not  obstructed.  The 
membrane  had  extended  into  the  first  bronchi. 
A  slight  diphtheritic  exudation  was  seen  over  the 
tonsils.  The  tube  had  produced  no  necrosis  of 
the  parts  with  which  it  lay  in  contact. 

Dr.  Major  stated  that  the  patient,  a  girl  aged 
3  years,  had  been  temporarily  relieved  by  the  use 
of  the  tube,  but  had  died  two  days  later. 

Dr.  Geo.  Ross  had  observed  shortly  before 
death  that  physical  signs  of  severe  bronchitis  had 
existed. 


THE  CANADA  MEDICAL   RECORD. 


125 


Ur.  Majur,  In  answer  to  Dr.  Roddick,  said 
that  the  longest  time  he  had  left  a  tube  in  tlie 
larynx  \vas;ten  days ;  there  was  only  slight  ero- 
sion of  one  ventricular  band,  but  no  ulceration. 
Tubes  are  very  liable  to  be  coughed  up. 

Angiuma  of  the  Liver. — Dr.  Johnston  also 
exhibited  a  microscopic  section  from  a  cavernous 
angioma  he  had  found  in  an  amyloid  liver.  The 
walls  of  the  cavernous  spaces  were  not  affected  by 
the  amyloid  change.  The  case  was  of  interest  in 
connection  with  the  question  as  to  whether  the 
angioma  arose  in  connection  with  the  hepatic 
artery  or  the  portal  vein.  This  point  had  been 
left  obscure,  as  attempts  to  inject  angiomata  by 
these  vessels  had  led  to  contradictory  results.  As 
amyloid  affects  primarily  the  branches  of  the  hep- 
atic artery,  this,  the  angioma  being  practically 
unaffected,  would  in  this  case  be  solely  of  portal 
origin.  The  minute  spots  of  amyloid  change  in  it 
being  accounted  for  by  the  fact  that  the  hepatic 
artery  nourishes  all  the  structures  of  the  liver. 

Physiological  and  Pathological  Reversion. — Dr. 
T.W.^MiLLS  read  a  paper  on  this  subject. 

Dr.  Shepherd  referred  to  the  extension  of  the 
principles  of  evolution  to  all  branches  of  science. 
He  has  long  .been  a  supporter  of  evolution  from  a 
morphological  point  of  view,  and  he  believed  the 
physiological  aspect  as  developed  by  Dr.  Mills 
affords  quite  as  broad  a  field  for  investigation. 
Just  as  the;development  of  the  embryo  is  the  com- 
pressed history  of  the  development  of  the  indivi- 
dual, so  Dr.  Mills'  paper  shows  that  death  tells  us 
the  tale  of  development  backwards. 

Dr.  Stewart,  referring  to  Dr.  Mills'  remarks  on 
the  dissolution  of  the  circulation,  said  that  in  old 
age  a  man  dies  along  the  track  of  the  circulation 
Some  one  says  that_death  from  old  age  was  the 
evolution  of  dissolution. 

Laboratory  Noteson  Papoid  Digestion. — Dr.  R. 
RuTTAN  read  a  short 'paper  on  the  above  subject, 
which  will  be  found  in  the  February  number  of 
this  Journal. 

Dr.  Geo.  Ross  said  he  had  been  using  the  drug 
for  some  time]  in  the  hospital  with  satisfactory 
results  in  diphtheria.  One  of  the  marked  effects 
of  the  application  of  the  [solution  was  the  entire 
suppression  of  the'characteristic^fKtor  of  the  dis- 
ease. He  used  a"5  per  cent,  solution,  and  the 
atmosphere  of  the  ward  was  kept  quite  fresh  and 
sweet.  It  certainly  seems  to  dissolve  the  mem- 
brane. 

Dr.  Stewart  suggested  its  use  as  an  escharotic 
for  the  removal  of  tuberculous  infiltrations. 


Dr.  Godfrey  said  he  was  now  using  a  5  per 
cent,  solution  to  destroy  a  hard  scirrhus  cancer 
of  the  heart,  and  so  far  was  thoroughly  satisfied 
with  its  action. 

Abdominal  section  for  Sarcoma. — Dr.  W  . 
Gardner  exhibited  specimens  from  a  case  of  sar- 
coma of  the  uterus  and  ovaries  on  which  he  h  d 
operated.  Rapid  recurrence  took  place  with  death 
on  the  seventh  week.  Dr.  Gardner  gave  the  fol- 
lowing account  of  the  case  and  the  operation  : 

The  patient  was  sent  in  by  Dr.  T.  L.  Brown,  of 
Melbourne,  who  was  consulted  only  a  few  days 
previously  for  some  bladder  symptoms,  when  he 
recognized  the  rapidly  growing  pelvic  and  abdom- 
inal tumor.  She  was  a  fair-haired,  light  complex- 
'oned,  vivacious,  and  very  prococious  child,  always 
delicate.  Menstruation  had  not  appeared,  and  the 
only  evidence  of  approaching  puberty  was  scanty 
pubic  hair.  The  tumor  evidently  sprung  from  th 
pelvis  but  had  risen  to  the  abdomen,  was  nodular' 
and  scarcely  moveable.  Though  recognizing  its  pro- 
bably malignant  nature,  operation  was  decided  on. 
The  growth  was  a  friable  mass,  with  a  few  cysts 
adherent  to  omentum,  intestines,  posterior  surface 
of  bladder,  and  everything  else  in  the  pelvis. 
Neither  uterus  nor  ovaries  were  distinguishable. 
The  cavity  was  washed  out  and  a  drainage-tube 
inserted.  Recovery"  was  scarcely  clouded  by  any 
symptom  of  importance.  Appetite  was  regained 
to  a  considerable  extent,  but  it  was  not  long  before 
a  return  of  the  growth  was  perceptible,  and  it  went 
on  with  mushroom  like  rapidity  till  the  abdomen 
was  greatly  distended,  and  she  died  from  exhaus- 
tion. The  tumor  was  examined  by  Dr.  Johnston 
and  pronounced  by  him  to  be  sarcoma. 


Stated  Meeting,  January  Qth,  1888. 

T.  G.  Roddick,  M.  D.,  in  the  Chair. 

pathological  specimens. 

Dislocation  of  the  Sixth  Jervical  Vertebra. — Dr. 
Hutchison  exhibited  the  dislocaed  cervical  ver- 
tebra, and  gave  the  following  history  : — 

H.  C.,  aged  37  years,  a  brakeman  on  G.T.R., 
while  walking  on  top  of  a  freight  car,  which  was 
running  at  the  rate  of  three  miles  an  hour,  fell 
between  two  cars,  the  rear  one  throwing  him  clear 
off  the  rails ;  he  fell  on  his  shoulders.  The  acci- 
dent look  place  at  5  p.m.,  Oct.  29th,  18S7.  He 
was  removed  to  the  van,  and  brought  to  Montreal, 
— a  distance  of  forty  miles.  During  the  journey  he 
suffered  a  great  deal  of  pain  in  both   arms ;  did 


126 


THE   CANADA   MEDICAL   RECORD. 


not  lose  consciousness.  I  visited  him  at  8.30 
o'clock  the  same  evening,  and  found  him  conscious, 
paraplegic  with  partial  paralysis  of  arms.  The 
arms  were  thrown  at  an  angle  to  the  body,  caus- 
ing great  pain  on  any  attempt  being  made  to 
restore  them  to  sides.  There  was  preternatural 
mobility  and  crepitus  in  region  of  fifth  cervical  ver- 
tebra. The  vertebral  line  was  thrown  forward  above 
the  seat  of  injury  ;  pupils,  pulse,  temperature  and 
respiration  normal.  Assisted  by  Dr.  Kinloch,  ex- 
tension was  practiced  without  an  antesthetic,  which 
relieved  the  pain  in  arms,  and  left  patient  in  a 
comfortable  position. 

Oct.  30th,  10  a.m. — Patient  slept  several  hours 
during  night,  suffered  no  pain.  Noticed  slight 
contraction  of  pupils  and  slight  stertorous  breath- 
ing. Uiinc  drawn  off  with  catheter.  4  p.m. — 
Stertor  increasing;  temperature  normal ;  partially 
comatose.  7  p.m. — Death  ensued  twenty-six 
hours  after  accident ;  during  twenty-two  and  a  half 
hours  of  that  time  the  patient  was  perfectly  con- 
scious. From  the  faint  crepitus  obtained  the  case 
was  thought  to  be  one  of  fracture. 

Dr.  Roddick  referred  to  a  similar  case  of  cervi- 
cal dislocation  that  was  successfully  treated  by  ex- 
tension by  the  late  Dr.  G.  W.  Campbell.  Dr.  R. 
had  practiced  extension  in  several  cases,  but 
unsuccessfully. 

Anencephalic  Monster. — Dr.  GuRO  exhibited  an 
anencephalic  monster,  showing  a  membranous  sac 
filled  with  fluid  corresponding  to  the  cranium. 
This  fcetus  appeared  to  be  about  at  the  sixth 
month,  and  was  dead  at  birth.  The  mother,  a 
somewhat  delicate  patient,  had  suffered  a  severe 
fright  early  in  gestation. 

Dr.  Mills  said  it  illustrated  his  paper  read  at  the 
previous  meeting.  The  development  of  this 
fcetus,  so  far  as  the  brain  is  concerned,  seems  to 
have  been  arrested  in  a  stage  of  its  existence  cor- 
responding somewhat  to  that  of  the  lowest  verte- 
brates. 

Drs.  Wyatt  Johnston,  J.  C.  Cameron  and  Shep- 
herd were  appointed  to  examine  the  fcetus  and  to 
report  at  a  subsequent  meeting. 

A  case  0/ Navus. — Dr.  Roddick  exhibited  a 
foot  removed  by  Syne's  amputation.  The  patient, 
a  woman,  30  years  of  age,  had  a  na^vus  on  the 
dorsum  of  the  foot,  which  grew  very  slowly  until 
she  married,  some  ten  years  ago,  when  with  each 
pregnancy  it  increased  considerably  until  it  had 
assumed  enormous  dimensions.  The  tissues  of 
the    foot,    including    all    the  toes,  had    become 


hickened,  resembling  elephantiasis.  Especially 
since  the  birth  of  the  last  child,  three  months  agor 
the  increase  in  growth  was  very  marked.  Lately 
quite  an  extensive  slough,  amounting  almost  to 
gangrene,  had  formed  on  two  of  the  affected  toes. 
This  caused  troublesome  and  often  alarming 
hemorrhage.  Owing  to  the  thickened  elephantive 
condition  of  the  tissues  of  the  foot  amputation 
was  deemed  ^the  only  feasible  procedure.  The 
posterior  tibial  artery  and  nerve  were  found 
enlarged  to  three  or  four  times  their  normal  size. 
The  glands  in  the  groin  were  also  very  much 
enlarged  at  the  time  of  operation. 


Stated  Meeting,  January  20th,  1888, 
T.  G.  Roddick,  M.D.,  in  the  Chair- 
pathological  SPECIMENS. 

Dr.  G.  Armstrong  exhibited   the  brains   from 
two  cases  of  cerebral  disease. 

(i)  A  case  of  Apoplexy. — The  first  brain  shown 
was  removed  from  a  man  seven  hours  after  death, 
occurring  at  the  age  of  56  years,  from  apoplexy. 
The  patient  was  an  Englishman,  enjoyed  robust 
health,  but  since  coming  to  Canada  has  been 
stronger  than  he  was  at  home.  For  a  fortnight 
before  death  he  had  been  at  home,  complaining 
of  weakness,  anorexia,  a  little  frontal  headache, 
and  rheumatic  pains  about  arms,  legs  and  back. 
No  elevation  of  temperature  or  acceleration  of 
pulse  ;  tongue  coated ;  bowels  moved  by  eating  a 
little  fruit.  On  the  morning  of  the  day  of  his  death 
he  awoke,  feeling  particularly  bright  and  cheerful. 
Expressed  himself  as  feeling  stronger,  and  thought 
he  would  be  able  to  return  to  office  in  a  few  days. 
About  8  a.m.  he  went  to  the  store  and  suddenly 
called  for  help,  sank  on  to  the  floor  unconscious, 
and  in  one  hour  was  dead,  never  having  regained 
consciousness.  Dr.  Johnston  kindly  performed 
the  autopsy  for  me.  We  found,  on  removing 
skull-cap,  a  large  clot  in  right  frontal  region,  just 
beneath  the  arachnoid.  On  removing  the  brain  the 
ventricles  were  found  distended  with  blood,  death 
having  resulted  from  the  blood  passing  along  the 
iter  into  the  fourth  ventricle,  and  thus  producing 
pressure  sufficient  to  paralyse  the  centres  of  or- 
ganic life.  On  closer  examination  the  blood  was 
found  to  come  from  a  rupture  of  a  vessel  of  the 
right  corpus  striatum.  Dr.  Johnston  afterwards 
found  that  the  vessels  were  fattily  degenerated. 
Heart  and  kidneys  were  examined  and  found  nor- 
mnl. 


THE   CANADA  MEDICAL   RECORD. 


127 


(2)  Cerebral  Si/pJiilis. — Tlic  .second  brain  shown 
was  removed  from  a  man  wlio  died  at  tiic  age  of 
62.     Dr.  Armstrong  gave  the  following  account  of 
the  case.    The  patient  claims  to  have  enjoyed  good 
health  up  to  June,  1885.     At  this  time  while  walk- 
ing to  liis  oflice  one   morning,   he   fell  down   but 
siiys  he  retained  consciousness  all  the  time.  Some 
men  passing  hcljjcd  him  up,  and  he  went  on  to  the 
office,  but  only   remained  a  short  time  and   then 
walked  home  again.     I  saw  him  soon  afterwards, 
when    I    found  him    quite  rational.      There  was 
present  no  paralysis  of  motion  or  sensation.    He 
told  me  that  for  some  time  his  appetite  had  been 
poor,  and  he  did  not  enjoy  his  pipe    as  much   as 
usual.     P'or  the  past   two  years  he  had  suffered 
from  frequent  micturition,  and  had  an   enlarged 
prostate.     After  he  had  micturated  I  drew  off  10 
ounces  of  slightly  turbid  'urine  with   the  catheter. 
Urine  contained  a  considerable  quantity  of  pus ; 
reaction  acid.     No  headache  or  dimness  of  vision. 
On  the  14th  November,   1885,  when  dressing,  he 
fell   suddenly  to  the  floor,  but  did  not  lose  con- 
sciousness.    When  his  wife  picked  him  up   she 
thought  he  had  no  power  in  his  limbs  ;  but  when 
I  saw  him  a  few    hours  later  I  could  detect   no 
paralysis  of  motion  or  sensation,  but  he  was  par- 
ially  aphasic.     Hecould  answer  questions  correct- 
■y  and  could  speak  in  short  sentences,  but  stopped 
in  the  middle  of  a  long  sentence.     Although  pre- 
viously a  good  penman,   his   present   scroll  was 
illegible.     A  peculiar  subjective   symptom  at  this 
time  was  his  hearing  pleasant  music,  especially  in 
the  left  side  of  his  head.     He  rather  enjoyed  lis- 
tening to  it.     All  the  parts  were  carried  correctly 
along  together.     The   treatment   at  this  time  was 
Hg.  and  large  doses  of  Pot.  lod.     His  condition 
improved  somewhat,  but   aphasia  never   entirely 
disappeared.     About  six  week  ago  he  became  sud- 
denly hemiplegic  on   the  right  side,    death  finally 
resulting    from  exhaustion  and  septic   poisoning 
from  large  gangrenous   bedsores.     Dr.    Johnston 
kindly  performed  the  autopsy  for  me.     We  found 
a  large  gmnma  occupying  the  third  left  frontal  con- 
volution, and  a  patch  of  softening  extending  almost 
quite  across  the  left  internal  capsule,  due  probably, 
Dr.  Johnston  thinks,  to   an  embolus.     It  is  very 
satisfactory  to  find  such  well  marked  lesions,  which 
accounts  so  well  for  the  symptoms  from  which  the 
man  died. 

Discussion. — Dr.  Buller  thought  that  the  tumor 
must  have  produced  double  optic  neuritis.  Larger 
doses  of  potassium  iodide,   40  to  60  grains  three 


times  a  day,  might  have  produced  very  beneficial 
results  in  this  case.  Referring  to  the  subjective 
symptoms  of  the  patient,  Dr,  B.  said  these  were 
often  caused  by  perturbation  of  the  nerve  centres, 
and  were  the  usual  early  symptoms  of  insanity. 

Dr.  Treniioi.me  strongly  advocated  tiie  admin- 
istration of  large  doses  of  iodide  of  potas- 
sium in  cerebral  syphilis. 

Dr.  RonnicK  could  not  understand  how  the 
wife  could  have  been  inoculated  by  the  husband, 
as  he  had  tertiary  syphilis. 

Dr.  Armstrong,  in  reply,  stated  that  the  wife 
had  all  the  symptoms  of  secondary  syphilis  about 
the  time  of  the  husband's  attack.  In  answer  to 
a  question  from  Dr.  Stewart,  he  said  that  the 
patient  at  no  time  exhibited  facial  paralysis  or 
any  other  affection  of  the  motor  system. 

Membranous  Croup. — Dr.  Johnston  exhibited 
for  Dr.  R.  J.  B.  Howard  a  specimen  which  he 
thought  an  example  of  membranous  croup  as  dis- 
tinguished from  diphtheria.  The  case  was  a 
sporadic  one,  and  the  disease  primary  in  the 
larynx.  No  membrane  had  ever  been  seen  in 
the  fauces.  Intubation  had  been  performed  by 
Dr.  Major.  The  child  had  died  suddenly  two 
days  later.  At  the  autopsy  tjie  tube  was  found 
plugged  with  mucus.  The  larynx  and  traches 
showed  a  uniform  sheathing  of  membrane  which 
formed  a  cast  of  the  trachea,  but  was  nowhere  ad- 
herent. The  same  condition  was  seen  on  the 
posterior  surface  of  the  epiglottis.  The  only  spot 
where  the  membrane  was  adherent  was  just  at  the 
rima,  on  each  side,  over  a  small  area  a  quarter  of 
an  inch  square.  The  glands  were  not  enlarged. 
On  detaching  the  membrane  the  mucosa  looked 
healthy  ;  on  microscopic  examination  it  was  found 
to  show  signs  of  proliferation,  but  was  nowhere 
necrotic,  except  where  membrane  was  adherent. 
In  about  1 5  cases  of  diphtheria  he  had  dissected 
in  the  last  3J.-2  years,  this  was  the  only  one  which 
had  appeared  to  bear  out  Virchow's  distinction, 
that  in  croup  a  necrosis  of  the  mucosa  was  not  the 
initial  lesion. 

Discussion. — In  reply  to  Dr.  Stewart,  Dr. 
Johnston  said  the'cause  of  death  was  suffocation, 
from  the  child  having  coughed  up  the  tube.  The 
constitutional  symptoms  were  not  marked. 

Dr.  J.A.  MacDonald  believed  that  tracheotomy 
would  have  saved  the  patient's  life. 

Dr.  Shepherd  agreed  with  Dr.  MacDonald  that 
this  was  a  case  where  tracheotomy  was  especially 
indicated.     He    could    not  see,    clinically,   any 


128 


The   CANADA   MEDICAL    EECORD. 


great  difference  between  membranous  croup  and 
diphtheria.  He  did  not  think  diphtheria  was  an 
extremely  infectious  disease.  When  whole  famil- 
ies were  infected  they  were  usually  exposed  to  the 
same  influences,  such  as  unhealthy  surroundings, 
bad  drains,  etc.  He  did  not  believe  diphtheria 
was  a  modern  disease.  The  so-called  putrid  sore 
throat  of  former  days  was  probably  diphtheria. 

Dr.  Armstrong  thought  that  there  was  a  good 
clinical  difference  between  these  two  diseases. 
True  croup  is  not  infectious,  and  there  is  no  glan- 
dular enlargement  or  pharyngeal  trouble  accom- 
panying the  laryngeal  affection. 

Dr.  Trenholme  had  seen  many  cases  of  true 
diphtheria  where  the  membrane  was  confined  to 
the  laiynx. 

Di.  Roddick  said  he  was  convinced  that  croup 
was  one  thing  and  diphtheria  quite  another.  He 
remembered  his  first  case  of  diphtheria,  and  it 
was  widely  different  from  any  form  of  croup  that 
preceded  it.  Undoubtedly  the  two  diseases  may 
occur  together,  as  with  tonsillitis  and  diphtheria. 
The  line  of  distinction  between  the  latter  two 
diseases  was  much  harder  to  draw. 

Dr.  BuLLER  believed  the  diseases  were  distinct. 
There  is  certainly  a  great  difference  between 
croupous  and  diphtheritic  conjunctivitis.  The 
plastic  exudation  of  the  former  affection  is  accom- 
panied by  no  severe  constitutional  symptoms,  and 
the  inflammation  is  confined  to  the  surface.  The 
diphtheritic  is  well  defined  and  virulent ;  the  whole 
lid  becomes  tense  and  brauny;  the  disease  is 
destructive  and  deep-seated.  The  two  processes 
are  quite  distinct  in  the  conjunctiva,  and  it  is 
difficult  to  see  why  they  should  not  be  so  in  other 
membranes. 

Dr.  Blackader  s.aid  that  the  difference  between 
pharyngeal  and  laryngeal  diphtheria  was  due  to 
differences  in  the  nature  of  the  submucous  tissues  ; 
in  the  former  the  deeper  tissues  were  not  so  close- 
ly attached.  There  was  no  difference  in  the 
miscroscopic  appearance  of  croupous  and  diph- 
theritic membrane,  but  he  believed  it  was, clinically, 
always  safest  to  treat  cases  of  membranous  croup 
as  diphtheria. 

Trichorexis  Nodosa. — Dr.  Shepherd  presented 
specimens  of  hair  affected  with  the  above  dis- 
ease taken  from  the  moustache  and  eyebrows  of  a 
reddish-haired  man,  aged  35.  The  nodes  on  the 
hair  were  pigmented.  The  disease  was  first 
noticed  two  years  ago,  and  that  time  the  left  side 
of  the  moustache  only  was  affected.     He  found  he 


could  not  grow  hair  on  this  side  of  his  moustache 
beyond  a  certain  length,  so  he  shaved,  and  for  the 
next  four  months  the  disease  did  not  appear  ;  but 
as  the  hair  grew  larger,  it  reappeared  and  spread 
to  the  right  side  of  moustache  as  well. 
During  the  last  two  months  the  same  disease 
had  affected  his  eyebrows.  Many  of  the  hairs 
had  several  nodules  and  many  were  split  at  the 
ends.  The  patient  is  very  certain  the  affection 
is  not  due  to  pulling  at  his  moustache.  Dr.  Shep- 
herd remarked  that  this  was  a  very  rare  disease, 
and  was  characterised  by  having  nodular  swell- 
ings along  the  shaft  of  the  hair,  and  the  hair 
breaks  easily,  usually  through  one  of  the  nodules. 
When  broken  the  hair  has  a  brush-like  end. 
Trichorexis  nodosa  is  not  a  parastic  disease.  It 
commonly  affects  the  beard.  The  first  symptoms 
noticed  by  patient  are  nodosities  of  the  shaft  of 
the  hair  and  great  brittleness,  the  part  of  fracture 
being  at  one  of  the  nodules.  Each  hair  has  four 
or  five  of  these  nodes,  which  in  people  with  red- 
dish hair  are  pigmented.  Nothing  is  known  of  the 
cause.  Something  is  due  to  mechanical  causes. 
By  some  the  lesion  is  regarded  as  due  to  the  gra- 
dual drying  of  the  cortical  substance,  whilst  others 
look  upon  it  as  an  atrophy  of  the  medulla  occur- 
ring at  different  points,  especially  at  the  points 
where  the  nodes  are.  The  hair  roots  are  unchan- 
ged or  slightly  atrophied.  Treatment  is  of  no 
avail. 

Bitmcul  J'okS^p 

TYPHOID  FEVER. 
The  general  method  adopted  at  the  Jefferson 
Hospital  by  Dr.  Jas.  C.  Wilson,  in  the  treatment 
of  typhoid  or  enteric  fever,  is  to  give  calomel  (gr. 
viiss-x),  and  sodium  bicarbonate  (gr.  x)  at  a  single 
dose,  at  night,  to  be  repeated  once  or  twice,  if  the 
case  is  in  its  first  week  ;  if  in  the  second  week  it  is 
not  repeated,  and  after  the  tenth  day  of  the  disease 
it  is  only  administered  if  required  by  the  state 
f  the  bowels.  Diarrhoea,  however,  is  not  to  be 
onsidered  as  a  contraindication  to  the  mercurial. 
When  the  evacuations  are  excessive  suppositories 
of  opium  Caq.  extract  gr.  j)  are  used  at  night. 
Enemata  of  thin  gruel  may  be  occasionally  resorted 
to  for  the  relief  of  constipation.  Cold  sponging  of 
the  body  is  resorted  to  twice  in  the  twenty-four 
hours  as  a  routine  measure  ;  hyperpyrexia  requires 
more  frequent  applications.  Carbolic  acid  (gr.  j) 
and  tincture  of  iodine  (gtt.ij)  are  given  from  the 
beginning,  every  two  hours  during  the  day  ;  every 
three  hours  at  night.  Antipyrine  (gr.  x-xv)  is 
given  in  a  single  dose  when  the  temperature  is  over 
104°.  Alcohol  is  not  necessarily  a  part  of  the 
treatment. 


THE  CANADA  MEDICAL  UECORD. 


129 


NON-EPILEPTIC    CONVULSIONS. 

Tlie  i)alient  lias  been  subject  to  these  attacks 
for  fifteen  years.  'I'lie  eyes  do  not  move  in  har- 
mony, owing  to  paresis  of  one  of  the  ocnlar  mus- 
cles. Tiie  third,  fourth,  fifth  and  sixlli  nerves 
may  be  affected.  There  has  propably  been  a 
lesion  in  the  middle  fossa  of  the  skull,  pressing 
uijon  these  nerves.  The  lesion  is  most  likely  a 
coarse    one.      Tiie    seizures    are    .symptomatic. 

Treatment :  iodide  of  sodium,  one  scruple,  thrice 
daily. 

Jiartholow  says  lh:it  when  pilocarpine,  mercury, 
and  iodide  of  jiotassium  arc  given  together,  the 
action  of  the  remedies  taken  is  hastened,  in  gum- 
mata  of  the  brain,  and  that  he  has  obtained  the 
most  happy  results  therefrom. 

Prof.  Keyser  considers  this  a  most  excellent 
antiiihlogistic  in  iritis : 

R     Ilydrargyri  chloridi  corrosivi,  gr.  1-20 

Hxtracti  belladonna' gr.  1-10  M. 

In  [lill,  ten  miinite;  afler  each  meal. 

IJefore  his  clinic  a  few  weeks  ago.  Prof.  Good- 
man removed  atone  operation  both  breasts  of  a 
woman  ivlio  has  suffered  severely  lor  many  years 
from  interstitial  lobular  mastitis.  I  fealing  was  by 
first  intention,  and  the  relief  was  coniplele. 

In  typhoid  fever,  Prof.  Waugh  has  so  far  had 
good  success  wiih  sulphocarbolate  of  zinc.  A 
case  was  shown  at  his  clinic  which  had  come  for 
treatment  when  suffering  with  fetid  diarrhtea,  high 
fever  and  hemorrhage  from  the  bowels.  Sulpho- 
carbolate of  zinc  at  once  stopped  the  ht-morrhages, 
removed  the  fetor  from  the  stools,  and  reduced 
the  temperature  two  degrees. 

This  makes  the  eighth  case  in  which  Prof 
Waugh  has  tried  this  i)reparalion  with  similar  re- 
ulls. 

Prof.  Garrelson  is  fond  of  this  treatment  for  a 
sessile  nasal  polypus  diflicult  to  snare.  He 
firmly  constricts  the  polypus  by  means  of  an  ordin- 
ary pair  of  dressing  forceps,  and  allows  them  to 
hang  on  the  growth  till  it  sloughs  off. 

Try  the  following  prescrijiiion  to  abort  an 
attack  of  acute  bronchitis.  I'rof  IL  C.  Wood 
says  that  it  is  very  valuable  : 

R     Potassii  citratis |j 

Syrupi  ipecacuanha  f  3J 

Succus  lirnonis  f3J 

Aqure ?  iij 

M.  S. — Two  tcaspoonfuls  every  three  hours. 

For  myalgia  in  a  strong  man.  Prof  Waugh  gave 

R     Ammonii  chloridi gr.  xxx 

Extracti  belladonna; gr.  y, 

M.  S. — As  a  dose  three  times  a  day. 

In  the  case  of  gastralgia.  Dr.  Pepper  was  led  to 
suspect  a  malignant  complication,  because  of  the 
absence  of  free  hydrochloric  acid  in  the  stomach 
six  hours  after  meals,  although  the  ])rominent 
symptoms  of  cancer  of  the  stomach  were  absent. 

Marked  pulsation  at  the  supra- sternal  notch  and 


over  the  innominate,  inaortic  in  sufficiency,  should 
not  be  mistaken  for  aneurism.  I'he  be..t  is  not 
expansile,  as  in  aneurism.  {Osier) 

Dropsy  does  not  occur  in  mitral  insufficiency 
unless  tricuspid  insnfliciency  co-exists.       {(Mer). 

When  convulsions  first  occur  after  the  thirtieth 
year,  and  usually  epileptiform  in  character,  suspi- 
cion points  to  cerebral  tumor.  {OslerJ. 

Chills  and  fever,  iniermittent  high  temi>erature, 
and  pus  in  urine,  the    urine  being    acid,    |)oint  to 
pyelitis. 
'  '  (0.,ler\ 

Several  cases  of  catarrhal  jaundice  yielded 
rai)idly  to  the  rectal  injection  of  cold  water,  one 
or  two  quarts,  at  a  temperature  of  from  50  °  to 
60°  E.,  as  recommended  by  Krull. 


TAPE  WORM. 

FROM    PHILADELrHI.\    llOSPITAt,. 

The  most  successful  way  to  get  rid  of  him  is  by 
making  him  let  go  with  his  hooks.  You  must  give 
him  a  narcotic  remedy.  We  have  one  remedy 
that  is  the  best  for  the  armed  worm,  "taenia 
solium.  "  Pomegranate  I  do  not  believe  will  ever 
fail,  if  properly  a])plied.  First  clear  out  the  canal. 
A  purgative  will  not  do  this.  Give  remedies 
that  liquefy,  such  as  phosphate  of  soda,  for  a  few 
days,  then  an  active  purge.  The  sodium  phos- 
phate must  be  given  in  the  intervals  of  digestion, 
in  decided  doses.     Then'give  : 

Pomegranate,   bark oz.  iv  ; 

Aq.  font O  ij. 

Boil  down  to  Oj,  and  give  largely. 

(Bartholow) 


PERSISTENT    HEADACHE. 

This  man  is  employed  at  the   chemical  works. 

There  is  no  malady  which  gives  as  much  trouble 
as  headache.  Guarana  and  such  remedies  are  only 
good  for  a  time,  which  speedily  expires.  The 
fifth  nerve  is  affected  in  this  case.  The  remedies 
that  will  cure  this  are  few.  Treatment :  remedies 
that  modify  the  functions  of  nutrition  ;  change  of 
occupation,  habits,  life  ;  amount  and  quality  of  air 
in  the  sleeping-room,  etc.  The  most  valuable 
remedy  is  Donovan's  solution ;  the  biniodide  has 
more  power  than  any  other  to  destroy  germs  in 
the  alimentary  canal,  which  we  believe  to  cause 
intestinal  disturbance  in  this  case. 
R  Liq.  arsenii  et  hydrarg.  iod.  gtt.  iij,  ter  in  die. 

{Barlholoiv.) 


FOR    TONSILLITIS  AND   PHARYNGITIS. 

Prof.  Woodbury  says  that  glycerites  of  tannic 
and  of  gallic  acid  are  valuable  preparations  for  the 
physician  to  have  in  his  office,  to  serve  as  applica- 
tions by  brush  or  in  the  form  of  a  spray  to  sore 
throat,  inflamed  tonsils,  and  the  like,  and  should 
have  been  included  in  the  last  revision  of  the 
Pharmacopceia. 


130 


THE  CANADA  MEDICAL  RECORD. 


ERYSIPELAS    TREATED     WITH    JABOR- 
ANDI. 

A  poor  woman  was  brought  into  the  Medico- 
Chirurgic.il  Hospital,  with  an  enormous  peri-typh- 
liticabsccss,  which  had  been  neglected.  It  pointed 
in  the  groin  and  on  the  thigh.  The  whole  surround- 
ing region  was  erysipelatous,  and  the  disease  had 
also  api>eared  on  the  face.  Fluid  extract  of 
jaborandi  was  at  once  given  by  Prof.  Waugh  in 
doses  of  M  XX  every  four  hours;  and  even  before 
the  abscess  was  opened  the  erysipelas  was  under 
control.  Enormous  quantities  of  fretid  pus  were 
evacuated  from  the  abscess  which  had  burrowed 
down  into  the  glutei.  The  woman  is  being 
supported  with  peptonoids,  wine,  iron  and  quinine. 


SODIUM   CHLORIDE  AS  A  PROPHYLAC- 
TIC AGAINST  GERMS. 

Prof.  Woodbury  advises  a  plentiful  use  of 
common  salt  in  one's  food,  for  he  thinks  that  it 
acts  as  a  preventive  to  zymotic  diseases,  and  that 
when  such  diseases  do  come,  they  are  much  lighter 
in  persons  accustomed  to  using  salt. 

Have  a  thermometer  in  a  sick  room,  and  see 
that  the  temperature  is  kept  at  from  70  °  to  75  ° 
Fahrenheit.  Keep  perfumes  out  of  the  sick-room  ; 
they  soon  have  a  stale  odor  and  are  offensive  to 
the  patient;  keep  visitors  out,  also;  they  are 
still  more  so. —  Prof.  Atkinson. 


MORPHINE  HABIT. 

Dr.  Wilson  showed  a  case  of  morphine  habit 
at  the  Philadelphia  Hospital,  January  14,  1SS8,  in 
which  one  drachm  of  morphine  only  lasted  the 
patient  four  or  five  days.  The  drug  was  origin- 
ally prescribed  by  a  physician  for  the  relief  of  pain 
in  hip-joint  disease.  In  treating  these  cases  it  is 
indispensable  that  the  physician  himself  administer 
any  morphine  required,  as  few  nurses  can  resist  tlie 
pitiful  appeals  of  a  victim  of  this  habit  while  under 
treatment.  The  treatment  must  be  largely  moral 
in  such  cases. 


SHOULDER  DISLOCATION. 

After  several  vain  attempts  to  reduce  a  sub- 
glenoid luxation  by  rotation.  Dr.  Janney  succeeded 
by  making  traction  directly  away  from  the  shoulder. 
He  declared  that  when  the  head  of  the  humerus 
is  lodged  beneath  the  glenoid  process  of  the 
scalpula,  rotation  is  often  useless. 


LAPAROTOMY  FOR  GUNSHOT  WOUND. 

Dr.  T.  G.  Morton  performed  a  laparotomy  on 
a  man,  on  December  29,  1887.  The  case  was  one 
of  gunshot  wound.  The  bullet  was  found  and 
extracted.  F'our  days  after  the  operation  the 
patient  was  doing  well. 


J^'/iQ4M^  of  Science. 


THE  TRE.\TMENT  OF  EARLY  PHTHISIS. 

By  J.  MiLNER  FOTUERGII.L,   M.   D. , 

Physicirui  to  the  City  of  London  Ilosiiital  for  Diseases  of 
the  Chest. 

When  the  student  has  left  the  examination  table 
and  entered  upon  actual  practice,  he  sees  other 
phases  of  disease  than  those  most  fiimiliar  to  him 
at  the  hospital — except  in  the  out-j)atient  dejjart- 
ment.  The  extiaordinary  and  unusual  cases 
upstairs,  which  absorb  so  much  of  the  visiting 
physician's  time,  become  so  much  more  extraordi- 
nary and  unusual  that  they  reach  vanishing  point, 
while  colds,  catarrhs,  exanthemata,  indigestion, 
bronchitis,  and  phthisis  constantly  come  before 
him.  If  he  be  a  careful  observer  he  will  soon 
learn  to  detect  the  early  onset  of  phthisis  pulmon- 
alis,  and  this  will  at  once  put  the  case  on  a  line 
of  appropriate  treatment  in  order  to  prevent  the 
■  case  becoming  worse,  and,  if  I'ossible,  to  inaugu- 
rate improvement ;  and  the  earlier  this  is  done, 
the  better  the  prospect  of  success. 

Beyond  the  physical  exainination  of  the  chest, 
the  usual  phenomena  complained  of  are  languor, 
loss  of  appetite,  and,  with  that,  loss  of  flesh,  and 
night  sweats.  The  burning  of  the  palms  and  soles 
is  not  so  common  now  as  it  used  to  be.  As  to 
the  hectic  flush  on  the  clieeks — once  the  theme  of 
Ijoets  and  novelists — it  is  rarely  found,  at  least 
among  town-dwellers.  ''  The  red  flush  on  his 
cheek  told  that  tonsmnption  had  already  hoisted 
his  bloody  flag  of  '  iS'o  Surrender,''"  wrote  the 
author  of  "  Guy  Livingston."  Rather  now  it  is 
a  pallid  and  greasy  skin,  which  carries  with  it  a 
grave  prognosis.  There  is  a  loss  of  body  weight 
with  an  increase  of  lowly  connective  tis.fue  in  the 
limgs  (This  it  is  which  gives  the  physical  signs  of 
early  pluhisis.  Impaired  elasticity  altering  the 
character  of  the  breath  sounds  ;  increased  density 
affects  the  percussion  note,  and  causes  the  lung  to 
be  a  better  conductor  of  sound),  while  the  ni^ht 
sweats  drain  away  the  body  salts.  If  the  patient 
be  a  girl  there  may  be  menorrhagia ;  but  far 
away  more  fiequently  there  is  arnenorrhoja  more  or 
less  complete. 

How  does  such  ,1  case  stand  from  a  therapeutic 
point  of  view.?  There  is  (i)  increased  outgoings 
otherwise  increased  body  expenditure.  There  is 
(2  )  defective  body  income.  To  meet  these,  to 
decrease  the  one,  and  to  improve  the  other,  is 
what  is  our  plain  duty. 

Without  forgetting  that  each  case  of  phthisis 
has  its  own  individual  characteristics,  which  must 
be  allowed  for  in  each  case,  some  useful,  broad 
rules  may  be  laid  down.  To  my  mind  the  first 
matter  to  be  looked  to  is  the  "  outgoings."  No 
one  entertains  any  misgivings  about  arresting  a 
diarrhcea,  which  obviously  weakens  the  body-i)ow- 
ers.     If  there   be     vomiting,    the    necessity   for 


THE   CANADA   MEDICAL  RECORD. 


131 


quelling  it  is  patent  to  all.  Where  the  patient  is 
a  woman  it  is  well  to  lessen  the  catenienial  loss 
;in(l  so  consL-rve  the  jiowers.  But  in  early  phthi- 
sis nienorrliagia  is  rare.  Rather  tiie  system  cuts 
down,  or  ahogether  cuts  off  a  discharge  to  which 
it  is  unequal,  and  the  return  of  tiie  menses  is 
liailcd  by  all  as  a  trustworthy  indication  of  gath- 
ering power.  Hut  theie  is  a  discharge  very  com- 
mon in  early  phthisis  loo  little  reganled,  and  that 
is  leucorrluea.  This  drain  is  ajit  to  fasten  on  a 
weak  orgiuiismand  to  cling  to  it  tenaciously.  Yet 
it  is  readily  amenable  to  treatment— if  the  patient 
<an  be  got  to  do  as  told.  'I'herc  is,  however,  a 
deep-rooted  aversion  to  the  use  of  vaginal  injec- 
tions among  British  women — at  least  such  has 
been  my  personal  experience. 

One  other  outgoing  there  is  remaining  to  be  con- 
sidered,and  that  is  the  justly  dreaded  night  sweats. 
In  very  early  days  of  practice  our  means  of  check- 
ing night  sweats  were  very  inadequate  to  the  end 
sought.  My  memory  can  call  up  a  whole  series 
of  cases  well  known  to  me  where  the  patients 
dwindled  away  befoie  our  eyes;  because  our  tonics, 
codlivcr  oil  and  port  wine,  were  unequal  to  meei- 
ing  the  drain  of  the  night  sweats.  W'c  were  feeb'e 
because  we  walked  in  the  darkness  of  ignorance, 
before  the  dawn  of  efficient  anti-hydrolics.  When 
Professor  Sydney  Ringer  introduced  belladonna 
for  the  arrest  of  night  sweats,  to  my  mind,  he 
revolutionized  the  prospects  of  most  cases  of 
phthisis. 

But  it  must  be  given  in  an  efficient  dose.  I 
never  begin  with  less  than  one  seventy-fifth  1-75 
of  a  grain  of  atropine.  If  a  small  dose  be  given 
anil  then  the  remedy  be  abandoned  because  this 
is  insufficient,  it  is  scarcely  "  homicide  by  misad- 
venture" to  my  way  of  thinking.  It  should  be 
pushed  to  one  twenty-fifth  1-25  every  night,  /.  e., 
in  practice,  not  at  the  examination  table.  As 
soon  as  the  drain  of  blood  salts  is  checked  the  ap- 
petite returns,  usually  without  resort  to  bitter 
tonics. 

So  much  for  the  first  line  of  attack. 

The  second  line  is  to  increase  the  body-income. 

At  one  well-known  hospital  quinine  aud  cod- 
liver  oil  constitute  the  treatment  of  phthisis  pul- 
monalis,  and  a  'very  good  line,  too;  but  scarcely 
quite  elastic  enough.  But  the  principle  is  there, 
viz.,  to  give  tonic  to  the  system,  and  to  supply  fat 
for  the  building  up  of  healthy  tissue.  Ir  is  cer- 
tainly good  practice  to  give  a  bitter  tonic,  as 
strychnia,  foriustance,  with  a  mineral  acid,  as  phos- 
phoric acid  ;  with  a  little  sulphate  of  magnesia. 
if  constipation  be  present,  as  is  very  often  the  case. 
If  the  tongue  carry  a  brown  hue,  indicative  of  he- 
patic disturbance,  then  sulphate  of  soda  must  be 
substitued  for  the  Epsom  salts,  maJgre  its  nauseous 
taste. 

The  dietary  should  consist  of  fish,  fat,  and  milk 
puddings,  with  a  little  meat.  When  the  stomach 
is  upset,  then  a  little  bismuth  and  soda  may  be 
given  instead  of  the  tonic,  and  the  food  should 
consist    of  milk  well  boiled   with   some  cf    the 


many  prepared  foods  on   the   market ;   and  beef- 
tea,  with  the  same,  or  broken  biscuit. 

When  the  gastric  disturbance  is  allayed,  then  it 
is  well  to  go  back  to  the  tonic.  Blisters  are  of 
questionable  advantage;  and  it  is  difficult  to  point 
out  the  indications  for  their  use.  Cod-liver  oil 
may  be  given  when  the  tongue  is  clean  and  the 
appetite  vigorous.  It  should  always  be  exhibited 
after  food.  The  same  may  be  said  of  chalybeats. 
These  measures  should  be  accomi)anied  by  fresh 
air — the  purer  the  better.  Bright  simlight,  cheer- 
ful surroundings,  pleasant  companions  are  matters 
of  no  little  moment.  As  to  a  sojourn  in  a  high- 
lying  Swiss  valley,  it  is  in  fashion  at  the  presnnt 
time,  though  as  one  of  the  very  best  physicians  in 
Great  Britain  remarked  : — "  The  cases  which  will 
get  well  at  Davos  are  those  which  will  get  well 
elsewhere'nnder  intelligent  management."  There 
is  no  altitude  too  lofty  for  the  tubercle  bacillus  to 
climb,  if  there  exist  a  bit  of  tuberculous  limg  to 
afford  it  a  congenial  home.  Certainly,  a  low-lying, 
damp  locality,  on  a  clay  soil,  must  be  abandoned 
for  gravel  or  a  chalk  down;  else  the  case  will  pro- 
bably take  the  wrong  direction. 

English  home  comforts  and  food  customs  can 
be  set  against  so  many  hours  of  sunshine  in  a 
mountain  valley.  That,  I  believe,  is  the  coming 
creed.  Such,  then,  is  the  second  line  of  attack 
upon  pulmonary  phthisis. 

Now,  for  two  minor  or  auxilliary  matters.  One 
is  the  use  of  inhalations.  Plain  steam  is  good  in 
irritative  cough  with  dry  air-tubes.  Iodine,  car- 
bolic acid,  eucalyptus,  or  Friar's  balsam,  or  ordin- 
ary terebene  are  often  excellent  medications,  and 
allay  cough.  The  other  is  a  resort  to  a  cough 
linctus.  On  this  matter  opinions  may  differ. 
Some  use  paregoric  to  allay  ceaseless  cough,  and 
do  a  great  deal  of  harm  very  often  therewith, 
though  paregoric  is  the  least  objectionable  of 
"cough  medicines."  The  reckless  resort  to  some- 
thing "  to  allay  the  cough"  has,  in  my  experience, 
been  too  frequently  followed  by  disaster  to  recom- 
mend itself  to  a  thoughtful  practitioner.  Some- 
thing to  allay  cough  and  jireserve  sleep  at.  nights 
certainly  does  more  good  than  harm;  but  "  cough 
stuff"  in  the  day  is  my  abhorrence.  It  may  be 
no  more  than  prejudice,  perhaps. 

Such,  then,  are  the  main  lines  on  which  a  case  of 
consumption  in  its  early  stages  has  to  be  carried 
on;  and  on  the  whole  it  will  be  found  to  be  not  un- 
satisfactory.— From  Hospital  Gazette. 


PULMONARY  CONSUMPTION  AS  TRE.\T- 

ED  IN  THE  PHILADELPHIA 

POLYCLINIC. 

By  Thomas  J.  Mays,  M.D., 

Professor  of  diseases  of  the  Chest  in  the  Philmlelphi.a 
PolycUnic. 

If  it  is  once  properly  understood  that,  in  the 
vast  majority  of  cases,  pulmonary  consumption  is 
a  local  disease,  the  nature  of  which  is  a  low  catarr- 
hal inflammation  of  the  alveolar  spaces,  resulting 
from  a  want  of  physiological  activity  in  the  affect- 


132 


THE   CANADA  MEDICAL  EECOKD, 


ed  part,  the  treatment  of  this  disease  will  become 
comparatively  simplified.  Strange  to  say,  how- 
ever, everything  which  is  known  to  be  ca])able  of 
producing  morbid  phenomena  in  the  human  body 
has,  one  time  or  other,  been  held  accountable  for 
the  causation  of  pulmonary  phthisis ;  and  it  is 
needless  to  tell  you  that  its  treatment  varied 
accordingly.  Let  us  premise  our  remarks,  there- 
fore, by  saying  that  it  is  a  disease  with  an  intense 
partiality  for  the  apex  of  either  lung;  and  the 
question  which  most  naturally  suggests  itself  is, 
why  the  apex  is  so  susceptible  to,  and  why  the 
middle  and  lower  portions  of  the  lung  surfaces  are 
so  free  from  it.?  Is  this  the  result  of  chance, 
or  is  it  a  law  with  antecedents  as  plain  as  the 
phenomenon  is  regular  ?  A  correct  solution  of  tliis 
imi)ortant  question  will  go  a  great  way  towards 
defining  the  true  origin  of  this  disease.  While 
not  at  all  wishing  to  be  understood  as  offering  an 
all-sufficient  exjilanation  of  this  difficuUy,  we  are 
quite  justified  in  holding  that  one  of  the  most 
potent  and  direct  causes  for  such  a  state  of  tilings 
lies  in  the  manner  in  which  the  bronchial  tubes 
enter  and  are  arranged  throughout  the  lungs. 
These  structures  conduct  the  air  principally  in  a 
downward  direction  towards  the  base  of  the  lungs 
— hence  the  lowest  parts  of  the  lungs  expand  first, 
then  the  middle,  and,  finally,  towards  the  very  end 
of  inspiration,  the  apices  exjiand,  if  at  all.  It  is 
our  firm  belief,  deduced  from  many  observations, 
that  in  most  persons  who — like  clerks,  telegraph- 
operators,  tailors,  shoemakers,  etc. — lead  a  seden- 
tary life,  and  who  maintain  a  stoojied  position  of 
their  chests  and  shoulders,  the  ajiices  ne\er 
l)ecome  fully  inflated.  Another  reason  why  the 
lower  parts  of  our  liuigs  are  inllated  more  than  the 
apices  is  because  we  possess  nearly  one-fourth 
mote  lung  surface  than  necessary  to  carry  on  the 
jiroccss  of  respiration  ;  and,  therefore,  that  part  of 
the  respiratory  surface  which  is  filled  with  the 
greatest  facility,  viz.,  the  base,  performs  the  work 
of  the  whole.  Therefore  both  the  structure  and 
the  function  of  our  lungs  conspire  to  diminish  the 
activity  of  the  apices  and  enhance  that  of  the 
bases.  We  have  already  stated,  that  the  chief 
factor  in  the  production  of  jnilmonary  consmnp- 
tion  is  a  physiological  inactivity  of  the  lung  ajiex  ; 
and  if  this  proposition  is  true,  then  it  should  fol- 
low that  those  persons  in  whom  the  apices  are 
least  developed  should  be  most  liable  to  this 
disease,  and  vice  versa. 

Not  long  ago  we  made  an  investigation  into  the 
nature  of  this  problem,  (i)  and  found  that  the 
abdominal  was  the  original  type  of  respiration 
among  both  se.xes  ;  that  the  costal  type  of  the 
female  developed  through  the  influence  of  abdom- 
inal constriction  produced  by  clothing;  that 
when  the  female  falls  a  victim  to  consumpt'ion,  her 
costal  movements  are  markedly  diminished  ;  and 
that  the  female  is  less  liable  to  consuniptiun  than 

(I)  An  experiment.il  inquiry  into  the  clicst  moveiiients  of 
the  \ai\3.nkma.\e.—T/iera}eittic  GazelU,  May,  iSb;. 


( 


the  male  civilized  life.  It  can  be  futhermore  said 
that,  according  to  Waldenburg,  the  vital  lung 
ca])acity  in  persons  who  lead  a  sedentary  life — 
such  as  professional  men,  students,  clerks,  etc. — 
is  smaller  than  those  who  follow  an  active  calling 
— like  sailors,  recruits,  etc. — and  it  is  a  well-known 
fact  that  the  latter  class  is  much  less  susceptible  to 
this  disease  than  the  former.  And,  moreover,  our 
American  Indians,  who  are  not  confined  on  reser- 
vations, and  who  are  free  to  obey  their  roaming 
instincts,  are  almost  entirely  exemjit  from  pulmon- 
ary consumption,  presumably  because  of  the 
greater  lung  capacity  which  their  active  life  entails 
on  them. 

All  these  facts  tend  to  confirm  the  correctness 
of  our  fundamental  proposition,  at  least  this  far, 
that  increased  lung  capacity  decreases  the  lialjihty 
of  consum|)tion.  We  think,  however,  when  this 
fact  is  coupled  with  the  other  fact,  that  the  civiliz- 
ed female  possesses  a  much  smaller  lung  ca|iacity 
than  the  male,  and  is  still  less  liable  to  the  disease 
than  the  male,  it  is  quite  obvious  that  it  is  not  a 
large  chest  capacity,  but  a  well  developed  apex 
ca|)acity  which  insures  immunity  from  the  disease. 
Barring  her  greater  apex  capacity,  there  is  no  rea- 
son, so  far  as  we  are  able  to  discern,  why  the 
female  should  be  more  exem])t.  from  consuinption 
than  the  male.  Indeed,  everything,  both  in  her- 
self and  in  her  surroundings,  tends  to  increase  her 
liability  in  this  direction.  She  is  the  weaker  of 
the  two  ;  she  undergoes  the  enervating  processes 
ofgestatif)!)  and  of  lactation  ;  she  leads  a  seden- 
tary and  inactive  life  ;  she  is  oc.cupieil  within  doois 
during  the  greatest  part  of  her  lifetime,  and  is 
therefore  constantly  exposed  to  causes  which  are 
known  to  proiluce  the  disease,  and  most  of  which 
make  the  male  notoriously  liable  if  he  is  ex])osed 
to  them. 

In  the  next  place  it  is  important  to  trace  the 
liathological  relation  between  apex  inactivity  and 
pulmonary  consumption  ;  or,  in  other  words,  we 
must  ascertain  liow  such  a  want  in  development 
]irepares  the  apex  for  the  onset  of  this  disease. 
You  are  all  aware  that  if  any  organ,  like  a  muscle, 
for  exam])le,  does  not  receive  adequate  physical 
exercise,  it  diminishes  in  size  ;  its  muscular  ele- 
ments and  connective  tissue  framework  shrink  in 
consequence.  Precisely  the  same  thing  may  hap- 
pen when  any  part  of  a  lung  is  deprived  of  its 
needed  exercise — that  is,  when  it  is  not  expanded 
as  lully  as  it  ought  to  be  dining  the  act  of  inspira- 
tit)n — the  air  cells  begin  to  shrink  and  collapse. 
The  shrinkage  is  due  to  a  contraction  of  the  con- 
nective tissue  around  the  air-cells  and  the  small 
bronchial  tubes,  and  when  sufficiently  pronounced 
it  constricts  the  blood  vessels  and  interferes  with 
the  free  circulation  of  the  blood  in  that  part  of 
the  lung,  and  congestion  and  a  low  state  of 
catarrhal  inflammation  follow  as  a  consequence. 
This  whole  condition  is  analogous  to  that  which 
occurs  in  the  acquired  form  of  atelectasy,  and  we 
would  especially  commend  to  you  the  rem  irks  of 
Prof.  Rindlleisch  on  the  subject  Atelectasia,  in  his 


THE   CANADA   MEDICAL    RECORD. 


133 


well  known  work  on  rathologiral  Histology.  In 
tracing  tliis  slate  of  things  faitiicr,  we  fnid  that 
the  epithelial  elonienls  inulliply  and  accunnilate 
in  the  alveoli,  ^m  1  pidduce  what  is  known  as  inlil- 
tration.  In  this  way  one  alveolus  fills  up  after 
another,  until  a  whole  group,  or  a  cluster  of  them, 
i^  involved.  Such  an  accumulation  of  catarrhal 
luoilucls  exerts  a  decided  pressure  on  the  sur- 
rounding ])ulmonary  and  bronchial  capillaries, 
am'  the  l)l(iod-sup|)ly  and  nourishment  are  gradu- 
ally diminished  and  finally  cut  off  from  these 
infiltrated  areas,  which,  in  due  course  of  time, 
become  more  or  less  isolated  and  circumscribed 
masses,  which  are  ])rone  to  imdergo  a  slow  pro- 
cess of  cheesy  degeneration,  if  the  morbid  process 
continues. 

Pathologically  then  we  have  to  deal  here  with 
a  local  infiltration  of,  or  an  accumulation  of 
catarrhal  e|iithelium  in  the  air  cells,  brought  on  by 
jjhysiological  inactivity  of  the  affected  area,  which 
area  is,  in  the  great  majority  of  cases,  confined  to 
either  apex.  Now,  what  is  to  be  done  in  a  thera 
peutic  way  ?  Clearly  there  are  here  two  very 
imjiortant  indications.  The  first  is  to  combat  the 
local  infiltraiion,  and  the  second  is  to  annihilate 
its  cause.  This  is  the  method  which  has  been 
pursued  for  some  time  in  the  hospital  of  this  insti- 
tution. 

In  regard  to  the  first  indication,  we  would  say 
that  we  have  here  an  intiammatory  deposit  differ- 
ing, in  principle,  in  no  wise  from  a  similar  deposit 
in  any  other  jiart  of  the  body,  and  the  dictates  of 
common  sense  point  out  that  that  which  is  useful 
in  the  one  condition  is  also  useful  in  the  other. 
We  all  know  the  inestimable  value  of  counter  irri- 
tation, and  of  passive  motion  in  producing  resorp- 
tion of  chronic  inflammatory  deposits  in  joints, 
muscular  tissues,  etc.,  as  well  as  in  the  external 
surfaces  :  and  in  consonance  with  this  view  we 
ap])ly  hot  flax-seed  meal  poultices,  every  day  from 
morning  until  night,  for  a  period  of  three  or  more 
weeks.  In  connection  with  the  poultice  we  apply 
friction,  iodine,  etc.  We  are  certain,  from  quite 
an  extended  experience,  that  these  measures  pro- 
duce a  powerful  impression  on  the  infiltration  in 
question,  and  that  they  facilitate  resorjjtion  more 
maikedly  than  any  other  means  at  our  command. 

In  addition  to  the  poultices,  we  use  local  or 
general  massage,  once  or  twice  a  day,  as  well  as 
electricity.  In  these  cases  of  constitutional  leth- 
argy these  adjuvants  have  the  happy  effect  of  aroas 
ing  the  local  and  general  cells  activity,  and  are 
usually  followed  by  an  increased  appetite.  In 
connection  with  all  these  external  applications — 
poultices,  massage  and  electricity — we  advise  our 
patients  to  take  plenty  of  fluid  food,  such  as  milk, 
etc.  This  should  not  be  given  to  the  extent  of 
satiation,  but  at  regular  intervals — say  half  a  glass 
or  a  teacupful  every  hour. 

So  much,  then,  for  the  principal  means  which  we 
believe  have  the  power  of  dispersing  the  infiltrated 
catarrhal  products  of  the  lung ;  and  what  can  be 
done  in  the  direciiu:i  of  counteracting  the  source 


of  the  disease?  From  what  has  already  been  said, 
it  must  l>e  quite  evident  to  you  that  any  measure 
which  im|)roves  the  air  capacity  of  the  apices  will 
accomplish  the  end  in  view.  Among  the  most 
important  measures  w^hich  fulfil  this  indication 
directly  are  voluntary  and  fi)rced  breathing.  'I'lie 
former  should  be  jjracticed  l)y  taking  deep  and 
long  inspirations  at  intervals  of  two  hours  or 
oftener  throughout  the  whole  day.  The  inspired 
air  should  be  retained  as  long  as  it  con- 
veniently can  be,  in  order  to  give  the  fullest  possi- 
ble expansion  to  the  whole  lung  surface.  The 
latter  mode  of  breathing  consists  in  inhaling  com- 
pressed and  exhaling  into  ratified  air,  or  Ihe 
reverse.  This  method  is  the  most  im|)ortant  lung 
expander  of  all.  It  should  be  begun  gradually — 
say  twice  a  day  for  a  week  or  two,  then  three 
times  for  one  week  longer,  then  fiiur  times,  and 
finally  allow  the  [latient  to  sjjend  most  f>f  his  time 
in  the  use  of  this  apparatus,  'i'he  great  difficulty 
here  is  the  limited  time  which  the  conipressed  air 
is  generally  employed.  We  are  convinced  that 
the  best  results  follow  when  its  use  is  protracted. 

Physical  exercise  is  an  important  indirect 
method  by  which  the  lungs  are  expanded.  Under 
these  conditions  more  oxygen  is  consumed  by  the 
muscles  of  the  body  than  during  rest ;  hence  more 
blood  flows  through  the  lungs  in  a  given  time,  and 
a  larger  lung  surface  is  thrown  into  activity.  Those 
])arts  of  our  lungs  which  are  but  rarely  or  never 
called  into  use  now  are  thrown  into  a  state  of 
healthy  expansion,  and  it  is  in  this  way  that  our 
whole  respiratory  apparatus  is  made  to  approacli 
that  condition  which  gives  the  savage,  and  those 
who  pursue  an  active  life,  that  freedom  from  con- 
sumption which  we  know  is  so  common  among 
them. 

Ill  carrying  out  this  method  of  treatment,  the 
following  points  shoHld  be  borne  in  mind:fiist, 
no  exercise  should  carried  to  the  extent  of  decided 
fatigue;  second,  whenever  possible,  the  body  and 
head  should  be  erect,  the  shoulders  thrown  back, 
and  the  lungs  thorouglily  filled  with  each  breath  ; 
and,  third,  sufiicient  food  must  be  taken  during 
the  intervals.  Among  the  most  imijortant  mea- 
sures to  increase  the  lung  capacity  is  that  of  pul- 
monary gymnastics,  which  should  be  carried  out 
in  accordance  with  the  following  directions  :  The 
arms,  being  used  as  levers,  are  brought  as  far 
backwards  as  possible,  and  on  a  level  with  the 
shoulders,  during  each  inspiration,  and  brought 
together  in  front  on  the  same  level  during  each 
expiration.  Another  way  is  to  bring  the  hands 
together  above  the  head  while  inspiring,  and 
gradually  bring  them  down  alongside  the  chest 
while  expiring.  When  a  deep  ins])iration  is  taken 
in  accordance  with  either  plan  and  held  until  the 
arms  have  gradually  moved  forwards  or  down- 
wards, and  even  longer,  the  ])rocess  of  chest 
expansion  is  materially  enhanced.  All  these 
movements  may  be  facilitated  by  using  dumb  bells 
or  chest-weights,  etc. 

This,  in  connection  with   stimulant  medicines 


134 


THE   CANADA   MEDICAL   RECORD, 


and  nutritious  food,  has  been  the  general  line  of 
treatment  pursued,  both  at  the  hospital  here  and 
in  our  private  practice,  for  some  time;  and  we 
commend  it  to  your  consideration,  in  the  full 
behef  that  you  will  not  be  disappointed  in  its 
results. —i'/ii7.  Mol.  Smy.  R( porta-. 


THE  MANAGEMENT  OF  THE  ANTERIOR 
LIP  OF  'I'HE  UTERUS. 

By  Dan.  Miixikin,    M.D.,    Hamilton,  O. 

Cin.  Lancet- Clinic. —  1. 1  venture  to  remind  you, 
ill  the  first  place,  that  in  many  obstetric  cases  we 
find  the  maternal  parts  prepared  for  delivery  and 
the  uterine  action  tpiite  vigoious  or  quite  intense, 
but  in  such  cases  can  barely  reach  the  os  uteri, 
even  by  tlie  rudest  examination,  with  two  fingers 
thrust  far  back  into  the  concavity  of  the  sacrum. 

In  such  cases,  if  it  be  found  possible  to  drag  the 
OS  forward  for  a  more  ])erfect  study  of  the  fonta 
nelles  and  sutures  of  the  child's  head,  it  will  often 
be  found  that  the  labor  suddenly  takes  on  a  moie 
active  character,  pos.'-il'.ly  with  pains  quickly  be- 
coming expulsive,  and  with  sudden  dilatation  of 
the  OS  and  softening  and  thinning  of  its  margins. 

When  such  a  sequence  is  observed,  the  operator 
is  apt  to  believe,  as  I  do  verily  believe,  that  he 
has  enabled  the  uterine  forces  to  accomplish  their 
work  more  efficiently  and,  though  the  hand  of  art 
has  been  busy,  more  naturally.  The  anterior  lip 
then  appears  an  impediment  to  labor.  It  is,  in 
such  cases,  a  sack  drawn  over  the  child's  head, 
for  you  will  allow  me  to  assume  for  the  present 
that  there  are  none  but  head  cases.  This  sac  has 
a  hole  in  it,  and  he  appears  the  wisest  obstetrican 
who  pulls  that  hole  forward  and  ui)ward,  with 
reasonable  force,  until  he  places  it  in  relation  to 
the  prominent  part  of  the  child's  head. 

2.  The  obstetrician  even  of  small  experience 
will  bear  me  out  in  an  assertion  that  the  anterior 
tip  of  the  uterus  is  commonly  the  most  resistant 
to  those  mechanical  and  physiological  influences, 
which  induce  the  softening  processes  which  should 
precede  the  extrusion  of  the  head  from  the  uterus. 
1  have  no  theory  to  olTer  in  explanation  of  this  fact, 
I  only  submit  that  it  is  a  fact. 

When  this  is  the  case,  the  rest  of  the  parturient 
canal  being  ready  for  the  rapid  advance  of  the 
child,  I  think  it  is  fair  to  say  again  that  the  anterior 
lip  is  an  obstacle  to  parturition.  M'hat  is  then  the 
remedy?     How  remove  this  obstacle? 

I  am  not  able  to  think  of  any  mode  of  removing 
the  obstacle,  save  by  an  imitation  and  acceleration 
of  the  physiological  mode  of  softening  the  op- 
posing structure;  and  there  is  no  convenient 
method  of  accomplishing  this  result  save  by  the 
same  manoeuvre  of  jiulling  the  os  forward,  hold- 
ing it  over  the  most  forward  and  prominent  part 
of  the  child's  head,  and  there  retaining  it  with  the 
deliberate  intent  to  expose  its  margins  fully  and 
early  to  the  tension  of  the  advancing  hand. 

3.  A  third  condition  demands,  it  seems  to  me, 
a  similar  procedure.  We  often  find  on  a  first  ex- 
amination, the  head  well  down  in  the  pelvis,  and 


the  posterior  margins  of  the  os  wholly  inaccessible 
to  the  touch,  and  yet  the  anterior  lip  is  in  such 
condition  that  it  forms  a  thick  cord  just  in  advance 
of  that  part  of  the  head  which  is  ready  to  glide 
under  the  pubic  arch.  Here  is  a  decided  impedi- 
ment to  labor.  Here  is  an  cedema  which  has  no 
more  tendency  to  mitigate  itself  than  has  the 
(edema  of  a  strangulated  finger  or  any  other  pinch- 
ed and  bruised  organ.  Whnt  are  we  to  do  about 
it? 

We  liave  no  such  question  to  ask  of  the  posterior 
lip  of  the  uterus  because  the  promontory  of  the 
sacrum  is  not  adapted  to  produce  or  to  maintain 
any  such  condition.  There  is  ample  room  back 
yonder,  and  the  posterior  lip  seems  to  be  naturally 
more  readily  softened  and,  during  labor  at  least, 
much  shorter. 

If  the  vulva  is  capacious,  I  place  the  tips  of  two 
or  even  three  fingers  against  the  cedematous  cord 
of  which  1  speak,  with  a  not  irrational  expectation 
that  by  pressing  firmly  upward  behind  the  jiubis 
I  may  be  able  to  drive  out  the  cedema  and  place 
the  anterior  lip  where  it  will  no  longer  be  iiiiiched, 
but  merely  be  attenuated  and  stretched  in  the 
physiological  manner  and  by  the  phy.:.iological 
means.  If  the  vulva  is  not  capacious  enough  lor 
this,  I  place  the  forefinger  in  the  vagina,  bend  it, 
lay  the  knuckle  against  the  cord-like  anterior  lip, 
and  make  the  best  pressure  I  can  in  that  manner. 

It  may  not  be  very  courteous  to  attempt  to 
anticipate  an  objection  which  will  surely  be  made 
to  this  [nocednrc — an  objection  to  the  effect  that 
the  manipulation  is  one  which  will  bruise  the 
anterior  lip.  The  objection  is  good,  but  short- 
sighted. Past  question,  the  pressure  on  the  cede- 
matus  structure  tends  to  bruise  it ;  but  it  is  already 
cruelly  bruised,  and  it  is  eminently  desirable  to 
put  it  out  of  the  way  of  further  bruising.  More- 
over, its  nutrition  is  profoundly  altered  by  the 
pressure  and  the  cedema,  and,  in  such  a  case, 
lime  is  an  important  element,  Better  the  severe 
and  brief  than  the  gentler  and  prolonged  bruising. 

For  three  clear  and  readily  ai)[)reciated  indica- 
tions, then  I  recommend  that  the  margins  of  the 
OS  be  put  upon  the  stretch  by  the  fingers  pushing 
or  pulling,  as  the  case  may  require  : 

First,  when  the  os  points  strongly  backwards 
in  a  direction  in  which  the  child's  head  cannot 
advance  ;  secondly,  when  there  is  a  preternatural 
rigidity  of  the  anterior  lip  out  of  proportion  to  the 
rigidity  of  the  posterior  lip  and  the  general  progress 
of  labor ;  and,  third,  when  there  is  an  cedematous 
condition  of  the  anterior  lip  due  to  pressure 
between  the  child's  head  and  the  mother's  pubic 
arch. 


THE  QUESTION  OF  EXTRACTION 

AFTER  VERSION. 

N.  Y.  3Icd.  Join:,  Nov.  26,  1SS7  (Editorial)  :— 

It  is  the  rule  of  practice  with  many  *lhat,    in 

transverse  presentations,  turning  by  the  feet  should 

be    followed    by     immediate    extraction.      This 

doctrine  has  recently  been  notably  supported  by 


TlIK  CANADA   MEDICAL  RECORD. 


135 


Winter,  on  tlie  strength  of  the  histories  of  310 
transverse  i)rcscntations  at  the  maternity  of  the 
University  of  Berlin.  Winter's  jiroposilions  are  : 
(i)  'I'lirnine;  should  not  be  jierformed  until  the 
OS  uteri  is  sulRcicntly  dilated  to  admit  of  extraction. 
(2)  The  best  results  for  the  child  will  be  secured 
when  version  is  immediately  followed  by  extraction. 

In  a  recent  number  of  the  Zeitsclirift  Jiir  Gt- 
huitshii/fc  1171(1  G'ljiiakdl'h/ic^  Dr.  R.  Dohrn,  of 
Konigsberg,  assents  to  the  first  of  these  proposi- 
tions, but  not  to  the  second. 

Winter's  second  proposition,  as  to  the  time 
wliich  should  elapse  between  version  and  extrac- 
tion, is  of  great  [iractical  importance.  That  writer 
reports  236  cases  of  turning  followed  by  inunediate 
extraction,  the  os  being  fully  dilated,  in  which  only 
5  children  wore  born  dead,  against  27  cases  of  turn- 
ing before  the  os  was  fully  dilated,  the  course 
of  the  labor  being  then  left  to  nature,  in  which  13 
children  were  born  dead.  These  facts,  he  thinks, 
speak  forcibly  in  favor  of  waiting  for  full  dila- 
tation and  then  immediately  following  version 
with  extraction.  To  Dohrn,  however,  these  fig- 
ures are  not  conclusive  upon  the  general  ques- 
tion, for  the  children  in  the  second  series  of  cases 
were  placed  under  more  perilous  conditions  than 
the  others,  in  consequence  ot  premature  interfer- 
ence, and  better  results  might  have  been  secured, 
in  all  i)robability,  if  complete  dilatation  had  been 
waited  for. 

Dohrn  believes,  with  Boer,  that  in  parturition 
the  forces  of  nature  should  De  allowed  full  sway 
until  tliere  is  evidence  that  they  can  no  longer  be 
trusted,  that  every  interference  for  which  there  is 
no  definite  indication  is  reprehensible,  and  that  ex- 
traction without  a  special  cause  is  no  exception  to 
this  rule.  The  results  of  extraction  will  vary  with 
the  manual  dexterity  of  the  operator  and  the  de- 
gree of  his  knowledge  of  the  mechanism  of  labor. 
This  is  amply  sliown  by  contrasting  the  two  per 
cent,  of  mortality  after  version  in  Winter's  statistics, 
the  operators  being  skillful  obstetricians  attached 
to  a  great  hospital,  with  the  fifty-seven  per  cent,  of 
mortality  which  is  given  as  the  f;ightful  rate  in 
general  practice  in  the  Duchy  of  Nassau,  accord- 
ing to  a  recent  report.  The  inference  is  obvious, 
that  the  natural  forces  were  not  given  fair  play  in 
that  locality.  An  important  adjunction  is,  that  in 
extraction  the  force  should  be  exerted  in  the  direc- 
tion which  the  uterine  contractions  indicate  that 
the  foetus  is  to  take  in  any  given  case.  In  29  cases 
in  Dohrn's  public  service,  in  which  turning  was 
performed  alter  the  os  was  fully  dilated,  the  delivery 
then  being  left  to  nature,  there  was  not  an  accident, 
and  he  therefore  infers;  (i)  That  in  transverse 
presentations  podalic  version  should  be  performed 
only  when  the  os  uteri  is  fully  dilated,  although 
to  this  there  may  be  occasional  exceptions.  (2) 
That  extraction  should  follow  immediately  i  po  1 
version  only  when  there  is  a  well-defined  indicauon 
for  such  a  procedure  ;  if  there  is  no  such  indication, 
the  safety  of  both  mother  and  child  will  be  most 
favored  by  awaiting  delivery  by  the  unaided  natural 
powers. 


F.^CAL  AN.IiMIA. 

a:  T.Med,  four.,  Dec.  3,  1887  (Editorial).— At 
a  recent  meeting  of  the  Medical  Society  of  London, 
Sir  Andrew  Clark  read  a  notable  paper  entitled 
"Observations  on  the  Anemia  or  Chlorosis  of  Girls, 
occurring  more  commonly  between  the  Advent  of 
Menstruation  and  the  Consummation  of  woman- 
hood. "  Lhider  this  title  the  Lana-l  |iublishes 
the  paper,  but  it  more  ])ithily  expresses  the  view 
that  the  author  took  of  the  affection  in  the  caption 
"  Fsecal  Anaemia  "  which  heads  its  rejiort  of  the 
discussion. 

We  have  not  space  to  give  a  summary  of  the 
argument,  but  must  content  ourselves  with  ]jre- 
senting  some  of  the  more  practical  as]jecls  of  the 
author's  conclusions.  The  crucial  test  of  the 
theory,  he  admits,  is  in  the  treatment,  and  he 
maintains  that  the  treatment  which  most  sjjeedily 
and  effectually  cures  the  disease  is  that  in  which, 
by  the  use  of  tonic  aperients,  full  and  regularly 
recurring  action  of  the  bowels  is  produced  ;  that 
with  the  suspension  of  this  treatment  the  disease 
recurs,  to  subside  again  on  its  resumption  ;  and 
that  no  treatment  appears  to  be  permanently  suc- 
cessful which  does  not  provide  means  for  securing 
daily  relief  to  the  intestinal  canal. 

In  ordinary  cases  he  would  direct  the  patient  to 
sip  a  quarter  of  a  pint  of  cold  water  on  waking  in 
the  morning  ;  to  take  a  tepid  sponge-bath  on  rising, 
drying  herself  quickly,  and  then  being  rubbed 
briskly  with  towels,  to  clothe  herself  warmly  and 
loosely,  taking  care  that  there  is  no  constriction 
of  the  body  or  of  the  limbs.  She  should  have 
four  simple,  but  liberal,  meals,  daily  :  Breakfast, 
between  eight  and  nine,  of  wholemeal  bread  and 
butter,  with  one  or  two  eggs,  some  broiled  fresh 
fish,  or  the  wing  of  a  cold  chicken  or  jjheasant, 
and,  toward  the  close  of  the  meal,  half  a  pint  of 
equal  parts  of  milk  and  tea,  not  infused  longer 
than  five  minutes  ;  lunch  or  dinner,  between  one  and 
two,  of  fresh,  tenderly  dressed  meat,  bread,  potato, 
some  well-boiled  green  vegetable,  and  any  simple 
farinaceous  pudding  or  cooked  fruit,  preferably 
apple,  drinking  one  glass  of  Burgundy,  clear  or  in 
half  a  tumblerful  of  water  ;  tea,  between  four  and 
five,  of  whole-meal  bread  and  butter,  with  a  cup  of 
equal  parts  of  tea  and  milk  ;  and  dinner  or 
supper,  between  seven  and  eight,  resembling  the 
mid-day  meal,  but  smaller  in  quantity.  Nothing 
is  to  be  taken  after  this  meal,  and  nothing  between 
meals.  The  patient  should  walk  at  least  halt  an 
hour  twice  a  day,  and  as  much  more  as  her 
strength  and  convenience  will  allow.  She  should 
go  to  bed  about  ten  o'clock,  and  at  that  time  the 
sponging  and  toweling  should  be  repeated.  The 
bedroom  should  be  cool  and  well  ventilated.  The 
patient  should  "  lead  a  simple,  regular,  active, 
occupied,  purposive  life,  "  and  not  notice  or  distrust 
herself.  This  seems  to  us  an  excellent  regimen  in 
the  main,  but  we  would  substitute  coffee  for  the 
tea. 

Together  with  these  hygienic  instructions,  Sir 
Andrew  Clark  prescribes  an  old-fashioned  ferrugi- 


136 


THte  CANADA   MEDICAL  feECOBO. 


nous  cathartic,  to  be  taken  twice  a  day.  Under 
this  plan  of  treatment,  nine  girls  out  of  ten  recover 
their  health  in  from  a  month  to  three  months,  and 
the  recovery  is  very  likely  to  prove  permanent  if 
they  are  then  ordered  a  pill  of  aloes,  myrrh  and  iron, 
to  be  taken  once  or  twice  a  week  in  doses  just 
sufficient  to  bring  about  a  moderate  natural  action 
of  the  bowels. 


CHLOASMA. 

This  is  a  very  frequent  affection,  occurring  upon 
the  face,  es]jecially  in  women  suffering  from  dis- 
orders of  the  generative  a|)paratus.  It  is  rare  in 
men.  The  common  name  for  it  is  "  moth  patches." 
The  affection  consists  of  yellowish-brown  or  brown- 
ish jiatches  on  variovis  jxirts  of  the  f;ice.  The 
forehead,  chin,  temples,  and  lower  portions  of  the 
cheeks  are  princi[inlly  affected.  There  is  neither 
desquamation  nor  infiltration,  and  no  subjective 
symptoms  of  any  kind  are  present. 

The  causes  are  ol)scure.  It  is  known  tliat  the 
discoloration  appears  frec[uenlly  during  pregnancy, 
to  disappear  after  parturition.  It  is  also  a  frequent 
accompaniment  of  uterine  a  d  ovarian  disorders, 
and  often  disappears  when  these  troubles  are  cured. 
The  relation  of  caused  an  effect  is,  however,  not 
known. 

Chloasma  resembles  very  closely  tinea  versi- 
color, a  discoloration  of  the  skin  due  to  a  vegeta- 
ble parasite.  'I'he  latter,  however,  in  nearly  all 
cases,  occurs  upon  the  chest,  abdomen,  arms  and 
neck,  namely  upon  those  portions  of  the  body 
covered  by  clothing.  It  is  very  rarely  seen  upon 
the  face  or  hands.  Chloasma,  on  the  other  hand, 
is  almost  entirely  limited  to  the  face.  Tinea  ver- 
sicolor is  slightly  scaly  and  sometimes  itches. 
Neither  of  these  features  are  |)resent  in  chloasma. 
Finally  the  latter  disease  occurs  nearly  altogether 
in  females  after  the  age  of  puberty,  and  generally 
in  those  who  suffer  from  derangement  of  the  gen- 
erative organs,  tinea  versicolor  is  ofiener  seen  in 
males. 

The  treatment  of  chloasma  consists  in  removing 
the  uterine  or  ovarian  disease,  if  any  can  be  found 
u]ion  which  the  pigmentation  depends,  and  in 
|iiomoting  the  casling  off  of  the  superficial  cpider 
null  layer  so  as  to  bring  a  less  pigmented  stratum 
to  the  surface.  For  this  pur])ose  the  applications 
recommended  above  for  freckles  will  be  found 
useful.  The  oiutment  or  lotion  of  salicylic  acid, 
or  a  lotion  of  corrosive  sublimate  2.2  grains  to  the 
ounce  may  be  used.  Soft  soap  s|)read  ui)on  strips 
of  muslin  like  an  ointment,  and  allowed  to  remain 
upon  the  pigmented  skin  for  several  hours  will 
produce  a  maceration  and  desquamation  of  the 
epidermis  which  often  leaves  the  skin  of  a  normal 
color  after  the  redness  has  disapjieared.  The  dis- 
coloration will  however  return  unless  the  use  of 
one  of  the  ointments  or  lotions  mentioned  is  con- 
tinued. 

The  application  which  will  give  the  most  satis- 
factory results    is   aa   ointment   of  subnitrate   of 


bismuth  and  white  precipitate,  in  the  following 
combination:  R. — Bismuthi  subnitrat.,  hydrag. 
ammoniat.,  aa  3  i;  vaselmi,  5  i.  M.  ft.  ungt.  S: 
Ai)i)ly  to  the  discoloraiions  at  bed-time,  and  re- 
move in  the  morning  with  Hebra's  spiritus  saponis 
kalinus. 

This  ointment  I  have  used  in  a  large  number  of 
cases  with  uniform  success.  .Sometime  it  is  a  little 
to  active  and  ]jroduces  irritation  of  the  skin.  Its 
use  must  then  be  intermitted  for  a  few  days,  or  the 
ointment  made  weaker.  Some  skins  can  stand 
a  much  stronger  application,  however,  and  I  have 
used  as  much  as  two  drams  of  each  of  the  active 
ingredients  to  the  ounce  of  vaseline. 

The  effect  becomes  manifest  in  a  few  days  after 
beginning  its  use.  There  is  slight  scaling  and 
roughness  of  the  skin,  showing  that  a  furfuraceous 
desquamation  of  the  epidermis  is  going  on.  In 
the  course  of  ten  to  fifteen  days  the  skin  has  be- 
come much  paler,  and  if  the  application  be  con- 
tinued the  normal  tint  of  the  skin  can  be  regained. 
This  can,  however,  only  be  mantained  by  the  con- 
tinued use  of  the  ointment,  unless  the  disease  of  the 
internal  organs  iipun  which  the  discoloration  de- 
pends has  been  removed. 

The  pigmentation  of  the  skin  from  sunburn 
usually  soon  disappears  after  the  cause  has  ceased 
acting.  The  bleachi'ng  can  be  somewhat  hastened 
by  a  lotion  of  corrosive  sublimate  in  emulsion  of 
almonds  (gr.  j  :  3  ii). 

I'ermanent  discolorations  of  the  skin  ai'e  some- 
times produced  by  a  mustard  poultice  or  blister. 
Hence  care  should  be  taken  to  avoid  making  these 
applications  to  the  face,  or  upper  part  of  the  chest 
in  women,  as  they  may  prove  the  source  of  an  an- 
noying or  humiliating  disfigurement  in  tlie  latter. 
I  have  seen  a  number  of  cases  in  which  the  chest 
had  become  jiigmented  from  mustard  poultices, 
thus  interfering  with  the  wearing  of  dresses  cut 
decollete.  To  many  women  this  is  not  altogether 
a  trilling  matter. 

In  these  discolorations  the  use  of  the  salicylic 
acid  lotion  above  mentioned  will  prove  useful. 
The  ])iognosis  must  not  be  too  sanguine,  however, 
as  the  pigmentation  is  liable  to  return. — Amefic.mi 
MfJintl   J>i(j,st. 


STRICTURES. 

Dr.  McCoimell  believes  that  the  only  satisfac- 
tory treatment  for  strictures  in  the  jjendulous  por- 
tion of  the  urethra  is  to  cut  them,  and  for  the  fir^t 
three  inches  he  prefers  a  bayonet-shaijed  tenotome. 
This  he  slips  along  the  floor  of  the  urethra  to  an 
inch  beyond  the  stricture,  and  on  drawing  out  the 
knife  cuts  the  stricture  about  a  line  in  depth,  and 
the  mucous  membrane  an  inch  before  and  behind 
it.  He  then  enlarges  the  urethra  by  divulsion,  puts 
the  patient  to  bed  for  several  days,  keeps  the  urine 
alkaline  (with  sodii  bicarbonas  gr.  x,  aiidmorphina; 
sulphas  gr.  J),  and  afterwards  passes  bougies  for 
j  some  time. 


T 


HE  CANADA   MEDICAL  RECORD. 


137 


■nil';  VALUE   OF    NITROGLYCERINE   IN 
'I'INNITUS  AURIUM. 

(Prcsentcil  at   tlic  Mccling  of  the  Otulo^icil  Section  in  tlie 

Inttriinliinal  Mt-ilical  Congress  at  Washington,  Sept. 

(jth,  1SS7.) 

By  I.otns  J.    LAirrENiiAcii,  M  D.,  rii.I)., 

Assistant  Sviryeon  to  tlie  Tcnnsxlvania   live  ami   Kar  Infu- 
niaiy,  I'liilaclelpliia. 

After  tlie  usiuil  experience  in  ear  worl;,  anil  a 
gradual  accumulation  of  un improving  cases  of 
tinnitus  auriuni,  I  began  to  study  the  general  effects 
of  nitioglycerine,  and  to  use  it  in  these  cises.  It 
had  been  used  by  others  in  tinnitus,  both  with  and 
without  success  ;  but  I  knew  of  no  way  of  recog- 
nizing the  cases  in  which  it  would  be  most  likely 
to  prove  serviceable.  In  order  to  learn  when  to 
use  it,  I  began  to  give  it  in  private  practice  to  all 
cases  of  tinnitus  in  which  I  had  found  no  improve- 
ment under  other  treatment,  and  in  public  ]irac- 
tice  in  all  cases  of  tinnitus.  In  some  cases  there 
was  improvement ;  in  others  there  was  none. 

In  the  patients  wliere  improvement  had  occur- 
red, there  was  fotmd  to  be  present  a  similarity  of 
conditions,  and  I  soon  satisfied  myself  that  there 
was  a  class  of  patients  in  which  the  nilroglycerine 
treatment  was  valuable.  I  found  it  most  service- 
able in  patients  having  the  tinnitus  aurium,  with- 
out much  impairment  of  hearing,  and  wheie  but 
little  change  had  occurred  in  the  naso-i)harynx,  and 
where  it  was  found  on  examination  that  some 
abnormal  condition  of  the  heart  existed,  either 
functional  or  organic. 

In  many  of  these  cases,  more  or  less  structural 
clianges  from  catarrhal  inflammation  of  the  middle 
ear  were 'present ;  among  them  change  in  the 
shape  and  translucency  of  the  drumhead,  with 
accompanying  change  in  appearance  or  posiuon 
of  the  triangular  light  spot. 

Follicular  pharyngitis  was  piesent  in  some  of 
the  cases.     The  tinnitus  was  generally  constant, 
or  nearly  so.     It  was  not,  as  a  rule,  more  marked 
when  the  patient  was  in  a  recumbent  position  ; 
occasionally   there   was  some   remission   in   that 
position.     The  thermometric  and  barometric  con- 
ditions of  the  atmosphere  influenced  the  tinnitus. 
Damp    weather,    with     low    barometer,     usually 
increased  it.     Dull,  heavy  headache  more  or  less 
persistent,  and  most  frequently  located  in  the  par- 
ietal  regions,    though   sometimes  located    in   the 
frontal  region,  was   of  frequent  occurrence.     In 
these  cases  I  used  the  nitroglycerine  in  pill  form, 
and  in  doses  of  one-hundredth   of  a  ^rain.     At 
first  but  one  pill  a  day  was  given,  generally  in  the 
morning.     The  amount   given,  later,   was  increas- 
ed, enough  of  the  pills  being  given  to  diminish  the 
tinnitus,  or  to  cause  headache.     As  many  as  six 
of  these  pills  were  given  in  a  day,  though,  usually, 
two   were   found   to  produce  a   beneficial  effect. 
Improvement   sometimes  was   manifest   within  a 
day  or  two  after  beginning  the  use  of  the  remedy. 
In  cases  of  long  standing,  the  remedy  was  some- 
times continued  for  a  period  varying  from  one  to 


three  months  before  a  satisfactory  result  was 
obtained.  Cases  in  which  there  was  recurrence 
of  the  tinnitus  seemed  to  yield  more  readily  on 
resuming  the  treatment  than  when  the  remedy 
was  first  administered.  'I'he  conclusion  which  I 
reached,  after  a  fair  trial  of  this  remedy,  was  that 
it  is  of  value  in  certain  cases  of  tinnitus  aurium — 
especially  in  tho.se  where  cardiac  lesion  exists, 
functional  or  organic,  and  where  there  is  little  or 
no  loss  of  hearing. — Fhil.  Mud.  Times. 


CREDITS  METHOD   OF    PLACENTAL  EX- 
PRESSION. 

Although  Mr.  Dease,  of  Dublin,  wrote,  as  early 
as  1783,  "  Should  the  detachment  of  the  i^laccnia 
not  be  effected  in  the   usual  time,  it  will  be  much 
facilitated  by  the  operator  judiciously  ap|j|ying  his 
hand  to  the  region  of  the  uterus,  which  he  may  ex- 
cite to  the  necessary  contraction  by   gentle  fric- 
tion ;  "  and  although  Ramsbotham,  in  1839,  "''  his 
textbook,  condemned   pulling  and  jerking  at  the 
cord,  and  advised  instead  gentle  pressure  over  the 
uterus,  it  was  not  until   1S60  that  external  expres- 
sion of  the  placenta  was  placed  on  a  scientific  bass, 
chiefly  by  the  labors  of  Crede,  of  Leipsic.    Shortly 
after  Crede's  publicaiion,  the   method  came  to  be 
known  by  his  name,  and  it  has  been  recommended 
in  the  obstetrical  books  of  all  languages,  with  the 
notable  exception  of  Charpentier's  classical  work, 
in  which    a  warm    protest   is  entered  against    it. 
Notwithstanding   the   general  acceptance   of  the 
method,   there  have  not  been  wanting  those  who, 
from  time  to  time,  have  dissented  from  it.     When- 
ever the  criticism  has  seemed  to  call  for  it,  Crede 
has  defended  his  method  manfully.     His  latest  de- 
fense is  directed  against  an  attack  that  was  made 
at  the   last   meeting   of   German    naturalists  and 
physicians,  at   Wiesbaden,  and   is  published  in  a 
recent  number  of  the  "  Archiv  fiir  Gynilkologie." 
He  discusses  the   objections  seriatim.     In   an- 
swer to  the  accusation  that  he  was  guided  by  the 
watch  in  his  procedure,  he  refers  to  his  different 
writings,  in  which  it  is  distinctly  stated    that  the 
time  for  expressing    the  placenta   should  depenJ 
upon   the  circumstances  of  the  case,   and   should 
have  three  different  objects    in  view  :   (i)  the  re- 
moval of  existing  dangers,  (2)    the  avoidance   of 
threatened  dangers,    and  (o)  the  saving  of  time. 
The  first   object   calls   for   immediate  action,   as 
everybody  agrees.     To  accomplish  the  second,  an 
effort  at  placental  expression  should  be  made  with 
the  second,  third,  or  fourth  pain,  but  the  placenta 
may  not  be  expelled  until  the  tenth  pain.     Usually 
from  fifteen  to  thirty  minutes  are  consumed  in  the 
process.     No  sane   man  would  object  to  rccou  se 
to  some  procedure  to  accomplish  the  third  objec 
provided  the  woman's  safety   was  not  endangeied 
thereby.    To  the  charge  that  the  method  is  attend- 
ed with   increased  loss   of   blood,  he  replies    that 
accurate  weighings  of  the  blcod  los; — as  accurate 
as  they  could  have  been — by  different  observers 
have  not  sustained  the  statement. 


138 


THE   CANADA  MEDICAL  RECORD. 


One  of  the  most  serious  objections  raised  was  that 
the  method  favored  the   retention  of  portions  of 
the  membranes  in  the  uterus,  and  thus  heightened 
the  danger  of  septic  infection.     Crede  denies  the 
premise  ;   furthermore,  granting  it  to  be  true,  he 
contests  the  legitimacy  of  the  deduction  with  the  fol- 
lowing facts  :  From  January  i,  1883,  to  March  31, 
1887,  4,969  women  were  delivered  in  the  Leipsic 
clinic  and  Poliklinik,  without  any  attention  being 
paid  to  retained  portions  of  the  membranes,  and  in 
not  a  single  case  did  death  or  even  severe  illness 
ensue  from  such  inattention.     That  the  method  re- 
quires some  skill  Crede  does  not  deny;  some  skill 
is  demanded  in  any  procedure  belonging  to  the  art 
of  medicine.     The  beginner  must  know  how,  and 
with  very  little  practice  he  will  acquire  the  necessary 
skill.     Reliance   on  the  action   of  the   abdominal 
muscles    has    been    recommended   to   supersede 
])ressure  over  the  uterus ;  but  after  delivery,  espe- 
cially   in    a    multipara,    the   abdominal    muscles 
are    flaccid    and    incajiable    of    powerful     con- 
traction.   Stimulation  of  the  lower  part  of  the  uterus 
also  has  been  advised,  but  by  Crede's  method  the 
wliole    uterus    is  stimulated  to  contraction,  more 
especially  the  fundus,  where  the  thickest  muscular 
layers   are   situated.     It  was  suggested  at    Wies- 
baden that  the  body  of  the  uterus  should  be  drawn 
up  over  the  placenta.     Not   only  would    this    be 
contrary  to  nature's  process,  but  it  would  involve 
considerable  danger,  inasmuch  as  the  lower   seg- 
ment of  the  uterus  is   thin  and   easily  torn.     The 
theory  that  the   separation  of  the  secundijies  re- 
quires the  accumulation    of  a   certain  amount    of 
blood  between  them,  and  the  uterine  wall  has  but 
few  adherents,  and  does  not  appear   to  be   well 
founded.     Crede    favors   the  old    view   that    the 
separation  is  brougiit  about  by  the  uterine  contrac- 
tions.    In   conclusion,  he  sums    up    as  follows : 
His  method  of  dealing  with  the  placenta  is  in  ac- 
cordance with  the  natural  process ;  it   has  been 
tested  by  experience;  the  objections  raised  against 
it  at  various  times  have  been  either  unfounded  or 
directed  against  jihantoms ;    of  the  many   recent 
proposed  modifications  ^of  the  method,   some  are 
not  new,  and  those  that  are  new  are  worthless  ;  in 
short,  the  method  stands  unassailed. — N'.  Y.  Med. 
Jour. 


COLORED  LIGHT  IN  THE  TREATMENT 
OF  THE  INSANE. 

Dr.  Ponza, Medical  Superintendent  of  the  lunatic 
asylum  at  Alessendria  (Italy),  reports  some  ex- 
perients  which  he  has  made  on  the  effect  of 
colored  light  on  lunatics.  The  idea  was  suggested 
to  him  by  the  observations  of  Robert  Hunt  on  the 
favorable  effect  which  light  transmitted  through 
violet-tinted  glass  on  the  development  of  animals 
and  plants.  Dr.  Ponza  selected  rooms  with  as 
many  as  possible,  and  he  has  the  walls  painted 
of  the  same  color  as  the  window-panes.  A  patient 
suffering  from  melancholia,  who  would  not  eat, 
was  placed  in  a  room  with  red  walls  and  window, 


in  three  hours  he  became  quite  cheerful  and  ask- 
ed for  food.  Another  lunatic,  who  always  kept 
his  hands  over  his  mouth  to  keep  out  air  and 
nourishment,  was  placed  in  the  same  room,  and  1 
the  next  day  he  was  much.better,  and  ate  with  a  '| 
hearty  appetite.  A  violent  maniac  was  placed 
in  a  blue  room,  and  became  quiet  in  an  hour. 
Another  patient,  after  spending  a  whole  day  in  a 
violet-colored  room,  was  completely  cured.  Theo- 
retically this  appears  to  be  a  very  interesting  ex- 
periment, but  we  have  good  reason  to  believe 
that  in  practice  it  is  of  little  real  service.  It  had 
one  very  good  effect,  which  was  that  it  induced 
the  medical  men  who  were  making  the  experiment 
to  spend  a  good  deal  of  time  and  attention  on  the 
patients  who  were  under  treatment.  One  German 
medical  man  who  visited  Alessandria,  said  it  was 
"  most  excellent  for  the  doctors."  It  is  probable 
that  in  some  future  day  electric  light  may  be  used 
for  the  darker  parts  of  asylums,  and  then  we  shall 
be  able  to  see  whether  electric  light  will  serve  to 
develop  vitality  in  men  as  it  has  been  proved  to 
do  in  plants.  In  many  persons  of  unsound  mind 
the  whole  vital  energy  is  defective,  and  the  medical 
officers  often  feel  a  sad  want  of  something  which 
will  ]3rodace  energy.  Stimulants  of  one  kind  or 
another  are  tried,  and  do  some  good ;  but  we 
should  welcome  some  more  general  natural  means 
of  improving  the  general  health.  The  asylum 
pliysician  Ipoks  to  food,  warmth,  and  exercise  as 
his  great  assistants  ;  and  if  electricity,  or  blue  or 
yellow  rays,  can  be  added,  so  much  the  better. — 
British  Medical  Journal,  March  3,  iSSS. 


ON  SCARLET  FEVER  AND  ITS  TREAT- 
MENT. 
By  Clement  Dckes,  M.  D.,  Physician  to  Rugby  School 

Drs.  Jamieson  and  Edington  have  proved  that 
the  specific  cause  of  scarlet  fever  is  a  bacillus, 
which  they  have  cultivated,  and  with  which  they 
have  inoculated  animals  and  produced  scarlet 
fever.  They  have  also  shown  that  this  bacillus 
occurs  in  the  blood  during  the  first  three  days  of 
the  fever ;  that,  later  on,  it  is  absent  from  the 
blood  ;  and  that  it  is  found  most  extensively  in  the 
desquamating  skin  after  the  third  week.  They 
have,  further,  indicated  a  method  by  which  this 
bacillus  can  be  destroyed  in  the  skin,  and  thus 
the  spread  of  the  infection  of  scarlet  fever  can  be 
minimised,  and  the  unprotected,  even  when  resid- 
ing in  the  same  house,  be  safe  from  falling  into  its 
rammels. 

But  a  still  more  important  matter  is  the  treatment 
and  arrest  of  scarlet  fever  in  each  individual;  for 
the  first  cry  a  parent  whose  child  has  scarlet  fever 
is,  "  What  can  you  do  to  save  my  child ;  and  how 
can  you  spare  him  from  being  maimed'.forjife  by 
its  sequela;?  "  His  second  question  being,  "  How 
can  you  prevent  its  spreading  to  my  other  chil- 
dren ?  "  This  second  question  Drs.  Jamieson  and 
Edington  have  answered.  It  is  with  the  hope 
that  I  may  induce   them  to  investigate  the   first 


THE   CANADA   MEDICAL   RECORD, 


139 


question  that  Iain  writing  tliis  paper ;  for  it  has 
already  been  liroiight  within  a  measurable  dis- 
lanee  of  being  answered  by  Dr.  lllingworth,  of  Ac- 
erington,  who  states  that  biniodide  of  mercury 
(Hg  I^  )  is  a  specific  for  scarlet  fever.  Recog- 
nizing  the  importance  of  his  letter  in  the  use  of 
mercury  as  a  germicide,  I  resolved  to  administer 
the  drug  at  the  earliest  opportunity.  I  have  now 
given  the  Hg  I„  in  several  cases  of  scarlet  fever — 
with  this  result,  that  it  not  only  arrests  the  fever, 
but  it  prevents  tlie  desquamation  of  the  skin,  or 
arrests  it  to  such  an  extent  that  only  a  slight  scur- 
fmess  of  the  skin  of  the  hands  and  feet  arises.  If 
such  be  found  to  be  invariably  the  case,  will  the 
bacilli  of  scarlet  fever  be  found  in  the  skin  at  all ; 
and  if  not,  will  not  the  infectious  period  of  scarlet 
fever  be  thereby  reduced  to  a  few  days  only,  and 
will  not  the  sequela;  of  scarlet  fever  be  absolutely 
prevented  ? 

The  Hg  L  can  be  administered  in  the  form  of 
of  a  pill  or  of  a  mixture  of  the  li.q  liyd.  perchloridi 
c.  pot.  iodid.  The  only  drawback  to  its  use  which 
I  have  at  present  found  is  that  if  it  be  given  before 
the  diagnosis  is  absolutely  certain,  the  physician 
will  be  apt  to  think,  when  he  finds  no  desquamation 
taking  place  at  the  usual  time,  that  the  case  was 
not  one  of  scarlet  fever.  The  drug  prevents  the 
desquamation  of  the  epithelium  of  the  tongue,  as 
well  as  of  the  skin,  and  the  throat  rapidly  heals 
under  its  use. 

I  was  busy  collecting  facts  when  Drs.  Jamieson 
and  Edington's  valuable  paper,  appeared,  and  I 
should  have  waited  till  I  had  collected  a  sufficient 
number  of  instances  before  writing  this  paper,  had 
it  not  been  for  the  desire  that  others,  especially 
the  above-named  authors,  would  assist  in  estab- 
lishing, or  refuting,  this  treatment,  for  the  exi)eri- 
ence  of  one  individual  is  limited. 

The  benefit  to  be  obtained  from  the  use  of  Hg 
I2  is  far-reaching  if  it  be  reliable  in  all  cases,  for  it 
not  only  prevents  the  desquamation  of  the  skin, 
and  thereby  probably  prevents  the  major  part  of 
the  infectious  nature  of  scarlet  fever,  but  it  will 
probably  also  be  found  that  it  obviates  the  neces- 
sity of  keeping  patients  in-  bed  for  three  weeks, 
which  is  the  only  safe  rule  hitherto,  and  isolated 
for  five  or  six  weeks,  and  will  prevent  the  occur- 
rence of  the  much-dreaded  sequela;. 

The  gist  of  the  whole  matter  seems  to  be  this: 
1,  that  if  the  bacilli  of  scarlet  fever  are  only  discov- 
ered in  the  blood  for  about  three  days ;  2,  that  if 
the  bacilli,  after  this  date,  chiefly  occupy  the  des- 
quamating cuticle;  3,  that  if  this  desquamation 
can  be  prevented  altogether  by  a  medicine  which 
destroys  bacilli  j  4,  then,  in  all  probability,  the  in- 
fection of  scarlet  fever  will  only  last  a  few  days, 
and  we  are  within  a  measurable  distance  of  limit- 
ing the  spread  of  scarlet  fever,  ane  of  removing  its 
fangs  by  preventing  the  sequelae. — British  Medi- 
cal Journal,  July  g,  18S7,  /.  67, 


GERMAN  HOSPITAL. 

Dr.  Vogler  presented  a  patient  who  suffered 
with  ])aralysis  of  the  left  side,  due  to  rupture  of  a 
blood-vessel  in  the  brain.  Patient  was  put  on 
iodide  of  potassium  and  the  fluid  extract  of 
hyoscyamus,  and  externally,  wet  cups  along  the 
s]>ine  and  electricity.  He  has  recovered  motion 
of  botli  limbs,  arm  and  leg  nearly  normal. 

Dr.  Vogler  presented  a  case  of  rheumatic 
arthritis;  jjatient  has  suffered  for  two  years  with 
swelling  and  pain  of  upper  and  lower  extremities, 
without  being  able  to  work. 

He  put  heron  large  doses  of  salicylic  acid  for 
some  days;  externally,  leeches,  and  leadwater  and 
laudanum  to  allay  the  inflammation. 

He  speaks  highly  of  an  ointment  composed  of 
powdered  camphor,  watery  extract  of  opium, 
belladonna,  simple  cerate,  and  zinc  ointment.  'IT,e 
sulphur-baths  of  this  country  or  Baden-Baden  and 
Wiesbaden  of  Germany,  and  a  dry  and  warm 
climate  are  advised  in  this  disease. 

Dr.  Deaver  presented  a  case  of  shoulder-joint 
amputation  (after  Larrey's  method),  which  he 
performed  some  weeks  ago  (for  injuries  patient 
sustained),  with  very  good  results. 

In  speaking  of  injuries  with  loss  of  blood,  Dr. 
Deaver  advocates  hypodermic  injections  of  alka- 
line solutions ;  if  that  should  not  be  sufficient,  he 
recommends  transfusion  of  blood.  For  stimulants, 
he  recommends  the  hypodermic  injection  of  ether 
as  the  best;  after  that,  whiskey  and  digitalis. 
Stimulants  by  the  stomach  should  be  given  after 
the  stomach  is  quiet,  and  they  should  be  given  in 
small  doses  at  short  intervals  with  hot  drinks. 

In  amputations.  Dr.  Deaver  uses  the  catgut  for 
the  ligaturing  of  the  blood-vessels,  hot  water  to 
stop  capillary  hemorrhage,  and,  as  an  aseptic, 
bichloride  of  mercury  solution,  i  in  2000,  to  wash 
the  parts  thoroughly,  and  then  an  antiseptic 
dressing. 

As  seminal  emissions  usually  cccur  after  the 
first  sleep,  and  are  caused  by  the  irritation  of  a 
full  bladder.  Dr.  Sudduth  gathers  from  this  that  it 
is  well  to  advise  patients  of  this  character  to 
empty  the  bladder  immediately  upon  awakening 
in  the  morning,  generally  about  4  a.m. 

BLEPHARITIS. 
Prof.    Keyser    has    excellent   results    from    his 
pomade  anti-blepharitic : 

Oleopalmitate  of  lead 20  parts. 

Almond  oil — 10     " 

Simple  cerate 5     " 

Balsam  of  Peru i     " 

Liquid  tar '4   " 

Spread  a  cloth  with  this  and  allow  it  to  lie  on 
the  inflamed  surface  each  night. 

FOR  FCETID  FEET. 

Since  the  offensive  odor  from  certain  persons' 
feet  has  been  shown  to  be  of  microbic  origin. 
Prof.  Gerhard  advises  several  applications  of 
bichloride  of  mercury,  T-50CO  or  i-ioooo. 


140 


The  CANADA   MEDICAL   EKCORD. 


KEITH    ON    HYSTERECTOMY    FOR 
FIBROMA. 

I  say  it  deliberately,  hysterectomy  is  an  opera- 
tion that  has  done  more  harm  than  good,  and  its 
mortality  is  out  of  all  proportion  to  the  benefits 
received  by  the  few.  What  is  the  mortality  of  this 
operation,  now  so  often  and  so  unnecessarily  per 
formed  ?  We  shall  never  know.  I  put  it  at  25  per 
cent.,  though  it  is  probably  much  higher.  1  may  be 
wrong;  others  can  correct  me  by  giving  their  total 
results.  In  other  words,  one  out  of  every  four  wo- 
men operated  on  by  hysterectomy  has  till  now 
died  after  an  operation  for  the  removal  of  a  tumor 
that  has,  as  a  rule,  a  limited  active  existence,  and 
that  of  itself  rarely  shortens  life.  We  have  no  right 
to  rush  our  patients  into  such  a  fearful  risk,  yet 
this  is  done  every  day.  In  abdominal  surgery 
responsibility  seems  to  have  become  old-fiishioned 
and  goneout  of  date.  Fortunately  for  those  afflict- 
ed with  uterine  tumors,  it  now  matters  little 
which  of  the  old  ways  of  operation  is  the  best  ; 
whether  the  ovaries  can  be  removed  or  not, 
whether  the  extra  or  intra-peritoneal  method  be  the 
better  way  of  performing  hysterectomy,  or  whether 
the  convalescence  lasts  in  the  one  case  six  weeks, 
or  in  the  other  twenty  days,  the  treatment  introdu- 
ced by  Dr.  Apostoli  must  take  precedence  of  all 
others.  The  success  of  this  treatment  is  a  great 
fact,  and  in  saying  that  I  accept  toto  animo  his 
teachings,  I  do  not  speak  without  some  experience 
of  his  practice.  We  have  already — my  son  and 
I — in  scarcely  five  months,  applied  electricity  in 
strong,  accurately- measured  doses  upwards  of  i,- 
200  times,  in  considerably  more  than  a  hundred 
l-iatients,  the  majority  in  cases  of  uierine  fibroids. 
The  labor  has  not  been  small — indeed  it  has  been 
very  hard — and  it  is  not  easy  to  get  the  science  of 
the  subject  into  an  old  head.  On  the  other  hand, 
it  has  opened  out  a  delightful  study,  which  increa- 
ses in  interest  every  day  the  deeper  we  get  into  it. 
When  I  came  back  from  my  holiday  in  the  be- 
ginning of  July  there  were  waiting  for  me  several 
cases  for  hysterectomy,  or  for  the  removal  of  the 
ovaries  for  bleeding  fibroids,  and  there  have  been 
others  since.  These  have  all  gone  home  without 
operation,  with  menstruation  almost  normal,  and 
improving  after  their  return,  with  the  tumors  in 
every  case  reduced  in  size,  with  pain  gone,  and 
with  a  freedom  to  walk  about  and  enjoy  life  such 
as  they  were  long  strangers  to.  In  one  case  only 
has  there  been  a  return  of  hemorrhage.  The 
tumor  had  gone  down  two-thirds,  she  was  appar- 
ently well,  and,  unwilling  to  detain  her  longer  in 
town,  she  was  allowed  to  go  home  too  soon.  All 
were  more  than  pleased  to  have  escaped  the  risks 
and  miseries  of  a  surgical  operation  that  at  once 
put^their  lives  in  peril.  We — every  one  of  us — 
consider  far  too  lightly  the  misery  that  such  opera- 
tions cost  our  patients  and  their  friends. 

Should  these  improvements  be  permanent 
(and  we  have  Dr.  Apostoli's  word  for  it 
that  if  the  treatment  be  carried  out  long  enough 
such  is  generally  the  case,  and,  so  far,  I  am   able 


to  endorse  almost  every  statement  that  he  haS 
made),  it  follows  that  the  field  for  hysterectomy) 
for  the  removal  of  ovaries  for  fibroids  is  narrowed 
down  to  the  smallest  limits.  I  have  never  been  in 
favor  of  hysterectomy,  simply  because  its  death 
rate  is  so  high  and  because  it  is  performed  for  the 
removal  of  a  tumor  that  rarely  kills.  So  strongly 
do  I  now  feel  on  this  subject  that  I  would  consi- 
der myself  guilty  of  a  criminal  act  were  I  to  advise 
any  patient  to  run  the  risk  of  her  life— and  such 
a  risk — before  having  given  her  a  fair  trial  to  this 
treatment,  even  were  I  sure  that  the  mortality 
would  not  be  greater  than  that  which  hysterectomy 
has  given  me  in  my  private  cases — under  4  per 
cent. — British  American  Jonrnal. 


TOBACCO    HEART. 

Of  the  cases  of  heart  disease  recently  treated  in 
the  writer's  room,  at  the  dispensary,  nine  were  diag- 
nosticated as  functional  disorders  due  to  the  ex- 
cessive use  of  tobacco.  All  the  nine  cases  occurred 
in  young  men  between  the  ages  of  seventeen  and 
twenty-seven  years. 

The  tobacco  was  used  in  all  the  cases  in  the 
form  of  chewing,  the  amount  ranging  from  a  half 
pound  to  one  pound  a  week.  The  habit  of  chew- 
ing was  begun  early  in  life  in  all  the  cases  ;  in  one 
case  at  the  age  of  five  years  ;  the  oldest  age  noted 
at  which  chewing  was  begun  M'as  twelve  years  ; 
the  aveiage  was  seven  years. 

The  symptoms  complained  of  were  palpitation, 
pain  and  dyspnoea.  Palpitation  was  present  in  all 
the  nine  cases  and  was  greatest  upon  making  any 
exertion.  Irregular  action  of  the  heart  at  the 
time  of  the  exainination  was  noted  in  only  one  case. 
Pain  was  complained  of  in  seven  cases,  and  always 
had  its  seat  immediately  over  the  heart  or  under 
the  sternum.  Dyspnoea  was  complained  of  in 
only  three  cases,  and  was  not  excessive.  Hyper- 
trophy of  the  heart,  as  evidenced  by  increased 
area  of  cardiac  dullness,  was  noted  in  two  in- 
stances. In  both  cases  the  dullness  extended  to 
the  right  edge  of  the  sternum.  In  the  two  cases 
in  which  hypertrophy  had  occurred,  care  was  taken 
to  exclude  any  other  cause  than  tobacco.  No 
murmurs  were    noted  in  any  of  the  nine  cases. 

Treatment  consisted  in  prescribing  total  abstin- 
ence from  the  use  of  tobacco,  and  in  some  cases, 
where  this  alone  did  not  suffice,  the  moderate  use 
of  bromide  of  potassium.  Notwithstanding  great 
length  of  time  during  which  tobacco  had  been  used, 
and  the  early  age  at  which  the  use  had  been  com- 
menced, this  simple  common  sense  treatment 
usually  sufficed  to  give  entire  relief  after  three  or 
four  weeks.  In  only  one  case  was  digitalis  use  . 
M.  H.  Fiissc/l,  iM.D.,  University  Hospital,  in 
Periscope. 


MELANCHOLIA. 

Dr.  Pepper  claims  excellent  results  from  hyos- 
cine,  with  the  ferruginous  tonics,  nutritious  die 
and  complete  change  of  the  patient's  surroundings. 


THE  CANADA   MEDICAL   RECORD. 


141 


SOAPS. 

Prof.  .Shoemaker  says  that  soda  .soaps  as  a  rule 
are  more  irritating  than  potash  soajjs.  Great 
caution  should  be  exercised  in  the  selection 
of  a  toilet  soap,  for  in  order  to  be  entirely  harmless 
these  should  have  a  neutral  reaction.  He  exhibi- 
ted to  the  class  a  number  of  principal  toilet  soaps, 
which  he  had  gotten  at  different  jjlaces  in  the  city, 
and  which  he  had  given  to  an  expert  to  be  tested. 
With  two  exceptions,  all  these  soaps  contained 
more  or  less  free  alkali.  This  free  alkali,  he  said, 
was,  especially  m  young  children,  the  cause  of 
many  skin  eruptions,  such  as  simple  erythema, 
seborrhoea,  pustular  eczema,  and  the  like. 

Prof.  .Shoemaker  then  enumerated  the  different 
medicated  soa|>s  and  their  jiarticular  values.  Alum 
soap  is  good  in  hyperidioses,  in  pustular  eczema, 
and  in  chafing.  Boro-glyceride  soap  is  useful  in 
acne,  seborrhcea,  and  for  rough  skin.  Chamomile 
soap  is  mildly  stimulating,  excellent  for  bromid- 
roses,  intertrigo,  and  is  the  best  soap  for  dand- 
ruff. Naphthal  soap  is  the  very  best  application 
for  animal  parasites  on  any  part  of  the  body,  and 
also  in  bromidroses.  Salicylic  acid  soap  is  a  non- 
irritating  antiseptic  soap,  and  is  good  for  toilet 
purposes.  Corrosive  sublimate  soap  is  serviceable 
for  removing  freckles,  chloasma,  rough  skin,  for 
changing  a  muddy  to  a  clear  complexion,  and  in 
all  kinds  of  itching. 

DYSPEPSIA   MIXTURE. 

Foi   chronic  gastric  catarrh,  Prof.  Gerhard  high- 
ly recommends  this  mistvni  dyspeptica  : 

BtFoliarum    sennae  3    ij 

Pulv.  rhei gr.  xl 

Ft.    infusion    with   ^iv    water  and  add 

Vini  ipecacuanha; -f    3  ss 

Ext.  hydrastis  Canadensis  fld f  '   jss 

Potassii  carbonatis  3  j 

Sig. Take  a  dessertspoonful  half  an  hour  before 

eating,  in  water  as  hot  as  can  be  borne. 


"VAGUE  PAINS." 

Prof.  Atkinson  considers  oil  of  gaultheria  a  most 
valuable  remedy.  He  gives  it  till  ringing  in  the 
ears  and  vomiting  occur.  For  a  girl  of  seven, 
weak,  pale,  anaemic,  and  troubled  with  "vague 
pains,"  he  gives 

5    Olei  gaultherice f  3  ij 

Mucilaginis  acacias, 

Syrupi  simplicis aa     f  fissM. 

Sig. —  3  j  every  three  hours. 

In  addition,  he  puts  her  on  a  tonic  course  of 
cod-liver  oil,  iron,  gin,  wine,  and  strychnia. 


PROGNOSIS  IN  CONVULSIONS. 

Convulsions  following  burns  in  small  children 
are  apt  to  prove  fatal.  I  have  never  known  a 
case  of  scarlet  fever  to  recover  in  which  a  convul- 
sion has  occurred  after  the  appearance  of  the  erup- 
tion.— Prof,  Atkinson, 


CYSTITIS. 

Dr.  Parish  established  an  artificial  vesico-vaginal 
fistula  in  a  woman  whose  urethra  had  been  dilated 
three  times  in  the  past  year  for  cystitis,  probably 
specific,  with  almost  constant  dribbling  of  the 
uiine.  Hei:laims  that  the  hollow  button,  inserted 
between  the  cut  edges,  causes  aggravation  of  the 
cystitis,  and  he  prefers  stitching  them  with  silk, 
al'.owing  the  sutures  to  remain  for  at  least  ten 
days. 


IN  FRACTURE  OF  THE  CL.WICLE. 

Dr.  White  claims  that  the  four-tailed  bandage  fills 
all  the  indications,  if  the  ])atient  can  be  kept  in  the 
supine  posture,  with  the  head  lowered.  The 
elbow  rests  in  a  small  hole  cut  in  the  centre  of  the 
bandage,  two  tails,  lo  inches  wide,  encircle  the 
chest,  and  the  other  two,  4  inches  wide,  are  car- 
ried round  the  shoulder,  opposite  the  fracture. 
No  pads  are  used. 


HYOSCYAMINE  FOR  ASTHMA. 

Dr.  Musser  recommends  hyoscyamine,  gr. 1-120 
every  three  hours,  internally  ;  or  where  a  rapid 
effect  is  desired,  gr.  i-i40to  1-120  hypodermically,' 
for  the  spasmodic  asthma  of  emphysema.  He  uses, 
in  addition,  nux  vomica  as  a  respiratory  stimulant, 
and  terebene  or  oil  of  eucalyptus  for  the  ac- 
companying bronchitis,  diminishing  the  hyoscya- 
mine as  the  other  drugs  are  increased. 


IRITIS. 


Prof.  Keyser  at  once  gives  gr.  i-i  2  bin  iodide  of 
mercury,  with  gr.  v  iodide  of  potassium,  three 
times  a  day,  and  applies  hot  stupes  of  hammamelis 
for  the  pain.  If  no  benefit  be  noticed  in  three  or 
four  days,  he  drops  the  mercury  and  tries  salicylic 
acid  gr.  xx  ter  die.  If  a  condyloma  is  detected 
on  the  iris,  he  is  sure  of  specific  cause. 


BROMINE  IN  CROUP. 

Prof  Howell  has  known  of  a  number  of  instan- 
ces in  which  a  drop  of  bromine,  with  each  dose 
of  bromide  of  potassium,  acted  well  in  throwing 
off  the  membrane  in  croup. 


FLATULENCE  DUE  TO  FERMENTATION. 

In  a  case  of  windy  dyspepsia,  due  to  indiges- 
tion of  starches.  Prof.  Waugh  simply  prescribed 
diastase,  with  excellent  results. 

In  the  case  of  a  child  seventeen  months  old, 
very  low  with  marasmus,  accompanied  by  diarrhcea 
and  vomiting.  Prof.  Waugh  stopped  its  milk  and 
substituted  predigested  food.  The  vomiting  and 
diarrhoea  he  treated  by  sulphocarbolate  of  zinc, 
gr.  \  every  two  hours.  The  child  is  improving 
arpidly. 


142 


THE  CANADA  MEDICAL  RECORD. 


Thiz  Canada  Medical  Record. 

A  Monthly  Journal  of  Medicine  and  burgery- 


EDITORS  : 

FSAVCI3    '.V.  CAMPBELL,   M.A.,  M.D.,  L.K.C.P.  LON'D, 
Editor  aiiU  Piopiietor. 

R.  A.  KENNEDY,  M.A.,  M.D.,  Managing  EJitor. 

ASSISTANT  EDITOR: 

A,  LAPIHORN  SMITH,  B  A..  M.D.,  M  BC  S.  Eng.,  F.O.S., 
LONDON. 

EUDStI  IPTri.V    Ta-0    DOLLAnS    PER    ANNCM. 


All  coinmunic'i (ions  and  Eichangp.s  musl  be  aidressed  lo 
t/ie  £dUors,UntweT3ati,  Post   Office,  Montreal. 


MONTREAL,  MARCH,  1888. 

PROFESSIONAL  SUCCESS. 

We  commend  to  the  attention  of  our  readers  the 
excellent  advice  to  the  graduates  of  the  valedic- 
torian for  the  Faculty  in  another  column,  on  the 
subject  of  professional  etiquette.  Indeed,  we  con- 
sider this  subject  of  so  much  importance,  that  we 
purjjose  devoting  a  column  of  our  pages  every 
month  to  the  reproduction  of  the  code  of 
ethics  of  the  American  Medical  Association. 

On  reflection,  it  will  be  evident  to  every  one 
that  it  is  to  the  advantage  of  the  profession,  both 
as  a  whole  and  as  individual  members,  that  all 
our  dealings  with  each  other  and  with  the  public 
should  be  of  the  most  honorable  nature.  Nothing 
ends  to  lower  us  so  much  in  the  eyes  of  the 
public  as  the  little  backbitings  and  petty  jealousies 
which  we  unfortunately  too  often  see,  and  which 
are  turned  to  the  disadvantage  of  the  backbiter 
quite  as  much  as  to  that  of  the  one  detracted. 
Even  if  something  disparaging  is  said  about  us  by 
a  brother,  no  matter  how  great  the  provocation 
may  be,  and  no  matter  how  much  we  may  be 
templed  to  retaliate,  it  will  prove  better  in  the 
long  run  to  take  no  notice  of  such  injustice, 
feeling  certain  that  in  the  end  truth  and  right 
must  prevail.  If  we  see  a  brother  succeeding  a 
little  better  than  ourselves,  let  not  this  excite  our 
jealousy  or  wrath,  but  rather  our  emulation  ;  for 
we  may  be  sure  that  he  possesses  some  little  quali- 
ties which  we  do  not.  Instead  of  wasting  our 
time  in  finding  fault  with  him  for  succeeding, 
rather  let  us  '  find  out  what  those  qualities  are 
and  cultivate    them.  ^In  ,'nine_  cases  out  _of  ten 


we  may  acquire    them  as  well,  and    turn  tlicm 
to  the  same  advantage  as  he  has  turned  them. 

Although  fortune  may  occasionally  help  a  man 
to  a  high  position,  no  power  on  earth  can  make 
a  man  fill  a  position  for  which  he  is  not  fit.  The 
highest  and  most  enduring  reputations  in  the  pro- 
fession have  been  those  which  were  made  slowly 
and  laboriously,  because  they  were  built  on  a  sure 
foundation.  And  it  is  a  rule,  to  which  there  are 
but  few  exceptions,  that  we  are  sure  to  attain 
just  that  position  for  which  we  are  fit,  and  no 
higher ;  consequently  hard  work  is  the  only  sure 
road  to  success.  In  the  practice  of  medicine  as  in 
the  evolution  of  nature,  the  fittest  will  survive. 


LONGEVITY   AND    MEDICAL     MEN. 

In  an  excellent  article  in  the  "19th  Century,"  Dr. 
Burney  Yeo  points  out  the  causes  which  lead  to 
a  long  life.  He  obtains  his  data  by  analyzing  the 
lives  of  those  who  have  reached  a  great  a;4e  and 
whose  mode  of  living  was  well  known.  He  finds 
that  the  most  important  thing  is  to  obtain  a 
regular  and  sufficient  amount  of  sleep.  The 
number  of  hours  required  is  greater  than  most 
men  get,  being  over  rather  than  under  eight  hours. 
The  truth  of  the  adage  "  early  to  bed,  etc.,"  is 
fully  borne  out  by  his  statistics.  The  second 
requirement  in  importance  is  to  have  one's  meals 
at  regular  hours,  and  to  have  sufficient  time  to  eat 
them  properly.  The  third  advantage  is  to  have 
a  mind  free  from  care  and  worry.  And  the  fourth  to 
have  plenty  of  excercise  in  the  open  air.  Although 
several  centenarians  were  in  the  habit  of  using 
during  a  considerable  part  of  their  lives  wine  and 
malt  liquors,  still  the  majority  were  either  total 
abstainers  or  exceedingly  abstemious. 

From  the  consideration  of  these  facts,  it  is  not 
surprising  to  find  that  the  average  death  rate  of 
medical  men  is  double  that  of  clergymen.  Is  there 
anywhere  a  medical  man  who  takes  plenty  of  time 
to  his  meals,  who  gets  more  than  eight  hours 
of  sleep,  who  is  free  from  anxiety,  or  who  gets 
sufficient  exercise  in  the  open  air? 

Although  many  of  these  adverse  conditions  are 
absolutely  inherent  to  a  doctor'slife,  still  there  are 
some  of  them  which  might,  with  a  little  trouble,  be 
considerably  ameliorated.  Take,  for  instance, 
night  work;  laying  aside  cases  of  midwifery,  the 
majority  of  times  a  doctor  is  sent  for  at  night  are 
for  cases  which  should  have  been  seen  to  during 
the  day,  or  even  the  day  before.  People  have  fallen 
so  into  the  way  of  thinking  of  the  doctor  as  a  kind 


THE  CANADA  MEDICAL   RECORD. 


143 


of  night  owl,  who  deh"{;htsin  prowh'ng  about  in  llie 
darkness,  that  they  forget  that  he  is  only  human, 
and  needs  unbroken  sleep  as  much  or  even  more 
than  any  otlier  worker  ;  indeed,  we  know  of  cases 
in  tlie  country  where  they  send  for  the  doctor  at 
nigiit,  simjily  because  it  suits  their  convenience  to 
go  for  him  after  the  day's  work  is  done,  and  be- 
cause they  are  too  busy  to  send  for  liim  in  the  day 
time.  The  victims  of  this  tlioughtlessncss  of  course 
broke  down  in  liealth,  and  had  to  give  up  jiractice 
altogether  for  nearly  a  year,  for  which  loss  they  re- 
ceived no  compensation.  There  is  a  way  to  avoid 
this  common  cause  of  I'jss  of  health  and  early 
death,  and  that  is  by  educating  the  people,  espe- 
cially one's  own  patients,  to  understand  that  a 
doctor  requires  rest  as  much  and  more  than  any 
one  else.  How  are  we  to  do  this  ?  By  refusing  to 
go  out  at  night  ?  No.  By  evincing  anger?  No. 
How,  then?  Simply  by  charging  double  or  tri- 
ple for  night  visits.  Let  us  get  up  and  go  with  the 
messenger  with  alacrity,  and  even  the  appear- 
ance of  pleasure  if  we  can,  but  wait  until  we  send 
our  bill,  and  then  remember  to  make  the  difference 
between  the  charge  for  night  visits  and  day  visits 
so  strikingly  great,  that  even  the  dullest  patient 
cannot  fail  to  observe  it.  Nor  need  we  fear  to 
loose  any,  or  at  all  events  many,  patients  by  fol. 
lowing  this  course.  They  will  soon  get  to  under- 
stand that  it  is  for  their  good  as  well  as  the  doc- 
tor's that  they  should  send  for  him  in  the  day-time. 

DOCTORS'  BILLS. 
In  the  article  referred  to  above,  another 
cause  of  shortened  life  is  financial  worry,  or  what 
might  be  expressed  by  the  words  "  being  hard  up.'' 
Whether  medical  men  are  ever  in  this  condi 
tion  we  cannot  state;  but  if  they  are,  it  is  not  to  be 
wondered  at,  when  we  remember  how  negligent 
they  are  in  business  matters,  but  more  especially 
in  sending  out  and  collecting  their  accounts. 
It  is  a  general  complaint  among  medical  men  that 
to  one  likes  to  pay  the  doctor's  bill.  That  the 
same  person  who  pays  his  grocer  and  butcher 
gladly  and  promptly  is  slow  in  paying  the  medical 
adviser,  to  whom,  perhaps,  he  owes  his  life.  And 
we  are  apt  to  say  that  our  patients  are  ungrateful. 
But  we  think  medical  men  are  themselves  to  blame. 
It  is  too  much  to  expect  of  human  nature  that  our 
patient's  gratitude  will  keep  as  fresh  after  many 
months  as  it  was  the  very  day  we  pronounced  him 
out  of  danger.  The  present  system  of  sending 
out  accounts   once   a   year    is   altogether  wrong. 


Even  the  patients  themselves  frequently  ask  many 
times  for  their  accounts  before  they  can  get  them, 
and  it  is  only  after  they  have  forgotten  all  about 
them  that  the  bills  come  in,  perhaps  when  they 
have  sjicnt  the  money  on  something  else.  If  doc- 
tors would  spend  a  few  hours  on  the  last  day  of 
every  month,  they  could  send  out  bills  for  services 
rendered  during  the  month,  as  well  as  reminders, 
in  the  form  of  a  second  account,  to  those  who  have 
forgotten  to  respond  to  the  first  one.  We  have 
followed  this  method  in  our  own  practice,  and  do 
not  think  v;e  have  ever  lost  any  patients  thereby, 
except  a  few  of  that  undesirable  class,  who, 
though  quite  able,  never  have  any  intention  of 
remunerating  the  physician  for  his  services.  In 
fact,  this  is  one  of  the  advantages  of  this  system  ; 
it  soon  lets  you  know  who  intends  to  pay  and  who 
does  not.  Indeed  we  know  of  some  specialists  in 
this  city  who  send  a  bill  to  a  patient  on  the  first 
day  of  the  month,  who  only  came  for  his  first 
consultation  on  the  thirtieth  on  purpose  to  let  him 
know  what  his  charges  were.  Be  it  understood, 
however,  that  in  these  remarks  we  are  only  refer- 
ring to  the  doctor's  right  to  be  paid  by  those  who 
are  quite  able  to  do  so ;  we  do  not  wish  to  dis- 
courage any  one  from  attending  all  poor  people 
free  of  any  charge. 

We  may  have  something  further  to  say  on  the 
subject  of  fees  in  our  next  issue,  as  this  is  always  a 
subject  for  discussion  among  medical  men. 


THE  CODE  OF  ETHICS  OF  THE  AMER- 
ICAN MEDICAL  ASSOCIATION. 

OF  THE  DUTIES  OF  PHYSICIANS  TO  THEIR  PATIENTS 
AND  THE    OBLIGATIONS    OF    PATIENTS    TO  THEIR 
PHYSICIANS. 

Art.  I. — Duties  of  Physicians  to  their  jmtients. 
I.  A  physician  should  not  only  be  ever  ready  to 
obey  the  calls  of  the  sick,  but  his  mind  ought  also 
to  be  imbued  with  the  greatness  of  his  mission,  and 
the  responsibility  he  habitually  incurs  in  its  dis- 
charge. These  obligations  are  the  more  deep  and 
enduring,  because  there  is  no  tribunal  other  than 
his  own  conscience  to  adjudge  penalties  for 
carelessness  or  neglect.  Physicians  should,  there- 
fore, minister  to  the  sick  with  due  impressions  of 
the  imjiortance  of  their  office  ;  reflecting  that  the 
case,  the  health,  and  the  lives  of  those  committed 
to  their  charge  depend  on  their  skill,  attention 
and  fidelity.  They  should  study,  also,  in  their 
deportment,  so  to  unite  tciidcntc^s    with  firmness, 


144 


THE   CANADA   MEDICAL   RECORD. 


and  condescension  with  mithority,  as  to  inspire  the 
minds  of  their  patients  with  gratitude,  respect  and 
confidence. 

2.  Every  case  commitled  to  the  charge  of  a 
j)hysician  should  be  treated  with  attention,  steadi- 
ness and  humanity.  Reasonable  indulgence 
should  be  granted  to  the  mental  imbecility  and 
caprices  of  the  sick.  Secrecy  and  delicacy,  when 
required  by  peculiar  circumstances,  should  be 
strictly  observed  ;  and  the  familiar  and  confidential 
intercourse  to  which  physicians  are  admitted  in 
in  their  professional  visits  should  b;  used  with 
discretion,  and  with  the  most  scrupulous  regard 
to  fidelity  and  honor.  '!'he  obligation  of  secrecy 
ext'-nds  beyond  tiie  period  of  professional  services; 
none  of  the  privacies  of  personal  and  domestic 
life,  no  infirmity  of  disposition  or  flaw  of  character 
observed  during  professional  attendance  should 
ever  be  divulged  by  the  physician,  except  when  he 
is  imperatively  required  to  do  so.  The  force  and 
arwl  necessity  of  his  obligation  are  indeed  so  great, 
that  professional  men  have,  under  certain  circum- 
stances, been  protected  in  their  observance  of 
ecrecy  by  courts  of  justice. 

3.  Frequent  visits  to  the  sick  are  in  general  re- 
quisite, since  they  enable  the  physician  to  arrive  to 
a  more  perfect  knowledge  of  the  disease — to  meet 
promptly  every  change  which  may  occur,  and  also 
tend  to  preserve  the  confidence  of  the  patient. 
But  unnecessary  visits  are  to  be  avoided,  as  they 
give  useless  anxiety  to  the  patient,  tend  to  diminish 
the  authority  of  the  physician,  and  render  him 
liable  to  be  suspected  of  interested  motives. 

4.  A  physician  should  not  be  forward  to 
make  gloomy  prognostications,  because  they  savor 
of  empiricism,  by  magnifying  the  imporlance  of  his 
services  in  the  treatment  or  cure  of  the  disease. 
But  he  should  not  fail,  on  proper  occasions,  to  give 
to  the  friends  of  the  patient  timely  notice  of  danger 
when  it  really  occurs,  and  even  to  the  patient 
himself,  if  absolutely  necessary.  This  oflice,  how- 
ever, is  so  peculiarly  alarming  when  executed  by 
him,  that  it  ought  to  be  declined  wherever  it  can 
be  assigned  to  any  other  person  of  sufficient 
judgment  and  delicacy.  For  the  physician  should 
be  the  minister  of  hope  and  comfort  to  tlie  sick ; 
that,  by  such  cordials  to  the  drooping  spirit,  he 
may  smooth  the  bed  of  death,  revive  expiring  life, 
and  counteract  the  depressing  influence  of  those 
maladies  which  often  disturb  the  tranquility  of  the 
most  resigned  in  their  last  moments.  The  life  of 
a  sick    person  can  be  shortened  not  only  by  the 


acts  but  also  by  the  words  or  the  manner  of  a  physi- 
cian. It  is,  therefore,  a  sacred  duty  to  guard  him- 
self carefully  in  this  respect,  and  to  avoid  all  things 
which  have  a  tendency  to  discourage  the  patiert 
and  to  depress  to  his  spirits. 

5.  A  physician  ought  not  to  abandon  a  pa- 
tient because  the  case  is  deemed  incurable  ;  for  his 
attendance  may  continue  to  be  highly  useful  to 
llie  patient  and  comforting  to  the  relatives  around 
him,  even  in  the  last  period  of  a  fatal  malady,  by 
alleviating  pain  and  other  symptoms,  and  by 
soothing  mental  anguish.  To  decline  attendance, 
under  such  circumstarrces,  would  be  sacrificing  to 
f  tnciful  delicacy  and  mistaken  liberality,  that  moral 
duty  which  is  independent  of,  and  far  superior 
to,  all  pecuniary  consideration. 

6.  Consultations  should  be  promoted  in 
difficult  or  protracted  cases,  as  they  give  rise  to 
confidence,  energy  and  more  enlarged  views  in 
practice. 

7.  The  op]5ortunity  which  a  i)hysiciiin  not 
unlYeqirernly  enjoys  of  promoting  and  strength- 
ening the  good  resolutions  of  his  patients, 
suffering  under  the  consequences  of  vicious  con- 
duct, u'.rglu  never  to  be  neglected.  His  counsels, 
or  even  remonstrances,  will  give  satisfaction,  not 
offense,  if  they  be  proffered  with  politeness,  and 
evince  a  genuine  love  of  virtue,  accompanied  by  a 
sincere  interest  in  the  welfare  of  the  person  to 
whom  they  are  addressed. 


PERSONAL. 

Our  readers  will  regret  to  learn  of  the  illness  in 
London  of  our  young  confrere,  Dr.  Rollo  Campbell, 
his  father,  Dr.  F.  W.  Campbell,  being  summoned 
to  England  to  attend  him.  From  advices  received 
to-day  however,  we  are  glad  to  learn  that  his  illness 
is  not  of  a  dangerous  nature,  being  simply  nervous 
exhaustion  from  overwork  in  preparing  for  and 
passing  the  first  half  of  the  examination  for  the 
M.  R.  C.  P.,  London,  in  which  he  has  been  suc- 
cessful. He  has  been  advised  to  defer  the  pass- 
ing of  the  other  half  until  his  health  is  better,  but 
with  the  determination  which  is  hereditary  he  is 
already  hard  at  work  again. 

Dr.  J.  B.  Howard  and  wife  have  sailed  for  a  pro- 
longed visit  to  Europe.  We  are  glad  to  learn  that 
with  good  care  she  has  completely  re  covered  her 
health. 

The  wife  of  Dr.  G.  T.  Ross  has  presented  him 
with  a  daughter. 


THE  CANADA  MEDICAL  RECORD, 


Vol.  XVI. 


MONTREAL,    APRIL,    1888. 


No. 


COZSTTEOSTTS. 


ORIUINAL  COMMUNICATIONS. 

uhsl.flii.-s  and  (iyiiecologyi  by  A.  Lap- 
thorn  Siiiilli Mri 

SOCiF.TY  PROCEEDINGS 

Mmlii-i)  rliinirni'  ilSuii.'ly  nl'  Mc.iil  real  117 

PKOGRESS  OF  SCIENCE. 
Sypliilis.    Ahoitivfi    TroatiiHMit.     Uiit- 

'cliisnn 151 

Til"  llyKiiMK!  of    riilhisis,  by  Dr.  F.  I,. 

Klick, 103 

CauHoH  of  'riiroat  AITections,   by  S.  W. 

I.aliKMiai,!   154 

At'ti-r  T'aitiR,  by  Theo.  rarvin 155 

l;[imiiii;i1isiii.     15y  WaugU  155 

Krlaiuiil  I'laoHiita,  by  (ino.  F.  Hiilbort  15i; 

*^iuii>^y      Hy  F.  r.  Atkinson 15(1 

I'hysiciaiis  Hnil  Drngjiists.  — /'nri/i«  /.'.'■.  157 
Hyilr.istis  Canailensis — Biilletlu   Uen. 

ilo  Thoroap    157 

Harm  of  iMuderate  Drinking,  by  l»r. 

Harley  158 


Tn-atim-nl  of  WartH  !)y  arsenic  inter- 
nally   158 

Ti;;lit"la<Mii(;a8acan«o  of  Mver  Disease  I5S 

lllorino  Hemorrhage,  by  (iooiloll 15!) 

Noi'tnrnal   K.niissions,  by  Dr.  Thor  of 

lincharcst 150 

I'roliuiinary  F.dueali'in.— /V/i/,™!../o«r.  15!' 

Sterility  in  the  Male.     Dr.  Hellield IfiO 

lIlilizatioM  of  Antisi'ptlcs 160 

Wart  eurcd  by  Electricity.    I.aplhorn 

Smith ICO 

Cocaine  in  Operation    for  Hydrocele. 

Dr.  I"ctit IBil 

.\rtilicial  FeertiiiROf  Infants,  by  .Tacobi  161 
TarilV  on  .Surgical  Instruments.— .Soi»Wi- 

em  f'rftrtiH  iwr 161 

'J'reatnn>iit  of  Colds.     Dr.  Wlielan 161 

VcMniting     of     Presanacy   cured     by 

('ocaine.     Dr,  Duncan 161 

Dust  or  Cinder  in  the  Eye.     Dr.  R.  W. 

St.  Clair 162 

Gravity  as  an  expectorant.    Pohjorinic,  162 
Read  Medical  Journals.  Dr.  T.  L.  Brown  162 


.Sohili'nifl  for  waslilngout  the  IJl.oilder. 
ITIt/.man 162 

Fa:cal  .\ccumnlation.    Worrall  162 

Keslored  his  .Joint.     Pancoast 162 

Some  Forms  of  Neuralgia  treated  with 
'I'll  cine 163 

Chlorido  of  Ammonium  hi  the  Treat- 
ment of  DiseaseH  of  the  I.iver 163 

A  New  MetliorJ  ol  supplying  the  con- 
tinuous or  Ralvanic  current  in  the 
trtiatmen'.  of  Fibroid  Tuniors  of  the 
Uterus    104 

The  Treatment  of  Wounds  by  Iodoform 
Tiimpons 165 

Remedy  in  Acute  Coryza 165 

EDITORIAL 

Duties  of  Pliyslclans  to  tlieir  Patients, 
and   the    obliKations    of  Patients    to 

their  Physicians  10ft 

New  Remedies   167 

Notices  of  Books 16'* 

I'EHSON  A  Lg 168 


i)ri&'mal  BnmmunkaihnL 


OBSTETRICS  AND  GYNECOLOGY. 

Ly   a.   Lai'THORN  Smith,  B.A.,  M.D.,  Lecturer  on 
Gynecology  in  Bislioji's  College,  Montreal. 

Tlie  Journals  of  the  last  month  are  remarkable 
for  a  pretty  general  attack  on  ergot  as  at  present 
iiscti  in  the  practice  of  obstetrics.  Some  observers 
such  as  Blanc  (^Annalti  do  Gi/nec.  (March, 
1 888),  going  so  far  as  to  say  that  its  admin- 
istration retarded  involution.  We  are  glad  to  see 
this  view  controverted  by  Drs.  G.  E.  Herman  and 
C.  O.  Fowler  (^Brit.  Med.  Jour.)  who  in  two  series 
of  cases  in  which  the  uterus  was  measured  exter- 
nally, on  successive  days,  found  that  the  uterus 
diminished  more  rapidly  in  size  in  those  treated 
with  ergot  continuously  during  the  fortnight  fol- 
lowing parturition.  Dr.  F.  W.  Putham  (in  Med. 
Siimmari/)  expresses  our  own  views  very  concisely 
as  follows ;  he  says :  first  I  adopted  a  rule  in  ail 
cases  of  multiparous  women,  whom  I  had  not  pre- 
viously attended  and  knew,  to  inquire  particularly 
as  to  the  character  of  their  previous  labors,  and 
especially  to  ascertain  if  there  had  been  any 
difficulty  of  this  kind.  If  there  was  a  history  of 
considerable  flooding,  or  if  there  was  actually  post 
partum  hemorrhage,  I  invariably  administered  the 
ergot. 

Second,  in  all  cases  where  there  seemed  to  be  a 
hemorrhagic  tendency  in  the  family. 

Third,  in  all  cases  where  the  uterus  did  not 
firmly  contract  within  a  reasonable  space  of  time, 
the  amount  of  time  to  be  determined  by  the 
circumstances  attending  each  particular  case  ;  and 


in  all  cases  where  the  uterus  contracts  well  at  first, 
but  soon  relaxes  sufficiently  to  permit  of  a  consid- 
erable hemorrhage. 

Fourth,  in  all  cases  of  after  hemorrhage. 

These  four  indications  are  believed  to  cover  the 
majority  of  cases  of  labor  which  may  be  termed 
normal  at  the  completion  of  the  second  stage  at 
least. 

Professor  Pajot  of  Paris  says:  Never  give 
ergot  when  there  is  anything  in  the  uterus.  The 
value  of  this  advice  will  be  appreciated  when  we 
think  of  the  cases  of  laceration  of  the  perineum 
of  the  cervix  uteri,  and  even  of  the  uterus  itself, 
which  have  resulted  from  its  administration  before 
the  parts  were  at  all  capable  of  allowing  the  head 
to  pass. 

With  regard  to  the  routine  administration  of 
ergot,  we  think  the  practice  a  good  one,  in  cities 
at  least,  because  the  natural  contractions  are 
nearly  always  defective,  owing  to  bad  hygienic  sur- 
roundings ;  and  this  has  been  our  custom  in  the  326 
cases  which  have  been  the  sum  of  our  experience 
extending  over  nearly  ten  years  without  a  death,  if 
we  except  a  case  of  heart  disease  in  which  the  dying 
woman  incidently  gave  birth  to  an  eight  months 
fcetus.  Neither  in  any  of  these  326  cases  have  we 
had  any  hemorrliage,  a  fact  which  we  attribute  tf) 
routine  administration  of  a  drachm  of  ergot  as  soon 
as  the  child  had  been  delivered.  We  have  gener- 
ally found  that  gentle  frictions  over  the  abdomen 
were  very  effective  in  bringing  on  firm  contractions, 
in  cases  where  not  having  the  ergot  with  us  we 
were  obliged  to  wait  until  a  supply  was  procured. 
Apart  altogether  from  the  question  of  ergot,  there 
is  nature's  means  of  securing  firm  contractions, 
which  \Yt;  fear  is  wilfully  or  ignorantly  ignored  ;  w? 


146 


THE   CANADA    MEDICAL   RECORD. 


refer  to  the  effect  of  placing  the  child  to  the  breast 
almost  as  scon  as  born,  or  at  any  rate  as  soon  as 
washed.  Dr.  King  in  an  excellent  paper  (Ainer. 
Jovr.  Ohstct.,  April,  1888)  says  :  "with  the  civilized 
woman,  when  the  child  is  born,  it  is  immediately 
taken  away  from  her  by  another, — the  nurse  or 
physician.  The  barbaric  woman,  on  the  contrary, 
is  able  to  rise  and  take  care  of  the  child  herself, 
and  so  do  the  animals.  I  have  thought  it  not 
improbable  that  this  apparently  trifling  difference 
may  have  a  very  material  influence  in  creating  the 
necessity  for  artificial  aid  in  placental  delivery. 
We  have  learned  by  experience  that  pressure  upon 
and  kneading  the  uterus  and  the  application  of  the 
child  to  the  breast  sec  ure  uterine  contraction  and 
promote  expulsion  of  the  after  birth.  The  very 
means  which  nature  has  provided  and  designed  to 
promote  placental  expulsion  are,  in  the  civilized 
female,  taken  away  from  her,  and  hence  the 
necessity  of  some  artificial  substitute,  which  is 
supplied  and  rightly  supplied  by  ihe  hand  of  the 
accoucheur." 

The  same  writer  makes  a  very  valuable  remark 
with  regard  to  drainage,  which  we  think  is  but 
little  put  in  practice  by  the  majority  of  practition- 
ers. He  says  :  "  from  the  necessity  of  recumbency 
for  some  days  following  delivery,  drainage  from 
the  uterus  ""and  vagina,  by  gravitation,  is  inter- 
ferred  with  in  the  civilized  woman.  On  the  con- 
trary, the  uncivilized  woman  as  well  as  the 
animals,  after  natural  labor,  are  able  to  rise  up  and 
walk,  and  thus  promote  drainage  by  gravitation. 
As  long  ago  as  ten  years  we  were  recommended 
by  one  of  the  oldest  practitioners  in  this  city.  Dr. 
Kingston,  to  allow  our  parturient  patients  to  sit 
up  for  a  few  minutes  several  times  a  day  while  they 
were  emptying  their  rectum  or  bladder,  so  that  at 
the  same  time  they  might  drain  their  uterus  and 
vagina  of  the  clots  and  bloody  serum  accumulated 
in  them  by  the  dorsal  recumbent  posture.  And 
we  have  never  had  any  cause  to  regret  following 
this  advice. 

While  the  death  rate  of  midwifery  cases  has 
tallen  very  considerably,  indeed  to  almost  nothing 
in  private  practice,  it  is  still  considerable  in  hos- 
pital practice  ;  the  difference  we  believe  to  be  due, 
not  to  an  unfavorable  state  of  the  health  of  women 
in  these  latter,  on  the  contrary  the  hospital  cases 
generally  come  from  a  much  more  robust  class 
than  those  in  private  practice,  but  rather  to  the 
presence  of  students  and  nurses  who  cannot  be 
induced  to  believe  in  aseptic  midwifery,  and  who 


will  without  compunction  go  directly  from  the 
dead  house  or  surgical  ward  to  the  bedside,  and 
even  into  the  vagina  of  the  parturient  woman.  In 
the  Feb.  number  of  this  Journal  we  called  atten- 
tion to  the  growing  conviction  in  the  minds  of  the 
most  advanced  obstetricians,  that  the  less  the 
woman  was  fingered  during  her  confinement  the 
less  likelihood  was  there  of  septic  complications. 
Kut  if  it  is  bad  enough  for  her  to  be  examined  by 
the  careful  and  educated  physician,  how  abomin- 
able it  is  to  have  her  examined  by  the  ignorant  and 
unscientific  nurse  whom  we  most  often  find  in 
great  demand  when  a  confinement  is  on  the  taj  is. 
As  an  instance  of  the  danger  from  this  source,  we 
might  mention  that  when  we  began  practice  we  were 
once  summoned  to  see  three  sick  children  in  the 
east  end  of  the  city,  and  whom  we  at  once  pro- 
nounced to  be  suffering  from  scarlet  fever.  Their 
grandmother,  who  had  one  of  them  on  each  knee, 
remarked  that  she  was  sorry  that  she  could  not 
stay  to  help  their  mother  to  nurse  them  as  she  had 
just  been  sent  for  to  attend  on  a  lady  in  the  west 
end,  whose  labor  had  already  begun  ;  of  course  I 
took  immediate  steps  to  prevent  her  from  starting 
on  her  murderous  errand. 

If,however,the  death  rate  has  considerably  fallen, 
the  same  cannot  be  said  of  the  number  of  minor 
accidents,  such  as  laceration  of  the  cervix  and  per- 
ineum, which  have  certainly  increased.  Now, 
although  Emmet,  when  he  first  wrote  on  lacera- 
tions of  the  cervix,  proved  by  his  statistics  that  the 
medical  man  was  not  in  these  cases  to  blame,  we 
have  noticed  what  is  somewhat  remarkable,  that 
among  English  women,  nearly  always  confined  on 
the  left  side,  the  laceration  is  nearly  always  to 
be  found  there ;  while  among  French  women, 
who  are  nearly  always  delivered  in  the  dorsal 
position,  the  laceration  is  either  by  bilateral, 
or  at  least  it  will  be  found  on  the  right  side. 
In  other  words  the  laceration  is  generally  found 
on  the  side  where  the  attendant  has  had  the 
best  opportunity  of  pressing  and  stretching  the 
cervix  with  his  right  index  finger. 

Dr.  King  calls  attention  to  another  evil  of 
frequent  vaginal  examinations  in  the  following 
words:  "One  of  the  means  which  nature 
has  provided  to  facilitate  the  tran.sit  of  the  head 
through  the  vaginal  canal  and  vaginal  outlet,  viz. : 
the  luxurious  layer  of  lubricating  mucous,  has  been 
repeatedly  disturbed,  broken  up,  and  withdrawn 
by  the  examining  fingers  of  the  obstetrician.'' 


THE   CANADA   MEDICAL   RECORD. 


147 


MEDICO-CHIRURGICAL  SOCIETY  OF 

MONTREAL. 
Rtdhd Mieling,  Fchruanj  3rd,  18S8. 
Jas.   Pkrkigo,  M.D.,  President,  in  the  ('hair. 
Drs.  Spendlove  and  Laberge  were  elected  mem- 

1)C1S. 

Ainijolrophlc  Lateral  Sj/iiial  Sclerosis. — Dr. 
Stewart  showed  a  case  of  amyotropliic  lateral 
sclerosis.  The  patient,  a  man  aged  34,  always 
enjoyed  a  good  health  until  his  present  trouble 
began,  which  was  about  a  year  ago.  The  first 
symptom  complained  of  was  a  feeling  of  pricking, 
coupled  with  a  cold  sensation  in  the  ball  of  the 
left  thumb.  Shortly  afterwards,  wasting  of  the 
thenar  eminence  was  noticed,  and  this  was  quickly 
followed  by  wasting  of  the  interossei  of  the  same 
hand.  At  the  present  time  there  is  very  marked 
atrophy  of  the  left  thenar  and  hypothenar  eminen- 
ces, and  of  all  the  interossei  of  the  same  side. 
There  is  slight  wasting  of  the  fle.\ors  on  the  ante- 
rior surface  of  the  forearm  and  of  the  biceps  and 
deltoid  of  the  same  side.  Tiie  s})inati,  as  well  as 
the  rhomboids  and  pectorals,  are  also  the  seat  of 
marked  atrophy.  There  is  slight  wasting  of  the 
corresponding  muscles  of  the  right  hand,  arm  and 
shoulder.  The  atrophic  muscles  are  subject  to 
fibrillary  twitchings ;  many  apparently  normal 
muscles  are  also  subject  to  these  twitchings.  He 
complains  of  "  waves  of  twitchings "  passing 
through  his  head  (scalp).  The  muscles  of  the 
lower  extremities  are  very  frequently  the  seat  of 
these  troublesome  twitchings.  The  left  hand  and 
shoulder  atrophic  muscles  exhibit  a  modified  reac- 
tion of  degeneration,  the  contractions  being  very 
slow  while  the  A  S  Z  <  K  S  Z.  During  the  past 
ten  days  there  has  been  a  gradually  increasing 
loss  of  power  in  the  left  lower  limb.  This  has 
now  attained  a  degree  almost  sufficient  to  prevent 
the  patient  going  about.  The  degree  of  paralysis 
varies  considerably  from  day  to  day.  The  para- 
lyzed muscles  are  neither  atrophied  nor  hypertro- 
phied.  They  are,  however,  in  a  constant  hyper- 
tonic state.  There  is  marked  exaggeration  of  the 
knee-jerks.  Ankle  clonus  is  present.  The  biceps 
and  triceps  reflexes  of  the  upper  extremities  are 
marked  also. 

The  integument  over  the  wasted  districts  is  con- 
stantly covered  with  a  profuse,  clammy  perspira- 


tion, and  at  times  a  papular  rash  appears,  but 
usually  only  lasts  a  few  hours.  There  is  no  atro- 
phy of  any  of  the  facial  muscles.  There  is  no 
history  of  heredity.  The  case  is  evidently  myelo- 
pathic in  origin.  It  is  a  well-marked  example  of 
Charcot's  "  Amyotrophic  Lateral  Sclerosis." 

Pathological  Specimens. — (i)  Potts'  Curvature. 
— Dr.  Johnston  exhibited  for  Dr.  Roddick  a  case 
of  very  extensive  caries  of  the  vertebraj  with  psoas 
abscesses.  The  caries  involved  the  bodies  of  all 
the  dorsal  vertebra  and  a  large  retro-thoracic 
abscess  had  formed  in  consequence,  but  without 
giving  rise  to  any  symptoms.  The  bodies  of  the 
last  dorsal  and  first  and  second  lumbar  vertebrae 
were  completely  destroyed,  causing  a  marked 
angular  curvature.  The  psoas  abscesses  were 
perfectly  symmetrical ;  passing  in  front  of  the 
psoas  tendon  below  Poupart's  ligament,  they  had 
'n  each  case  passed  backward  and  inward,  reach- 
ing to  the  fold  of  the  buttock  near  the  lesser  tro- 
chanters. On  the  left  side  the  abscess  had  passed 
down  to  the  popliteal  space  when  it  was  opened 
by  Dr.  Roddick ;  Dr.  Bell  had  subsequently 
opened  it  above  in  the  left  gluteal  region.  There 
was  no  tuberculosis  anywhere,  and  the  walls  of 
the  abscess  showed  no  tubercles.  The  pus  con- 
tained no  tubercle  bacilli. 

(2)  General  Tuberctdosis. — Dr.  Johnston  show- 
ed another  case  of  vertebral  disease,  where  the 
bodies  of  the  second  and  third  lumbar  vertebrae 
were  infiltrated  with  extensive  caseous  areas.  A 
small  tuberculous  abscess  had  formed  in  the  right 
side,  at  the  level  of  the  third  h:mbar  body.  This 
had  involved  a  small  vein  opening  into  the  vena 
cava  inferior.  There  was  acute  miliary  tuberculo- 
sis of  both  lungs,  which  had  caused  his  death. 
The  patient  had  been  under  Dr.  Ross  with  symp- 
toms of  deep- seated  pain  referred  to  the  right  sacro- 
iliac articulations. 

Nephrotomy. — Dr.  Shepherd  related  a  case  of 
nephrotomy  for  hydro-nephrosis  which  was  follow- 
ed by  death  in  two  days.  The  following  is  the 
history  of  the  case  :  C.  VV.,  aged  66,  a  tall,  thin 
man,  who  had  always  been  healthy,  though  there 
was  a  tuberculous  family  history,  was  suddenly 
seized  some  two  years  before  with  acute  pain  in 
the  left  renal  region,  which  passed  down  towards 
the  bladder.  It  was  relieved  by  opiates,  and 
afterwards  for  a  time  he  felt  fairly  well.  He  had 
a  second  similar  attack  of  severe  pain  a  month  or 
two  afterwards.  After  this  he  began  to  urinate 
more  frequently,   and  occasionally  the    urine  was 


148 


THE   CANADA    MEDICAL   RECORD. 


bloody.  He,  however,  attended  to  his  business, 
and  was  in  fairly  good  health.  About  a  year  ago 
he  noticed  that  his  urine  was  thickish,  and  that  he 
made  it  more  frequently.  This  was  benefited  by 
treatment,  though  up  to  four  weeks  ago,  when  he 
had  to  take  to  his  bed,  he  was  continually  grow- 
ing weaker  and  losing  flesh.  His  urine  was  never 
free  from  sediment,  and  he  had  occasional  attacks 
of  painful  and  frequent  micturition.  He  had  a 
chill  some  time  in  October  and  took  to  his  bed ; 
his  micturition  now  became  more  painful,  pain 
greatest  at  point  of  penis,  and  the  deposit  in  his 
urine  was  increased  in  amount.  His  urine  was 
still  occasionally  bloody.  Dr.  Sh.epherd  first  saw 
him  in  December  ;  he  was  then  in  a  weak  condi- 
tion, passing  his  urine  painfully  and  frequently. 
There  was  a  large  amount  of  pus  in  urine  ;  nearly 
one-sixth  of  whole  amount  passed  (45  oz.)  daily 
was  pus.  Urine  perfectly  sweet ;  specific  gravity 
loio,  alkaline,  and  containing  a  slight  amount  of 
albumen.  He  also  complained  of  severe  and  con- 
tinuous pain  in  his  bladder.  On  examination,  the 
bladder  was  found  to  give  no  evidence  of  stone, 
but  patient  had  a  moderately  large  prostate.  On 
examining  the  region  of  the  kidney,  pressure  below 
the  last  rib  on  right  side  gave  rise  to  severe  pain, 
and  there  was  a  distinct  fullness  to  be  felt  there. 
This  fullness  and  pain  on  pressure  did  not  exist 
on  the  left  side.  Under  ether,  a  tumor  could  be 
made  out  in  the  region  of  the  right  kidney.  This 
was  aspirated,  and  some  three  or  four  ounces  of 
clear  fluid  drawn  off,  which  had  no  urinous  smell, 
but  on  chemical  examination  proved  to  be  almost 
pure  urine.  No  pus  was  evacuated.  After  each 
examination  patient  passed  large  quantities  of 
bloody  urine.  The  patient's  condition  not  im- 
proving, and,  in  fact,  growing  much  worse,  opera- 
tion was  suggested.  For  some  time  Dr.  Shepherd 
was  in  doubt  as  to  which  kidney  was  manufactur- 
ing the  pus,  the  right  kidney,  on  aspiration,  giving 
clear  fluid  and  the  history  of  renal  colic  being  on 
left  side.  However,  as  the  pain  and  tumor  exist. 
ed  in  the  right,  it  was  determined  to  explore  this 
side.  This  was  done  on  Jan'y.  22nd,  Drs.  Fen- 
wick  and  Ross  assisting.  There  was  considerable 
fat,  but  the  kidney  was  easily  reached,  and  on 
examination  the  pelvis  and  calyces  were  found 
much  distended  with  fluid ;  about  six  ounces  was 
evacuated.  From  the  condition  of  the  kidney  it 
was  pretty  certain  that  the  large  apiount  of  pus 
did  not  come  from  this  kidney,  an.^  only  clear  fluid 
was  evacuated  on  incision.     Th^;  exploration  fai^ 


ed  to  detect  any  pockets  of  pus.  It  was  supposed 
that  the  wrong  kidney  had  been  cut  down  upon, 
and  that  the  suppurative  disease  existed  in  the  left. 
'I'he  wound  was  sutured  and  a  large  diain  placed  in 
it.  The  patient  recovered  well  from  the  operation, 
but  secreted  no  more  urine,  and  died  uremic  two 
days  later. 

Autopsii  hi/  Dr.  ir.  G.  Jvliuaton  twdvc  Imiirs 
lifter  death. — A  very  strong  urinous  ammoniacal 
odor  noticed  about  the  body,  which  was  well 
nourished.  In  abdomen  the  kidneys  did  not  pro- 
ject below  the  edge  of  the  floating  ribs.  A  rubber 
drainage  tube  in  a  wound  in  left  lumbar  region. 
Pelvis  of  left  kidney  moderately  distended.  Ure- 
ters on  each  side  distended  to  about  size  of  fore- 
finger. Both  kidneys  showed  marked  hydrone- 
phrosis, with  dilated  pelves  and  calices,  papillae 
flattened.  Renal  substance  atrophied  and  micros- 
copically showed  extensive  cirrhotic  changes,  but 
was  free  from  any  appearance  of  acute  inflamma- 
tion, and  the  collecting  tubules  are  not  dilated.  No 
calculi  present.  The  jjclves  and  ureters  contained 
opaque  purulent-looking  fluid,  but  the  mucosa  no- 
where eroded.  Bladder  contained  about  10  oz. 
dark  urine,  was  sacculated  behind  prostate  gland, 
the  middle  lobe  of  which  was  greatly  enlarged. 
The  lateral  lobes  also  slightly  enlarged,  but  soft. 
Muscular  coat  of  bladder  greatly  thickened,  and 
trabeculae  prominent.  The  mucosa,  on  the  con- 
trary, very  thin  and  atrophic,  nowhere  ulcerated, 
but  shewed  deep  slaty  pigmentation. 

Dr.  Johnston  thought  the  most  interesting 
symptom  was  the  presence  of  what  api)eared  to  be 
pus  in  the  urine ;  that  is  to  say,  a  dense  cellular 
deposit  not  accompanied  by  much  mucus.  This 
was  always  laid  down  as  a  sign  by  which  sui)pur- 
ation  in  the  kidney  can  be  distinguished  from 
catarrh  of  the  bladder,  and  in  this  case  had  materi- 
ally influenced  the  diagnosis.  Here,  however, 
there  was  no  true  pus  present  in  the  sense  of  a 
product  of  suppuration  accompanied  by  necrosis. 
The  anomaly  was  probably  explained  by  the  con- 
dition of  the  bladder  mucosa,  which  showed  a 
marked  atrophy,  while  in  most  cases  of  cystitis 
following  prostatic  obstruction  he  had  found  the 
bladder  mucosa  greatly  thickened  and  hypertro- 
phic. This  atrophic  mucous  membrane  being  un- 
able to  secrete  any  considerable  amount  of  mucins 
had  made  the  appearance  of  the  urinary  deposit 
very  misleading. 

A  Case  oj;  Diabetes. — Dr.  Kennedy  reported  a 
case  of  di^abetes  in  which  a  daily  analysis,  pf  the 


TIIK   CANADA   MEDICAL   RECORD. 


140 


iniiicliad  been  iikuIc  Iroin  Ocl.,  iSS6,  for  ten 
monlhs.  'J'lic  pnliciit  was  a  female  aged  28  years- 
The  tables  recorded  quantity  of  urine,  specific 
gravity,  amount  of  sugar,  urea,  etc.,  including 
drink  and  food  taken.  At  commencement  of  treat- 
ment the  average  daily  amount  of  sugar  was  seven 
ounces.  Codeia  was  first  given  with  Ijcnefit,  but 
lost  its  effect  during  second  month,  at  which  time 
the  ]Kilienl's  condition  became  serious,  On  Dec. 
ist,  1.S86,  nitro-glycerinc  was  given  and  continued 
with  slight  intermission  for  five  months  ;  its  action 
was  markedly  beneficial,  as  the  patient  continued 
to  improve.  So  far  as  Dr.  Kennedy  was  aware, 
this  was  the  first  time  the  remedy  had  been  used 
in  this  disease.  Jambol  was  given  for  a  short  time 
as  an  additional  remedy,  but  not  continued.  Iron, 
strychnine,  etc.,  were  given  for  the  ana;mia,  etc. 
A  strict  diabetic  diet  was  followed  with  saccharine 
as  a  sweetening  agent.  In  July,  1SS7,  no  medicine 
was  given,  as  the  patient  was  almost  well,  and  dur- 
ing the  last  week  of  this  month  the  condition  was 
normal,  with  no  sugar.  At  the  present  time  the 
patient  is  perfectly  well.  During  the  ten  months 
the  patient  passed  52  lbs.  of  sugar. 

Discussion. — Dr.  Ruttan  said  that  this  case 
deserved  more  than  a  passing  notice.  There  was 
probably  not  another  case  recorded  in  which  such 
an  accurate  and  thorough  analysis  of  the  urine 
had  been  made.  A  daily  quantitative  estimation 
of  the  most  important  constituents  of  a  delicate 
patient's  urine  extending  over  a  period  of  ten 
months  should  reveal  something  of  interest.  It 
is  important  to  note  the  fact  that  whenever  there 
was  a  sudden  decrease  in  the  percentage  of 
sugar,  there  was  an  increase  in  the  acetone 
group  of  excreta,  and  this  was  accompanied  with 
the  most  alarming  symptoms.  AVhelhcr  there  is 
any  relation  between  quantities  of  sugar  and 
acetjlacetic  acid  excreted  has  not  been  determined, 
but  there  are  few  who  believe  that  the  symptoms 
of  diabetes  are  due  to  the  sugar  or  to  the  want  of 
proper  assimilation  of  carbohydrates.  If  these 
acetone  products  do  not  of  themselves  pioduce 
the  coma  and  toxic  symptoms  of  diabetes,  their 
appearance  durinp;  and  preceding  coma  is  a  re- 
markably common  coincidence.  In  a  recent  case 
of  sudden  diabetic  coma,  the  urine  examined  for 
Dr.  Howard  looked  only  a  trifle  pale,  had  no 
acetone  odor  when  fresh,  specific  gravity  i  020, 
only  2.7  per  cent,  of  sugar,  but  was  highly  acid, 
acidity  =1  to  ^Yo  of  ^  grain  of  oxalic  acid  per 
ounce,  and  was  loaded  with  acetylacetic  acid.     In 


an(jiher  ca;,e,a  life  insurance  candidate  recently  exa- 
mined, no  sugar  reaction  was  obtained  by  Fchlings' 
solution,  but  the  acetone  reaction  was  marked  ; 
specific  gravity  was  normal.  Two  days  later  this 
patient's  urine  gave  3  per  cent,  of  sugar  and  no 
acetone;  specific  gravity  1028.  The  specific 
gravity  of  diabetic  urine  is  no  index  to  the  quan. 
tity  of  sugar,  nor,  indeed,  if  acetone  Ijc  found,  is 
it  in  relation  to  the  total  sr)lids,  as  the  acetone 
and  alcohol  resulting  from  the  decomposition  of 
acetylacetic  ether  would  greatly  lower  the  si)ecific 
gravity.  No  work  can  be  done  of  much  clinical 
interest  regarding  acetonemia  or  diacetona;mia, 
till  a  more  convenient  method  of  estimating  ace- 
tone be  found  than  that  recommended  by  Sal- 
kowski. 

Dr.  Mills  wished  to  express  his  appreciation  of 
these  tables.  Analyses  of  the  urine  so  accurate, 
complete,  and  continued  daily  over  so  long  a 
])eriod  were,  he  believed,  without  a  parallel.  It 
would  be  difficult  to  say  what  their  value  might 
be  ten  years  hence,  when  the  subject  of  diabetes 
was  better  understood.  The  physiological  experi- 
ment of  puncturing  the  floor  of  the  fourth  ventricle 
was  tmsatisfactory,  and  must  necessarily  be  so  if 
we  were  correct  in  crowding  so  many  "centres" 
into  this  region.  Vaso-molor  effects  follow  it  in 
time,  but  we  are  learning  more  and  more  that  nu- 
trition is  less  dependent  on  blood-pressure  than 
has  been  supposed.  From  the  results  of  the 
urinary  analyses  in  this  case  and  others,  it  was 
clear  that  in  diabetes  the  nutritive  processes  were 
profoundly  di  turbed.  Why  should  we  suppose 
tljat  sugar  production  was  dependent  on  only  one 
set  of  chemical  reactions  in  the  body  when  it  is 
now  known  that  sugar  or  allied  bodies  can  be 
made  in  the  laboratory  by  a  variety  of  processes, 
even  a  variety  of  syntheses  ?  May  not  diabetes 
originate  in  aberrant  metabolism  in  different 
organs  ?  It  is  fmpossible,  at  all  events,  to  have 
for  any  length  of  time  one  colony  of  cells  (organ) 
disordered  without  widespread  evil  in  the  economy. 
Should  not  diabetes  be  regarded  as  a  complication 
of  disorders  starting  either  as  a  more  or  less  gen- 
eral disturbance  of  the  nutritive  process  ?  Or,  if 
we  confine  the  term  to  that  derangement  of  one 
organ  which  leads  to  excessive  production  of  sugar, 
regard  it  as  the  starting  point  only,  instead  of  fixing 
the  whole  attention  upon  this  and  treating  the 
disease  as  if  it  consisted  wholly  in  derangement 
of  one  set  of  processes  resulting  in  excess  of  sugar. 
It   looks   as  if  the   chemists,    physiologists  and 


loO 


tllE   CANADA    MEDlC'Ar,   UiiCoRft. 


pathologists  must  unite  in  the  investigation  before 
the  present  partial  and  unsatisfactory  views  of  the 
actual  condition  would  give  place  to  broader  and 
truer  ones. 

Dr.  BuLLER  said  that  the  color  rings  observed 
by  the  patient  when  looking  at  a  light  were  pro- 
bably due  to  a  slight  conjunctivitis,  and  were  not 
characteristic  of  the  disease. 


Stated  Meeting,  Feirunry  11  tit,   1888. 
Jas.  Perrigo,  M.D.,  President,  in  the 

Chair. 
Extra-Uterine  Fwtatinn  {Tubal);  Rnplnre  ; 
Abdominal  Section  ;  Recovery. — Dr.  Wm.  GARb- 
NER  related  the  case,  while  Dr.  W.  G.  John- 
son exhibited  the  specimens — a  degenerated  fcetus 
and  a  chorionic  villi — -under  the  microscope.  The 
patient,  aged  29,  was  married  last  July.  She  had 
an  early  miscarriage  in  October,  for  which  she  was 
attended  by  Dr.  A.  A.  Browne  of  the  city.  After 
this  she  menstruated  twice,  the  last  time  on  the 
and  December  last.  Towards  the  end  of  the 
month  she  had  morning  sickness  for  a  few  days. 
During  the  early  part  of  January  a  colored  bloody 
vaginal  discharge  appearing,  lasting  nearly  a 
fortnight.  About  the  middle  of  January  she  was 
seized  with  violent  pelvic  and  abdominal  pain, 
with  most  alarming  collapse,  during  which  for 
many  hours  she  was  almost  pulseless.  From  this 
in  a  few  days  she  partially  recovered,  but  soon 
there  were  recurrences  of  pain,  faintness  and 
symptoms  of  peritonitis.  Her  physicians,  Drs. 
Browne  and  George  Ross,  recognizing  the  nature 
of  the  case,  requested  Dr.  Gardner's  opinion,  and 
after  examination  he  fully  concurred  in  their  diag- 
nosis of  ruptured  extra-uterine  fcetation.  The 
next  day,  the  symptoms  continuing  alarming,  it 
was  decided  to  open  the  abdomen,  The  right  fal- 
lopian tube  was  found  expanded  into  a  friable 
mass,  in  which  the  fcetus  was  found  imbedded  in 
clots.  On  attempting  to  ligature  this  it  tore  away, 
so  that  it  was  not  tied.  The  pelvis  was  full  of 
clots.  These  were  scooped  out,  and  then  the 
cavity  was  washed  out  with  a  forcible  stream  of 
water  from  Lawson  Tail's  large  blunt  trocar  car- 
ried to  the  dependent  parts.  A  drainage-tube 
was  then  inserted  and  left  for  eight  days.  For 
the  first  nine  days  the  course  of  the  case  was  per- 
fectly favorable.  Then  evidences  of  cystitis  ap- 
peared, and  have  continued  to  be  rather  severe 
and  attended  with  some  fever.  There  seems  no 
reason  to  doubt  that  recovery  will  ultimately  be 


complete  and  permanent.  Dr.  Gardner  remarked 
that  such  a  case  as  this  well  illustrates  the  triumphs 
of  the  modern  extensions  of  abdominal  surgery, 
and  for  this  particular  one  we  owe  all  that  is  worth 
knowing  to  Lawson  Tait,  whose  remarkable  re- 
sults in  a  long  series  of  such  cases  are  now  well 
known.  The  diagnosis  will  not  always  be  easy, 
but  given  sufficiently  alarming  symptoms  the 
abdomen  must  be  opened  and  the  condition  found 
dealt  with  as  may  be  necessary  ;  and  it  is  a  great 
satisfaction  to  know  that  in  the  hands  of  com- 
petent surgeons  the  operation  itself  cannot  be  said 
to  be  a  source  of  danger. 

Discussion. — Dr.  Johnston  said  that  in  examin- 
ing the  specimen  sent,  amongst  a  large  amount  of 
blood-clot  he  had  found  a  small,  firm,  fleshy  mass 
i^  inches  long,  which  appeared  to  be  a  thick- 
walled  sac  torn  open.  In  one  spot  a  typical  area 
of  chorionic  villi  was  seen.  Within  the  sac,  attached 
to  one  wall,  was  a  small  mass  covered  with  a  smooth 
membrane  (amnion).  This  appeared  to  be  a  blight- 
ed and  degenerated  fcetus,  of  which  only  the  eye 
sjiot  and  the  intestines  were  distinctly  recognizable. 

A  microscopic  specimen  of  the  villi  was  exhibi- 
ted, showing  this  structure  to  be  quite  typical. 

Dr.  Geo.  Ross  had  been  called  to  see  the  patient, 
and  had  found  her  after  the  attack  almost  pulseless, 
in  extreme  pain,  temperature  subnormal,  and  very 
pallid.  He  had  strong  suspicion  of  hemorrhage 
in  the  peritoneum  and  peritoneal  inflammation. 
There  was  a  reasonable  expectation  of  the  patient 
rallying  from  that  attack,  but  the  danger  of  recur- 
rence was  very  great.  Dr.  Brown  had  early  arrived 
at  a  diagnosis  from  the  symptoms  of  tubal  preg- 
nancy. He  heartily  congratulated  Dr.  Gardner 
on  the  very  successful  result  in  this  case,  and  said 
that  as  far  as  he  knew  it  was  the  only  case  in 
Canada  of  early  diagnosis  of  extra-uterine  preg- 
nancy and  successful  operation  for  the  same  by 
abdominal  section. 

Dr.  Shepherd  asked  if  opinion  was  not  now  in 
favor  of  the  belief  that  all  intra-iieritoneal  pelvic 
haematocele  were  due  to  ruptured  tubal  pregnancy. 

Dr.  Gardner,  in  reply,  stated  that  they  were 
not  always  due  to  extra-uterine  pregnancy.  He 
had  operated  for  a  pelvic  hfematocele,  which  was 
part  of  a  general  condition.  They  may  also  be 
caused  by  rupture  of  varicose  veins,  etc.  Mr. 
Lawson  Tait  treats  all  large  hemorrhages  in  mar- 
ried females  as  if  due  to  extra-uterine  pregnancy. 
Electricity  would  not  have  availed  here,  and  can 
only  be  of  use  while  there  is  life  in  the  foetus. 


tllK  CANAbA  MEDHJAL  RECOtlD. 


151 


Carcinoma  of  the  Stomach  and  Liver. — Dr. 
Gi",ORf!R  Ross  cxhibiicd  the  stomach  and  a  portion 
of  tlie  liver  from  tlie  case,  and  related  the  following 
history  :  'l"he  ;)atient,  aged  55,  had  l)cen  under 
observation  for  four  months,  and  had  never  had 
any  gastric  symptoms,  but  suffered  from  jirofuse 
diarrluea  and  had  a  haggard  appearance.  Mxamin- 
alion  had  shown  a  hard  mass  in  tlic  left  Ii)|)Ochon- 
driuni,  which  mnvcd  with  the  diaphr.tgni  ;  the  liver 
was  not  enlargetl.  'J'here  was  no  pain  after  eating, 
and  no  vomiting.  The  diarrh(ea  was  controlled 
and  the  ii;itient  ate  and  drank  well,  luit  had  con- 
tinuous pain  in  the  epigastrium.  'I'he  hard  nodule 
in  the  left  iiypochondrium  raiiidly  increased  in 
size,  and  it  looked  as  if  the  left  lobe  of  the  liver 
was  the  seat  of  the  tumor,  but  its  origin  was  always 
doubtful.  Later  the  patient  developed  album- 
inuria, and  amyloid  casts  were  found  in  the  urine. 
The  patient  gradually  sank.  Dr.  Johnston  found 
at  the  autopsy  a  large  fungating  cancerous  ulcer, 
occupying  an  area  nearly  four  inches  in  diameter 
on  the  anterior  surface  of  the  lesser  curvature  of 
the  stomach.  Neither  the  pyloric  nor  esophageal 
opening  was  obstructed.  The  base  was  deeply 
fissured,  and  had  extended  into  the  inferior  surface 
of  left  lobe  of  liver  to  nearly  one  inch  of  the  super- 
ior surface.  No  secondary  deposit.  Nature  of 
growth  scirrhus.  Amyloid  disease  of  glands  in 
portal  fissure,  stomach  and  intestines  marked, 
and  the  kidneys  slight  ;  spleen  amyloid,  but  not 
enlarged. 

Calculo2is  Nephritis.— V>x.  Johnston  presented 
from  Dr.  Bower  of  Waddington,  New  York,  a 
specimen  of  calculous  nephritis,  where  the  entire 
renal  substance  was  destroyed,  the  kidney  con- 
sisting of  a  series  of  suppurating  sacs,  each  con- 
taining a  calculus  of  uric  acid  with  phosphatic 
incrustation ;  a  large  calculus  blocking  orifice  of 
the  ureter.  The  other  kidney  had  been  greatly 
shrunken  and  disintegrated  apjiarently  from  p)e- 
litis,  but  contained  no  calculi.  The  symptoms 
were  persistent  pyura,  and  towards  the  close 
urfemic  coma. 

Peritoneal  Cancer. — Dr.  Bowilr  also  exhibited 
a  specimen  of  secondary  carcinoma  of  the 
peritoneum.  The  growths,  whose  microscopical 
characters  were  those  of  ence|jhaloid  cancer, 
were  all  situated  beneath  the  peritoneal  coat 
of  the  intestines,  soft  and  vascular,  ranging  in 
size  from  a  pea  to  an  egg.  The  seat  of  primary 
growth  was  uncertain. 

Pharmacology  of  Arsenic— T)t.  Stewart  read 


a  pa])er   on  this  suljject,   which   appeared  in   the 
April  number  of  the  Jouknai,. 

Discussion. — Dr.  Bell  could  recall  at  least 
three  post  mortems  he  had  seen  in  the  Montreal 
General  Hos]jital  while  house  surgeon,  and  in 
each  case  there  were  well  marked  inflammatory 
lesions.  He  was  suri)rised  to  hear  from  Dr. 
.Stewart  that  in  none  of  his  cases  were  there  any 
inllanimatory  lesions. 

Dr.  Reed  could  remendjer  one  case  of  poison- 
ing from  Paris  green  in  which  there  was  no  gas- 
tro  enteritis. 

Dr.  McGannon  of  Brockville  referred  to  a  case 
of  arsenical  poisoning,  where  the  poison,  Paris 
green,  had  been  found  in  the  stools  and  vomit. 
Patient  died  in  seven  hours.  No  post-mortem 
was  allowed. 

Dr.  Shepherd  said  that  if  Dr.  Stewart's  state- 
ment was  accepted,  viz.,  that  arsenic  did  not  kill 
by  the  violence  of  its  inllanimatory  action,  but  by 
the  lowered  blood  pressure,  then  we  must  change 
our  method  of  treatment  of  such  cases.  The 
[loint  was  a  new  one  to  him,  as  he  thought  that 
in  all  cases  death  was  due  to  inflammatory  action. 
He  still  had  confidence  in  the  use  of  arsenic  in 
certain  diseases  of  the  skin,  viz.,  psoriasis  and 
bullous  eruptions,  and  in  these  cases  had  used  it 
extensively,  but  had  never  seen  the  erythema  or 
staining  produced  ;  this  might  be  due  to  the  diffi- 
culty of  detecting  erythema  or  staining  whenchry- 
sophanic  acid  was  employed. 

J^m^'teM  a/  Sdeme. 

MR.  JONATHAN  HUTCHINSON    ON  THE 
ABORTIVE  TREATMENT  OF  SYPHILIS. 

The  early  treatment  of  syphilis  by  small  doses 
of  mercury  long  continued  is  by  no  means  a  new 
method,  many  surgeons  having  carried  it  out  for 
years  past.  There  are,  however,  some  who  still 
use  mercury  on  the  old  lines,  and  Mr.  Jonathan 
Hutchinson  has  done  good  service  in  directing 
the  attention  of  the  profession  to  the  subject,  and 
pointing  out  the  splendid  results  which  may  be 
obtained  by  the  early  and  persistent  use  of  mer- 
cury in  small  doses. 

Mr.  Hutchinson  communicated  his  views  to 
the  members  of  the  Medical  Society  of  London, 
on  the  28th  ult.,  in  a  paper,  the  chief  points  of 
which  are  as  follows  : — 

"  For  many  years  past  I  have  been  in  the 
habit  of  assuring  patients  who  came  to  me  with 
indurated  chancres,  but  without  any    other  symp- 


152 


THE   CAiTAbA   MEDICAL   ftECOEfi. 


toms,  that  they  would  in  all  probability  wholly 
esca|3e  the  secondary  stage.  As  years  have  gone 
on  I  have  found  myself  holding  out  this  hope 
with  increasing  confidence.  My  treatment  has 
been  almost  uniform,  and  has  consisted  in 
giving  mercury  in  the  form  of  grey  powder  in  one- 
grain  doses  three  times  aday,  at  least,  and 
more  frequently  if  the  symptoms  did  not  quickley 
yield.  1  have  always  told  the  patient  that  he 
must  take  these  jiills  for  six  months  at  least.  The 
results  have  also  been  very  uniform,  or  have  va- 
ried chiefly  according  to  the  period  of  the  disease 
at  which  the  treatment  was  begun.  The  effect  of 
the  medicine  in  softening  the  induration  is  usual- 
ly quite  evident  within  a  week,  and  may  be 
expected  to  be  comiilete  in  the  course  of  a  njouth 
or  a  little  more.  After  this  the  patient  remains 
without  symptoms  till  the  end  of  the  course,  except, 
perhaps,  some  slight  persisting  enlargement 
of  the  inguinal  glands.  At  the  end  of  the  six 
months,  if  the  treatment  is  left  off,  there  not  very 
infrequently  follows  in  three  weeks  or  a  month 
an  erythematous  general  eruption.  This  eruption 
is  never  severe,  never  becomes  papular  or  scaly, 
and  always  vanishes  in  a  few  days  if  the  mercury 
is  resumed.  It  is  never  attended  by  failure  of 
health,  and  but  rarely  by  sore  throat.  On  account 
of  its  frequency  after  six  months'  courses,  I  have 
lately  been  in  the  habit  of  continuing  the  treat- 
ment for  nine  or  twelve  months,  and  am  willing 
to  admit  that  it  might  be  wise  to  continue  it  for 
still  longer  periods.  I  must  state  that,  in  a  cer- 
tain proportion  of  case's,  sores,  in  the  mouth  or 
scaly  patches  in  the  palms,  or  a  liability  to  tran- 
sitory erythemata  on  the  skm  have  occurred,  but 
they  have  generally  been  in  connection  with  some 
special  kind  of  irritation. 

"  The  statement  which  I  wish  to  make  quite 
clear  is  this  :  that  I  believe  that  it  is  quite  possi- 
ble by  the  early  and  continuous  use  of  mercury, 
to  suppress  the  secondary  stage — in  other  words 
to  make  it  abortive.  In  exceedingly  few  cases 
where  it  has  been  possible  to  use  mercury  with- 
out interruption  in  this  way  have  I  known  a 
well- characterised  secondary  eruption  or  a  typical 
sore  throat  to  occur.  In  cases  where  diarrhaa 
or  a  sudden  ptyalism  have  caused  the  course  to  be 
interrupted,  the  success  has  been  less  complete  ; 
but  where  the  patient  is  careful,  and  can  bear  the 
drug,  I  may  repeat  that  I  believe  that  it  is  easily 
possible  to  prevent  secondary  symptoms.  This 
assertion  is  not  by  any  means  the  same  as  say- 
ing that  it  is  possible  to  cure  syphilis,  for  it  does 
not  concern  itself  with  the  tertiary  stage.  It  is 
desirable,  I  think,  in  order  that  we  should  arrive 
at  sound  conclusions,  that  we  should  take  our 
problem  in  parts.  In  making  the  proposition 
which  I  desire  to  submit  to  you  this  evening, 
that  mercury  is  a  specific  antidote  for  the  syphi- 
litic virus,  and  that  by  its  use  the  disease  may  be 
made  abortive,  I  will  divide  my  argument  into 
several  parts. 

"The    first  statement  shall  be  one  with  which 


all  will  agree.  It  is  this  :  That  in  cases  in  which 
induration  is  well  characterised  and  considerable, 
it  always  yields  quickly  and  definitely  to  the 
influence  of  mercury.  The  very  rare  apparent 
exceptions  to  this  which  we  witness  occur  to 
those  who  in  a  peculiar  m.thner  resist  the  influ- 
ence of  mercury.  We  never  see  sores  remain 
typically  hard  vihen  the  patient  is  under  the  inflii- 
eiuc    of   mercury. 

"The  next  is  that  in  cases  in  which  high  tem- 
])eratures  have  been  observed  in  syphilis  they 
always  abate  under  the  influence  of  mercury. 

"  .  hirdly,  1  believe  that  all  will  agree  that  when 
a  patient  receives  no  treatment  until  his  eruption 
is  well  out,  the  use  of  mercury  will  usually  in  the 
most  definite  manner  cause  the  eruption  to  disap- 
pear. There  is  but  little  less  certainty  about  this 
than  there  is  as  to  the  disappearance  of  induration 
in  the  sore,  and  the  exceptions  occur  only  when 
the  treatment  disagrees,  and  has  to  be  inter- 
rupted. 

"If  these  several  propositions  be  true,  if  mer- 
cury always  causes  induration  when  present  to 
soften  down,  fever  when  present  to  subside,  and 
an  erui)iion  when  preent  to  disappear,  I  cannot 
think  that  any  will  see  much  improbability  in  the 
assertion  that  if  used  before  the  fever,  rash,  &c.. 
have  shown  themselves,  and  steadily  continued,  it 
will  prevent  their  development.  It  would  be 
extraordinary  if  these  symptoms  should  develop 
de  novo  under  the  very  conditions  which  all  but 
invariably  secure  their  removal  when  extant. 

"  The  practical  questions  which  come,  then, 
before  the  surgeon  are  these — In  what  manner 
and  at  what  stage  ought  mercury  to  be  given  so 
as  best  to  secure  its  antidotal  eflicacy  ?  The  ver- 
dict that  mercury  given  in  short  courses  is  not 
preventive  of  the  development  of  syphilis  has 
been  recorded  in  unmistakable  terms  by  the  sur- 
geons of  the  past  generation.  Mr.  Judd,  indeed, 
whose  reports  are  full  of  interest,  and  contain 
proof  alike  of  ability  and  of  candour,  thought  that 
such  courses  favoured  the  absorption  of  the  virus, 
and  made  the  disease  eventually  more  severe. 
His  courses  were,  however,  of  a  fortnight,  a  month, 
or  six  weeks  at  the  most,  and  were  always  atten- 
ded by  free  ptyalism.  The  modern  introduction 
of  the  small-dose  system,  with  the  avoidance  of 
ptyalism,  makes  it  necessary  that  we  should  inves- 
tigate the  whole  question  anew.  I  do  not  suppose 
that  there  is  mucli  difterence  as  to  the  special  pre- 
paration of  mercury  which  is  employed,  though 
it  will  not  do  to  take  this  for  granted.  Some  of 
the  records  of  M.  Diday  as  to  his  failures  to  pre- 
vent symptoms  would  add  to  the  suspicion  that 
the  iodide  of  mercury,  as  employed  by  him,  is  less 
efficient  than  the  mercury  only,  in  the  form  of 
grey  powder.  The  great  point  is  that  a  prepara- 
tion should  be  used  which  can  be  pushed  with- 
out producing  symptoms  which  necessitate  its  tem- 
porary discontinuance.  Its  efficacy  may  be  taken 
as  proved  by  the  prompt  disappearance  of  the 
primary  induration.     The  dose   which  is  efficient 


THE  CANAbA   IVtEDtCAt   HECJOUft. 


m 


to  this  result  will,  if  steadily  persevered  with,  pro- 
bably be  cfticienl  in  picveiiting  the  development 
of  other  sym|itoms. 

"  I  iiiiist  admit  that  the  gross  total  of  cases  of 
primary  syphilis  which  have  been  under  my  care 
has  not  been  so  large  as  that  wiiich  falls  to  the 
share  of  specialists,  particularly  tliose  holding  hos- 
])ital  appointments.  More  patients  come  tome 
in  the  secondary  or  later  stages  than  in  the  pri- 
mary. Still,  my  ex|)erience  has  been  consider- 
able, and  jiislilies,  I  think,  the  general  statements 
which  I  have  ventured  to  make  to  you  this  even- 
ing. It  is  to  be  clearly  untlerstood  that  I  have 
been  speaking  only  of  cases  in  which  the  indura- 
tion was  characteristic,  and  in  which  an  interval 
of  from  five  to  seven  weeks  had  occurred  since 
the  ex])osure.  I  have  never  allowed  myself  to 
diagnose  a  sore  as  infectious,  or  to  begin  mer- 
cury, except  under  these  conditions. 

"There  is  another  class  of  cases  which  bear 
testimony,  which  is,  I  think,  very  valuable  as 
regards  the  antidotal  efticacy  of^  mercury.  I 
allude  to  those  in  which  the  patient  comes  under 
care  with  his  rash  fully  out,  and  having  as  yet  had 
no  treatment.  The  possibility  of  aborting  the  rest 
of  the  malady  in  these  is  less  certain,  yet  I  think 
we  may  generally  expect  it  with  much  confidence. 
If  such  patients  will  take  mercury  their  symptoms 
will  disappear,  and  if  they  will  continue  it  there  will 
be  no  relapses. 

"  In  conclusion,  I  may  express  my  hope  that  it 
will  have  been  clear  to  all  that  my  object  in  this 
paper  has  not  been  to  claim  credit  for  any  particu- 
lar method  of  treatment,  far  less  to  make  boast 
of  personal  success.  My  wish  has  been  to  draw 
attention  to  a  clinical  fact  which,  although  hitherto 
much  ignored,  or  even  denied,  must  have  been 
for  long  more  or  less  under  the  cognizance  of  all 
engaged  in  the  treatment  of  syphilis  according 
to  modern  rules.  The  fact  to  which  I  refer  is 
that  the  early  use  of  mercury  does  not  only  greatly 
shorten  the  duration  of  the  primary  phenomena, 
but  that  it  also  much  modifies,  and  in  many  ins- 
tances entirely  prevents,  those  of  the  secondary 
one.  I  have  indeed  ventured  to  assert  that,  when 
circumstances  favour  the  febrile  stage  of  the  exan- 
them,  syphilis  may  be  rendered  wiiolly  abortive. 
If  we  can  accept  this  proposition,  1  feel  sure  that 
we  shall  have  gained  a  step  in  the  orderliness 
of  our  future  work,  and  in  reference  to  this  the 
following  problems  seem  to  lie  before  us  : — What 
plan  of  treatment  is  most  successful  in  suppress- 
ing the  febrile  or  secondary  stage  ?  uoes  the  sup- 
pressing of  this  stage  tend  to  prevent  what  are 
called  reminders,  or  those  minor,  and  for  the 
most  part  local,  symptoms  which  often  intervene 
between  the  febrile  stage  and  tertiary  pheno- 
mena? Are  those  in  whom  the  febrile  stage  Ijas 
been  aborted  by  artificial  means  more  or  less 
than  others  liable  to  tertiary  phenomena  ?  Is  it 
possible  by  anticipatory  treatment  to  prevent  or 
abort  the  phenomena  of  the  primary  stage  ;  and, 
if  this   be  done,  what  is  the   infiuence   upon    the 


father  course  of  the  disease  ?  It  has  been  well 
said  that  all  men  use  syllogisms,  whilst  but  few 
have  studied  logi:;  and  in  like  manner  I  may 
remark  that  most  of  us  have  been  jiractising 
more  or  less  com|iletely  the  abortive  treatment 
ofsy[)hilis,   though    without  giving  it   that  name." 

—  Ijiillilnil    Ildxpltill  Giiziltf. 


THE  HYGIENEOF  PHTHISIS. 

From  a  paper  on  the  above  subject  by  Dr.  F. 
L.  Flick,  and  published  in  the  I'ltUadelphia 
Medical  and  Surgical  Reporter,  we  make  the  fol- 
lowing selection : — 

''  Pulmonary  gymnastics  are  powerful  weapons 
against  phthisis,  and  should  be  especially  used 
by  those  who  are  unable  to  extricate  themsel- 
ves from  the  unhygienic  surroundings  and  cir- 
cumstances in  which  their  necessities  have  placed 
them.  Though  the  use  of  a  gymnasium  is  very 
desirable  for  practising  these,  it  is  not  necessary. 
The  principle  involved  is  ventilating  the  unused 
aiv-ceils,  and  any  combination  of  forced  respi- 
ratory movements  that  will  thoroughly  inflate 
the  hmgs  will  accomplish  this.  Gradually  filling  the 
lungs  with  air  whilst  retracting  the  shoulders 
and  extending  the  chest,  or  taking  a  deep  inspi- 
ration whilst  extending  the  arms  above  the  head, 
and  expiring  whilst  placing  them  parallel  with 
the  body,  are  two  simple  exercises  which  do  all 
that  is  necessary,  and  can  be  taken  without 
interfering  with  the  most  busy  life,  or  causing 
fatigue.  A  habit  should  be  made  of  thus  ventilat- 
ing the  unused  portions  of  the  lungs,  and  it  should 
be  done  at  times  when  the  purest  air  can  be 
secured.  The  most  practical  germicide  that  we 
as  yet  know  of  for  the  bacillus  tuberculosis  is 
fresh  air  ;  or,  more  correctly  speaking,  it  fur- 
nishes the  least  favorable  habitat  for  its  develop- 
ment. A  better  oxygenation  of  the  blood  is, 
moreover,  secured  by  such  exercises,  the  circu- 
lation is  stimulated,  and,  indirectly,  the  diges- 
tion and    assimilation  improved. 

"  As  regards  the  hygiene  of  phthisis,  when 
the  disease  is  once  established,  it  is  based  upon 
the  same  principles  as  that  for  its  prevention. 
Sufticient  nourishing  food  and  sufficient  fresh  air, — 
these  are  the  sine  qua  nan.  The  prime  object 
in  every  case  of  phthisis  should  be  to  secure  a 
good  digestion  an  i  assimilation.  Every  thing 
that  is  done  should  be  done  with  this  object  in 
view.  Good,  nourishing,  and  easily  digested 
food  should  be  taken  in  abundance,  and  every 
care  taken  that  the  stomach  be  not  deranged 
by  indiscretions  in  eating  and  drinking,  or  by 
overloading.  As  soon  as  the  body  begins  to  be 
nourished,  the  lungs  will  improve.  As  an  aid 
to  digestion,  outdoor  exercise  is  very  important. 
Without  it  the  system  cannot  be  made  to  use  up 
a  large  quantity  of  food.  Inasmuch  as  warm  cli- 
mates offer  greater  inducements  to  keep  invalids 
out  of  dcors,  and  make  bedroom  ventilation  a 
little  mo-e  agreable,  they  are  highly  commendable 


164 


Me    CANADA    MEbiCAL    RECORD. 


to  consumptives  ;  but  they  are  by  no  means  essen- 
tial to  their  well-being.  A  cold  climate  will  do 
just  as  well,  if  the  patient  has  the  courage  to 
endure  the  discomforts  entailed  by  it.  It  is 
much  better  that  a  consumptive  have  home  com- 
forts in  the  worst  climate  in  the  world  than 
that  he  be  compelled  to  undergo  the  tortures  of 
boarding-house  or  fourth-class  hotel  life  at  a 
health  resort.  In  all  warm  climates  the  houses 
are  built  for  warm-H  eather  use,  and  no  provision 
is  made  for  the  stiay  blizzard  that  occasionally 
comes  along.  Though  the  temperature  may  be 
very  equable  from  day  to  day,  there  is  always  a 
marked  variation  between  day  and  night.  In 
consequence  of  the  ra])id  radiation  of  heat,  the 
houses  become  coo!  and  damp  during  the  night, 
against  which  tliere  is  likewise  no  provision, 
except  in  first-class  modern  hotels.  In  many 
places  suitable  food  is  difficult  to  obtain,  even  at 
the  most  extravagant  prices.  All  in  all,  the  average 
person  who  has  consumption  had  better  remain 
at  home  unless  his  home  is  in  a  large  city,  and 
then  he  should  go  into  a  neighboring  contry, 
where  he  can  secure  home  comforts  and  plenty 
of  suitable  food,  let  him  dress  warm,  take  outdoor 
exercise  whenever  he  can,  eat  plenty  of  light, 
nourishing  food,  take  ample  rest  and  sleep,  and  he 
will  get  along  much  better  in  his  native  hearth  than 
he  would  with  small  means  in  the  most  model 
consumption  climate.  It  is  important  that  the 
entire  body  be  warmly  clad  in  cold  weather. 
Either  silk  or  woollen  clothing  ought  to  be  wore 
next  to  the  skin.  The  circulation  should  be  kept 
equable  throughout  the  whole  body,  hence  the 
extremities  ought  never  to  be  allowed  to  become 
cold.  When  the  feet  get  cold,  the  lungs  become 
congested.  Rubbing  the  body  with  a  coarse 
towel  has  a  good  effect  in  equalizing  the  circula- 
tion. The  ancients  recognized  t'.iis  fact,  and  laid 
stress  on  it.  Balneum  alienum  est,  says  Celsus. 
Sponge  baths,  if  carefully  taken,  will  do  good. 
They  should,  however,  be  taken  in  a  warm  room, 
and  followed  by  a  rest.  Sea-voyages  used  to  be 
highly  recommended  in  the  early  days  of  medi- 
cine, and  theoretically,  at  least,  ought  to  be  bene- 
ficial in  the  first  stages  of  the  disease.  The  ocean 
offers  a  pure  atmosphere,  and  frequently  the  salt 
air  stimulates  appetite  and  improves  digestion. 
In  the  advanced  stages  of  the  disease,  they  are, 
however,  impracticable,  and  should  never  be  at- 
tempted. 

"Gypsy  life,  or  travelling  through  the  country 
by  easy  stages,  and  camping  out,  is  most  benefi- 
cial to  consumptives,  even  in  advanced  stages. 
The  ancients  had  their  patients  carried  from 
place  to  place  in  chairs.  In  the  territories  most 
remarkable  cures  are  brought  about  by  this  mode  of 
living.  Persons  unable  to  walk  are  hauled  in 
wagons  on  improvised  beds,  and  it  is  astonishing 
what  a  revivifying  effect  constant  exposure  in  the 
open  air  has.  But,  though  much  can  be  done  to 
ameliorate  the  condition  of  the  consumptive,  the 
most  important   duty  of  the   medical    profession 


at  the  present  day  is  to  lend  its  aid  in  bringing 
about  such  a  change  in  public  and  private  hygiene 
as  to  give  the  disease  less  chance  for  develop- 
ment." 


CONSTITUTIONAL  CAUSES  OF  THROAT 

AFFECTIONS. 

By  S.  \V.LANGMAir>,"M.D.,  Boston. 

The  N.  Y.  Med.  Jour.,  December  24,  1887.— 
While  I  would  not  be  understood  as  undervaluing 
the  minute  and  systematic  description  of  morbid 
appearances  and  functional  peculiarities  of  the 
upper  respiratory  tract,  I  would  suggest  that  a 
most  interesting  and  important  lesson  to  be  learned 
from  such  observation  and  description  is,  that  all 
that  is  morbid  in  this  region  has  underlying  causes 
which  may  be  external  to  the  body  but  may  be 
intrinsic,  and  the  exhibition  of  natural  or  acquired 
idiosyncrasies  of  the  individual. 

It  has  sometimes  seemed  to  me  that  our  atten- 
tion has  been  too  commonly  fixed  upon  the  local 
morbid  phenomena  of  diseased  throats,  and,  again, 
that  we  are  prone  to  consider  climatic  conditions 
as  causes  rather  th.m  factors  in  the  production  of 
such  disease. 

That  atmospheric  conditions  do  affect  the  res- 
piratory mucous  membrane  no  one  doubts,  but 
why  such  atmospheric  conditions  are  operative  at 
one  time  in  the  same  individual,  and  innoxious  at 
another  time,  is  well  worth  our  consideration. 

That  a  pharyngitis  may  be  the  tell-tale  of  a  poi- 
soned or  morbid  condition  of  the  general  system 
is  evident,  when  we  think-for  a  moment  of  the 
pharyngeal  exhibition  of  acute  diseases,  of  scar- 
latina, of  measles,  of  typhoid  fever,  of  syphilis,  of 
phthisis,  of  sewer-gas  poisoning. 

Who  can  deny  the  morbid  conditions  of  the 
system  which,  although  as  yet  not  well  understood, 
are  known  some  way  to  be  due  to  wrong  function- 
ing in  the  chylopoietic  system  may  be  ihe  fons  et 
on'jo  of  many  intractable  faucial  inflammations? 
That  such  is  the  case,  I  have  enough  evidence  to 
direct  successful  treatment.  The  congested,  exces- 
sively irritable  pharynx  of  alcoholism  is  so  well 
marked  as  to  make  a  diagnosis  unquestionable. 

We  must  look  further  than  the  laryngoscope 
will  enable  us  to  see  if  we  would  rightly  compre- 
hend the  causes  of  the  congested  naso-pharynx 
of  the  young  adolescent.  We  must  consider  in 
young  persons  how  much  the  process  of  the  second 
dentition  has  to  do  with  the  stimulation  of  neigh- 
boring parts. 

The  enlarged  submaxillary  or  cervical  glands 
do  not  always  indicate  a  scrofulous  diathesis  ;  at 
any  rate,  the  abstraction  of  the  decayed  molar  will 
frequently  result  in  the  disappearance  of  the  ob- 
trusive glands.  And  so  it  is  with  the  enlarged 
tonsil. 

I  think  I  shall  voice  the  experience  of  many 
when  I  say  that  one  of  the  most  intractable  dis- 
eases which  we  are  called  upon  to  treat  is  chronic 
recurring  coryza.     In  many  cases    the   treatment 


THE   CANADA   MEDICAL   RECOUD, 


155 


first  advocated  by  our  own  members — the  destruc- 
tion of  the  supersensitive  are.as  in  the  nasal  cliam- 
bers,  or  the  removal  of  obstructinp;  erectile  tissues 
— seems  to  constitute  a  cure,  but  in  other  cases  no 
allowable  destruction  of  the  mucous  membrane  or 
underlying  structures  seems  to  more  than  modify 
the  severity  of  the  seizures  and  the  frequency  of 
their  occurrence.  In  such  cases  we  must  look 
beyond  the  mucous  membrane. 

Let  him  who  has  tried  to  banish  with  sprays  and 
]iencilings  the  long-existing  sensation  of  a  "  lump 
in  the  throat,  which  rises  and  threatens  to  choke" 
his  patient,  try  the  exercising  power  of  a  dose  of 
castor  oil,  and  he  will  be  surprised  to  learn  that  an 
overloaded  colon  has  been  trying  to  tell  its  story 
as  stories  are  told — by  the  throat.  How  often 
will  the  paroxysmal  cough  be  banished  by  the 
same  procedure) 

In  my  experience  the  magic  effect  of  quinine 
upon  an  inflamed  throat  has  been  clearly  shown  in 
a  few  cases  of  former  residents  of  a  malarious 
climate,  exhibited,  I  must  confess  as  a  dernier 
rcssort  when  local  applications  had  failed. 

The  familiar  designation  of  one  form  of  pharyn- 
gitis would  seem  to  imply  that  Nature  herself  set 
tiie  limit  to  unrestrained  sermonizing. 

"Clergyman's  sore  throat"  exists  to-day  and 
teaches  its  lesson  to  those  of  us  who  study  it,  al- 
though it  has  long  ceased  to  masquerade  in  our 
nomenclature  in  clerical  habiliments. 

It  is  a  pharyngitis  with  the  descriptive  prefix 
follicular,  viz.,  long  continued,  chronic.  But  such 
a  pharyngitis  is  not  peculiar  to  the  sacred  teacher. 
Its  origin  is  not  by  any  means  in  the  necessary  use 
of  the  voice.  The  sedentary,  studious  life,  with 
resulting  disordered  digestion,  together  with  other 
conditions  inseparable  from  the  profession  of  the 
priest,  are  quite  enough  to  produce  a  throat  affec- 
tion which  has  been  considered  peculiar  to  clergy- 
men. 

Local  treatment  is  the  nature  of  rcjjair;  the 
constitutional  and  hygienic  treatment  must  be  in 
the  direction  of  renewal  of  normal  processes.  The 
swollen  and  congested  mucous  membrane,  the  hy- 
pertrophied  tonsils,  the  elongated  uvula,  and  the 
prominent  follicles  must  be  regarded  as  symptoms 
only.  The  pain  and  discomfort,  the  spasm  of  the 
glottis,  or  the  recurring  vocal  disability  will  not  be 
banished  for  any  length  of  time  unless  the  under- 
lying constitutional  abnormity  is  removed. 


\ 


AFTER-PAINS. 

By  Theophilus  Parvin,  M.D.,  LL.D.,  Prof,  of  Obs.  and 

Diseases  of  Women   and  Children  Jeft". 

Med.  Coll.  of  Phila.,  Pa. 

Va.  Med.  Monthly,  October,  1887  : — By  many 
practitioners,  after-pains,  if  not  excessive  as  to 
suffering  or  as  to  continuance,  are  regarded  as 
beneficial — evil  bringing  good,  hurt  that  causes 
healing.  They  claim  that  they  are  dependent 
upon  uterine  contractions,  which  secure  thorough 
emptying  of  the  uterus  and  normal  retraction  of 
the     organ,   anc}    thiis    heniorrhage   is   guarded 


against,  and  uterine  involution  promoted.  At  least 
partial  confirmation  of  this  view  is  given  by  the 
well-known  fact  that  these  pains  are  more  severe, 
other  things  being  equal,  after  a  rapid  labor,  or 
in  case  the  uterus  has  been  greatly  distended  as 
l)y  plurii)arous  pregnancy,  or  by  polyhydramnios. 
It  is  not  my  purpose  to  dispute  this  ojjinion  as 
probably  just  in  many  cases.  Nevertheless,  it 
does  not  apply  to  all ;  and  to  make  this  position 
good,  an  inquiry  must  be  made  into  the  cause  or 
the  causes  of  these  pains. 

Almost  all  recent  writers  upon  obstetrics  ex- 
plain after-pains  as  resulting  from  retained  clots, 
or  a  clot,  which  the  uterus  endeavors  to  expel — a 
view  almost  the  opposite  of  that  which,  in  a  past 
age,  was  held  to  explain  the  ascent  of  water  in  a 
pump  ;  nature  abhors  a  vacuum,  so  now  the  uterus 
abhors  a  plenum. 

But  without  further  reference  to  the    etiology  of 
after  pains,  I  wish  to  suggest   that  in    some   cases 
the  affection  is   of  purely   nervous  origin.     How 
often    the  obstetrician    is  reminded   of  the  great 
differences  in  the  response  which  the  womb  gives 
to  irritant  causes  !  Thus   one  pregnant  woman  is 
exposed  to  the  greatest  mental  or  physical  shocks 
without  miscarriage  resulting,   while  in  another  it 
is  produced  by  the  most  trival  causes  :  the  induc- 
tion of  premature   labors  is   in  one  case   effected 
within  twenty-four  hours  by  the  introduction  of  a 
flexible    bougie    in  the  uterine  cavity,    while   the 
same   mean,    conjoined     with     alternate    vaginal 
douches  of  hot  and  cold  water,    may  be  used  in 
another  for  a  week  before   the    desired  result    is 
accomplished.     Now,  the   simplest   and   the  true 
explanation  of  these   different  effects  is  found  in 
the    relative  irritability  of  the   uterus  in  different 
subjects — the  organ  is   normally    irritable  in  one 
woman,  excessively   so    in  a    second,  defectively 
so  in  a  third.  So,  too,  I  believe  that  in  some  cases 
violent   and   tormenting    after-pains   may    be  the 
expression  of  excessive  irritability  of  the  uterus, 
and  that  just  as  we  may  have   vesical  or   rectal 
tenesmus  without  any  inflammatory   change,  and 
without  there   being  ui  either  bladder   or  rectum 
anything  more  than  a  drop  or  two  of  urine  or  of 
mucus    requiring   expulsion,   so  there    may   be  a 
tormenting    and   very   painful    uterine    tenesmus 
when  the  uterus    has  nothing  to    expel,  and   only 
the    normal   lochial    flow   passing   off.     Holding 
this  view,    I  cannot   regard  after-pains  as  in  all 
instances  beneficent,   but   only   evil.     Of  course  I 
know   that   the    use   of  quinine  for  the   relief  of 
after-pains  is  by  no  means  new,  but  I   believe  it, 
in  combination  with  opium,  is  the  best   treatment 
in  case  this  suffering  is  caused  by  excessive  irrita- 
bility of  the  uterus. 

When  rheumatism  seems  to  have  finally  settled 
in  a  certain  joint,  try  this :  Wrap  around  the 
affected  part  several  thicknesses  of  flannel,  first 
soaking  them  in  cod-liver  oil.  Encase  this  in 
oiled  silk ;  and  each  day  remove  the  silk  and  pour 
on  a  teaspoonful  of  the  oil.— PivOF.  Waugh. 


156 


THE   CANADA   MEDICAL   RECORD. 


THE   TREATMENT  OE   RETAINED    PLA- 
CENTA. 

By  Geo.  F.  Hulbert,   MD.,  late  Supt.  Female  Hosp , 
St.  Louis.  Mo. 

Weekly  Med.  Review: — i.  The  treatment  of 
retained  placenta  is  to  be  determined  by  the  con- 
ditions present,  as  regards  presence  or  absence  of 
hemorrhage  and  the  jieriod  of  gestation. 

2.  Before  the  third  month.  Uterine  contrac- 
tion being  ahvays  present,  with  slight  hemorrhage  ; 
ergot,  hot  vagmal  antiseptic  douche,  rest,  good 
food  ;with  pronounced  hemorrhage  or  evidence  of 
decomposition,  curette,  ergot,  hot  intra  uterine,  at 
first,  vaginal  afterward,  douche — rest,  good  food. 

3.  After  third  month,  to  and  at  term  {a)  iner- 
tia and  no  hemorrhage ;  manipulations  tending 
to  excite  uterine  contractions,  as  kneading  of  body 
and  fundus  by  hand  on  abdomen  ;  insertion  of 
two  fingers  in  vagina,  su])porting  and  elevating  the 
uterus  if  nee  essaiy,  fl.  ext.  ergot,  hotdouc!  e;  electri 
city,  in  the  order  named.  These  failing,  delay  with 
work  is  proper  for  a  reasonable  time,  the  limit 
being  an  hour.  Then  insertion  of  the  hand  into 
uterus  and  deliver  as  in  inertia  with  hemorrhage  or 
adherent  placenta. 

(h)  Inertia  with  hemorrhage  ;  wliere  hemorr- 
hage is  slight  and  relaxation  is  of  moderate  degree, 
ergot,  kneading,  hot  douche,  electricity.  No 
delay  is  proper  save  for  the  execution  of  the  above 
means  ;  these  failing  the  rules  for  the  next  condi- 
tion are  imperative.  When  relaxation  and  hemorr- 
hage is  pronounced,  ergot,  kneading  of  uterine 
body,  insertion  of  hand  into  uterine  cavity,  and 
complete,  clean,  and  effectual  delivery  of  secun- 
dines,  followed  by  hot  intra  uterine  antiseptic 
douche,  and  if  necessary  use  electricity,  hot  vine- 
gar, then  stronger  but  less  desirable  styptics, 
should  they  be  demanded. 

4.  When  the  retention  is  due  to  irregular  con- 
tractions, ergot,  mechanical  stimulation  by  hand 
to  the  part  demanding  it.  This  not  availing, 
insertion  of  hand  and  complete  delivery,  as  in 
inertia  with  hemorrhage. 

5.  When  adherent  placenta  is  foimd,  immediate 
separation  by  the  fingers  and  delivery  of  entire 
contents  of  uterine  cavity  before  withdrawal  of 
hand,  followed  by  hot  intra  uterine  antiseptic 
douche. 

The  above  is  our  creed,  and  in  the  forgoing 
will  be  found  the  reasons  for  the  faith  that  is  in  us. 
I  am  satisfied  they  are  based  upon  our  undersand- 
ingof  scientific  application  of  our  knowledge  and 
experience. 

One  word  regarding '•' pulling  on  the  cord,"  I 
advise  no  one  to  do  it  or  not  to  do  it,  for  the 
reason  that  I  cannot  impart  the  degrees  of  the 
pull,  in  pounds  or  any  other  exact  measure ; 
furthermore  it  is  a  very  ineffectual  means  of 
delivering  the  placenta.  I  can  only  say  that 
pulling  on  the  cord  is  a  natural  and  common 
practice    with  rne.     As    far  as  the   danger    fi  om 


inversion  is  concerned,  that  can  be  prevented  by 
an  intelligent  handling  of  the  uterine  body  with 
the  hand  on  the  abdomen.  Any  evidence  of 
inversion  will  be  readily  perceived.  Common 
sense  and  ordmary  judgment  Will  guide  in  the 
force  applied. 

TREATMENT  OF  QUINSY. 

Nortliwi-stcrn  Lancet: — Dr.  F.  P.  Atkinson  says 
in  the  London  Prnclitioner:   The  effervescing  citra- 
tes will  be    found  useful  in  allaying  not  only  this 
but   all   other  kinds  of  glandular  inflammations, 
and  I  order  twenty  grains  of  bicarbonate  of  jiotas- 
sium  to  be  taken  with  fifteen  grains  of  citric  acid 
every  four  hours  in  a  state  of  effervescence.     Guai- 
acum,  which  has  long  been  known  to  be  beneficial 
in  throat  cases,  is  best  given  in  the  form  of  lozen- 
ges made  up  with  black  currant  jam,  in  accordance 
with  the  directions  of  the  pharmacopceia   of  the 
Throat  Hospital,  Golden  Square.     One    of  these 
lozenges  should   be   sucked   frequently.     Iodine, 
when  applied  locally  in  cases  of  glandular  inflam- 
mation, is  known  either  to  reduce  the  enlargement 
or  to  hasten    suppuration,  according  to  the   stage 
in  which  it  exists  ;  and  a  gargle,  containing  from 
twenty  to  twenty-five  minims  of  the  tincture  to  the 
ounce  of  water,  will  be  found   particularly  useful. 
This  may  be  used  by  taking  a  little  in  the  mouth 
and  shaking  the  head  from  side  to  side.     Port  wine 
is  an  essential  part  of  the  treatment,  and  it  is  ne- 
cessary for  the  patient  to  take   from  four  to  six 
ounces  in  the  course  of  the  day,  besides  plenty  of 
beef  tea  and  milk.     By  this  method  resolution  is 
almost  always  brought  about,  and  the  patients  are, 
with  scarcely  a  single  exception,  able    to  resume 
their  usual  duties  about  the  fourth  day.  The  usual 
duration  under  the  old  methods  of  treatment  was 
almost  always  from  nine  to    ten  days.     I    would 
patticularly  urge  upon  those  who  are  willing  to  give 
the  above-mentioned  method  of  treatment  a  trial 
not  to  be  discouraged  if  the   patient  com]3lain   o 
feeling  no  better  or   even   worse  for  the  first  two 
days,  but  to  persist  with  it  all  the  same,  and  they 
will  be  certain  to  meet  with  the  success  they   and 
their  patients  desire.     Though   the  bowels  are  al- 
most always  confined,  it  is  not  advisable  to  admin- 
ister ajserients,  since  as  soon    as  recovery    takes 
place  they  are  moved  as   regularly   as    possible, 
without  any  extraneous  assistance.  When  suppura- 
tion has  commenced  in  the  tonsils  (which  may  be 
looked  for  about  the  sixth  day,  and  made  out   by 
great  throbbing  in  the  ear  on  theaffected  side), it  is 
best  to  omit  the  effervescing  citrates  and  guaiacum 
lozenges,  and  depe.id  upon  the  iodine  gargle,  to- 
gether with  the  port  wine  and  beef  tea.     Suppura- 
tion is  by  this  means  hastened  and  suffering  cur- 
tailed.    In  conclusion  I  would  ask  those  who  put 
this  method  of  treatment  on  trial,  to  keep  a  record 
of  their  cases,  and  after  a  time  make  a  report  both 
of  the  successful  and  unsuccessful  ones,  so  that  we 
may  arrive  at  really  truthful  conclusions  concern- 
ing the  disease. 


THE    CANADA    MEDICAL   RECORD. 


157 


PHYSICIANS  AND  DRUGGISTS. 

The  Indiana  Legislature  has  jiassed  a  law  de 
daring  that  "  From  and  after  the  jiassage  of  thi-i 
act,  no  pharmacist,  druggist,  apothecary  or  other 
person,  shall  refill  more  than  once  jircscriptions 
containing  o])iiim  or  morphine,  or  preparations  of 
either,  in  which  the  dose  of  opium  shall  exceed 
one-fourth  grain,  or  morphine  one-twentieth  grain, 
exce]>l  with  the  verbal  or  written  order  of  a  [ihysi- 
cian. 

A  violation  of  the  law  is  declared  a  misdemeanor, 
pimishablc  by  a  fine  of  not  less  than  ten  or  more 
than  twenty-l'ive  dollars. 

Would  not  a  similar  law  be  in  order  in  Califor- 
nia? Such  a  law  would  not  only  benefit  the 
apothecary,  and  the  physician,  but  the  patient. 
The  proscription  might  be  carried  still  further, 
and  declare  that  no  prcxi-riptimi  should  be  filled  a 
second  time  without  the  consent  of  the  physician. 
It  is  this  repetition  of  formulas,  that  not  only 
detracts  from  the  physician's  fees  (richly  earned) 
but  from  his  rejjutation — e.  g.  A  physician  writes 
a  prescription  for  bronchitis  ;  it  relieves,  and  the 
prescription  is  given  by  the  druggist  to  a  patient 
suffering  from  aortic  aneurism.  It  does  not  relieve, 
and  the  physician  is  c:onsidered  of  no  account. 
Every  medical  man  will  understand  the  proposi- 
tion. It  is  this  "  quacking  over  the  counter,  " 
this  assumption  of  medical  knowledge  gleaned 
from  prescriptions, and  from  superficial  reading  of 
quack  advertisements,  that  calls  for  reprobation. 
Let  us  instance  a  case  not  two  hours  old.  A 
young  man  called  for  advice  for  gonorrhoea.  He 
says:  "I  always  take  any  patient  who  comes  to 
the  store.  I  have  the  prescriptions  of  several 
good  ]jhysicians  and  I  give  them  the  medicine  pre- 
scribed— first  one,  then  another.  By  and  by  they 
get  well ;  or  they  don't — but  I  don't  seem  to  have 
the  same  luck  with  myself.  I  tried  first  one  and 
then  another,  and  really  I  am  worse  off  every  day. 
Now  I  come  to  you  to  get  well. 

Dr. — But  if  I  give  you  my  prescriptions  you 
will  use  them  for  others. 

P. — Yes,  of  course,  I  must  do  it,  to  bring  busi- 
ness, so  that  my  employer  may  keep  me. 

Dr. — Would  you  place  the  prescription  on  file  ? 

P. — Not  if  I  know  it  I  My  boss  would  be  as 
wise  as  I,  and  use  my  knowledge,  and  discharge 
me  as  not  being  a  better  physician  than  himself. 
Don't  he  keep  his  private  formula  from  me?  He 
locks  up  his  formula  book,  and  I  only  do  the  rough 
work.  He  would  not  employ  me  if  I  could  not 
prescribe  for  people  who  ask  for  advice  in  his 
absence.  If  I  go  to  him,  he  looks  in  his  book,  and 
advises  ine  what  to  give,  and  I  give  it.  If  it  don't 
cure,  we  try  some  other  doctor's  prescription. 
If  they  don't  get  well,  no  matter, — we  sell  the 
medicine,  and  charge  big  prices. 

Dr. — But  suppose  you  sent  them  to  a  physi- 
cian? 

P. — Well,  he  would  furnish  medicine  perhaps, 
and  we  would  loose  both  goose  and  feathers.     We 


like  to  get  prescriptions  for  tough  cases,  and  then 
we  gain  so  much  more  ;  but  doctors  have  dropped 
to  it,  and  don't  trust  us  more  than  they  can  help. 
Why,  doctor,  you  would  be  astonished  to  learn 
how  many  physicians  furnish  their  own  medicine. 
ICveiy  doctor  seems  to  have  a  pocket  case,  and  if 
we  get  a  jMescription  nowadays,  it  don't  amount 
to  anything.  The  doctors  are  shy  of  us,  and 
don't  send  as  many  as  usual.  Now,  doctor,  I'll  tell 
you  something.  All  of  your  good  prescriptions  are 
put  up  as  our  own  medicines,  and  advertised  for 
the  cure  of  the  diseases  for  which  you  prescribed 
them.  The  store  is  full  of  them.  Of  course,  I 
mean  yours  and  others.  If  it  was  not  for  these, 
we  w'ould  not  be  able  lo   \ny  exjjenses. 

Dr- — Well,  my  boy,  my  bill  for  you  is and  I 

shall  furnish  medicine — to  prevent  you  from  using 
my  ijrescrijjtions  in  the  store. 

P. — But,  doctor,  I  have  no  money,  but  will 
send  you  patients  enough  to  i)ay  twice  my  fees. 
Will  that  do?  other  doctors  will  do  that. 

Well — no— commissions  of  that  kind  are  not 
acceptable.  You  had  better  try  some  other  i)hy- 
sician. 

This  is  no  fancy  sketch,  but  a  verbatim  conver- 
sation. Will  any  one  ask  why  doctors  keep  the 
medicines  they  prescribe  ?  They  do  not  sell  them, 
perhaps,  but  give,  then  the  patient  m.'ist  return  for 
a  repetition  of  medicine,  mtd/ec. — I'ncijic  Record, 
S'lii  Friinciseo. 


CONTRIBUTION     TO    THE     STUDY     OF 
HYDRASTIS  CANADENSIS. 

.Givopiszew,  of  St.  Petersburg,  has  recently 
made  an  elaborate  study  of  this  old  American 
remedy,  with  the  following  results  : 

1.  Aqueous  extracts  of  hydrastis,  even  in  large 
doses,  are  not  poisonous  to  warm-blooded  ani- 
mals. 

2.  Hydrastis  produces  cardiac  depression  and 
consequent  reduction  of  arterial  tension. 

3.  It  always  produces  uterine  contractions. 
The  aqueous  extract  is  to  be  preferred  for  this 
purpose.  The  contractions  of  the  pregnant  uterus 
near  term  are  most  powerful,  those  of  the  virgin 
uterus  weakest. 

4.  Large  doses  of  hydrastis  may  induce  pre- 
mature labor  after  the  fourth  month. 

The  author  sums  up  the  clinical  uses  of  hydras- 
tis as  follows  : 

1.  Hydrastis  is  an  excellent  remedy  for  uterine 
hemorrhages  due  to  inflammations  or  misplace- 
ments of  his  organ  ;  also  for  profuse  hemorrhages 
occurring  about  the  meno])ause. 

2.  The  uterine  contractions  produced  by  hydras- 
tis are  weaker  than  those  produced  by  ergot. 

3.  The  use  of  this  drug  is  followed  by  no 
untoward  symptoms.  It  produces  no  gastro- 
intestinal disturbance,  but,  on  the  contrary,  will 
frequently^  relieve  dyspepsia. — Bulletin.  Gen.  dc 
Therapeutique. 


158 


THE   CANADA   MEDICAL    RECORD. 


THE  HARM  OF  MODERATE  DRINKING. 

It  is  very  well  known  that  hard  drinking  surely 
kills ;  it  is  equally  well  known  that  moderate 
drinking  is  usually  injurious.  There  are,  however, 
two  forms  of  the  latter  habit :  in  one,  the  indivi- 
dual drinks  moderately  and  only  at  his  meals, .in 
the  other,  he  drinks  over  a  bar,  taking  a  "nip" 
of  whiskey,  a  "cocktail,"  "  fizz,"  etc.,  in  accordance 
with  the  idiosyncrasy  of  his  palate,  his  geographi- 
cal location,  or  personal  associations.  These 
last-named  indulge  in  what  our  continental  breth- 
ren call  "  nipping  "  or  "  pegging,"  and  the  prac- 
tice of  nip|)ing  has  been  apparently  shown  by  Dr. 
Harley  and  others  to  be  injurious  to  health  and 
life. 

Dr.  Harley  gives  the  following  telling  statistics  : 
Death-rate  of  men  between  the  ages  of  twenty- 
five  and  sixty-five. 

Men  PLxposed  to  the  Trmptations  of 
"  Nipping." 

Liver         Urinary 
diseases.       diseases. 

Commercial  travellers 6i  44 

Brewers 96  55 

Inkeepers,  publicans,  vintners, 

barmen,  and  waiters 240  83 

The  comparative  death-rates  of  men  of  the  same 
age  engaged  in  other  industries,  not  exposed  to 
the  temptation  of  "  nipping,"  are,  again,  as  fol- 
lows : 

De.'vth-rate  of  Men  not  Exposed  to  the  Temp- 
tations of  "  Nipping." 

Liver         Urinary 
diseases,     diseases. 

Gardeners  and  nurserymen...  18  39 

Printers 28  30 

Farmers  and  graziers 41  31 

Drapers  and  warehousemen...  35  37 

In  addition  to  the  above  Dr.  Harley  cites  the 
following  statistics  of  beer,  which  apply  to 
Prussia  : 

Probable  Duration  of  the  Life  of  Men. 

In  the  Not  in  the 

Age.  liquor^trade.       liquor  trade_ 

25 26.23  32.08 

35 20-°i  25.92 

45 15-19  19-92 

55 "-16  14-45 

65 8.04  9.72 

Further  statistics  are  given,  showing  the  extra- 
ordinary excess  of  mortality  from  liver  disease 
among  innkeepers,  bartenders,  vintners,  waiters, 
and  publicans,  as  compared  with  persons  in  other 
occupations.     The  ratio  is  as  six  to  one. 

To  all  this  it  may  be  said,  on  the  other  hand, 
that  nothing  lies  like  figures,  and  that,  after  all, 
the  mortality  rate  is  not  greater,  for  example,  in  a 
whiskey-drinking  country  like  Scotland,  than 
in  presumably    temperate    regions    like    certain 


States  of  New  England  or  the  West.  It  is 
more  than  probable  that  Dr.  Harley's  figures 
point  to  the  truth  ;  but  the  question  rises,  in  view 
of  the  pretty  even  range  of  mortality  in  countries 
of  temperate  and  "nijjping"  habits,  whether,  if 
liquor  is  taken  away,  some  other  death-producing 
agency  does  not  set  at  work  ?  We  believe  that 
the  medical  piofession  must,  at  any  rate,  accept 
the  fact  that  "nipping"  shortens  life — N.  Y, 
Medical  Record. 


TREATMENl'  OF  WARTS. 

The  methods  of  treating  warts  have  undergone 
quite  a  revolution  in  the  past  few  years.  Every- 
one almost  has  employed  nitrate  of  silver  or 
nitric  acid  for  their  extirpation,  and  removal  by 
the  knife  or  ligature  has  also  be:n  a  favorite  pro- 
cedure. Of  late,  however,  it  appears  that  the 
same  end  is  obtained  by  internal  medication.  We 
were  told  not  so  very  long  ago,  that  by  taking 
small  doses  of  carbonate  of  magnesium  daily, 
the  warts  would  disapear.  In  a  late  number  of 
the  Bristol  Mcdiio-CInnirgical  Review,  Mr.  Bing- 
ley  G.  Pullin  gives  a  short  account  of  the  benefi- 
cial results  he  has  obtained  by  giving  arsenic 
internally.  In  the  first  case  detailed,  a  young 
lady  of  1 7,  the  hands  were  the  seat  of  the  warts, 
and  a  mixture  containing  liquor  arsenicalis  three 
minims,  twice  a  day,  was  given,  and  in  about  a 
week  the  warts  had  disappeared.  In  another 
case  of  a  boy  of  eight,  two  minims  of  liquor 
arsenicalis  was  administered  twice  a  day  :  in  two 
weeks  all  the  warts  but  one  had  disapiieared,  and 
this  was  easily  removed  by  the  fingers.  In  a 
third  case  in  a  patient  four  years  of  age,  one 
minim  of  the  same  drug  effected  a  cure  in  about 
ten  days,  two  doses  of  the  medicine  being  given 
daily.  Mr.  Puliin  says  that  he  has  treated  a 
number  of  other  cases  with  equally  gratifying 
results,  and  he  very  pertinently  remarks  that  in 
treating  young  children,  especially,  a  j^ainles 
method  is  of  the  highest  advantage.  The  plan  is 
one  which  is  certainly  worth  trying.  Another 
advantage,  which  is  not  mentioned,  is  the  avoid- 
ance of  sores.  There  is  one  point  in  connec- 
tion which  must  not  be  forgotten.  In  all  the  cases 
reported,  it  was  only  the  hands  which  were  invol- 
ved, or  at  least  those  are  the  only  implicated 
parts  which  are  mentioned.  The  question  which 
naturally  arises  is,  will  this  method  act  so  favor- 
ably upon  warts  in  other  regions?  If  so,  it  would 
be  of  the  highest  value,  for  many  persons  are 
affected  with  warts  of  the  face,  neck,  scalp,  etc., 
who  leave  them  go  untreated  on  account  of  the 
terror  which  they  have  for  the  knife  and  caustics  . 
— St.  Louis  Med.  and  Si(rg.  Journal. 


Tight  Lacing  Les-sen^  the  Flow  of  Bile, 
at  least  in  rabbits.  Such  is  the  conclusion  arrived 
of  by  Dr.  W.  J.  Collins  after  a  series  of  experi- 
ments. The  unfettered  action  of  the  diaphragm 
is  essential  to  the  normal  flow  of  bile. 


TnD   CANADA   MEDICAL   RECORID. 


159 


UTRRINK  HEMORRHAGE. 

r.Y  Wii.i.iAM    OooDKi.L,    M.I).,  Prof.  Gyntcolugy  Univ. 
Penn.,  Phila.,  Pa. 

Vd.  Mid.  Monthly  . — Suppose  a  wom.^n  about 
fifty  years  of  age,  wlio  lias  borne  children,  comes 
to  you  with  the  statement  that  at  the  age  of  forty- 
five  tli:  menses  ceased,  and  that  she  had  no 
discharge  of  blood  from  the  vagina  from  that  time 
until  six  months  ago,  when  she  again  began  to 
lose  blood,  what  would  you  suspect?  Vou  should 
suspect  cancer  of  ihe  cervix.  Why  ?  ]>ecause 
as  a  result  of  her  labors  a  laceration  of  the  cervix 
has  probal)ly  hajipencd,  and  carcinoma  has 
developed  in  the  cleft  of  the  tear.  I  will  venture 
to  say  that  in  ninety  five  out  of  a  hundred  cases 
this  diagnosis  would  be  correct.  [I'hat  was  my 
suspicion  in  a  case  which  1  had  placed  under  the 
care  of  Dr.  James  B.  Hunter,  of  this  city,  who 
found  only  fungoid  degeneration,  and  cured  the 
patient  by  dilating  and  curetting  the  uterus.  An 
almost  identical  case  occurred  in  the  practice  of 
Dr.  A.  P.  Dudley,  who  ])resented  theniaeial 
removed  by  the  curette  to  the  N.Y.  Path.  Soc. — 
Ed.] 

Suppose,  however,  that  a  woman,  also  about 
fifty  years  old,  has  not  borne  children,  and  that 
the  menses  have  not  ceased  but  have  continued 
and  increased  in  quantity,  what  then  should  pass 
through  your  mind?  You  should  infer  that  the 
hemorrhage  is  probably  due  to  one  of  two  factors — 
either  to  a  fibroid  tumor,  which  is  the  more 
tommon,  or  to  a  polypus.  The  fact  that  she  has 
not  borne  children  would  tend  to  eliminate  the 
suspicion  of  carcinoma;  for  it  is  exceedingly  rare 
to  find  cancer  of  the  neck  of  the  uterus  in  sterile 
women.  I  have,  however,  seen  this  in  two 
instances,  one  of  which,  however,  tends  to 
strengthen  the  lule.  This  was  the  cnse  of  a  lady, 
about  sixty  jears  of  age,  who  had  a  large  fibroid 
turnor  of  the  womb,  which  in  the  process  of  enu- 
cleation had  forced  open  the  os  to  the  size  of  a 
silver  dollar,  and  was  protruding  from  it.  I 
wrenched  the  tumor  off  and  removed  it.  Cancer 
subsequently  developed  in  the  cervix,  which  had 
been  injured  by  the  long  protrusion  of  the  tumor. 
The  second  exception  came  to  my  notice  a  few 
months  ago.  It  was  that  of  a  married  lady  who, 
I  am  sure,  has  never  borne  a  child.  She  had  a 
cancer  of  the  neck,  of  the  womb,  from  which 
she  died.  Carcinoma  will  sometimes  attack  the 
fundus  of  the  uterus  in  the  sterile,  but  this  is  also 
very  rare. 


THE    MEDICAL    TREATMENT    OF  NOC- 
TURNAL EMISSIONS. 

In  a  recent  number  of  the  Wiener  Medizinis- 
che  Blatter,  Dr.  Thor,  of  Bucharest  gives  some 
particulars  as  to  the  effect  of  antipyrin  in  cases 
of  nocturnal  emissions.  Lupulin  and  camphor 
had  been  justly  abandoned  in  such  cases.  Cursch- 


mann  states  that  the  sedative  effect  of  lupulin  on 
the  genital  organs,  in  spite  of  all  the  rec(jnnnen- 
dations,  was  not  proved.  As  to  cimphor,  it  lias, 
according  to  hisoijinion,  no  better  effect.  Fiirbriii- 
ger  is  of  the  same  opinion.  ZeissI  recominends 
it  in  the  first  place,  as  do  Purgsz,  and  other 
writers.  The  effect  of  mix  vomica  arsenic  and 
atropine  is  also  often  uncertain.  Among  all  the 
remedies  hitherto  employed,  brcjinide  of  potas- 
sium or  bromide  of  sodium  was  the  most  use- 
ful. Diday  recommends  it  to  the  exclusion  of 
every  other  drug-.  Bromide  of  |)otassium,  from 
two  to  five  grammes  in  a  glass  of  water, 
taken  just  before  going  to  bed,  will,  according 
to  his  experience,  exert  a  jjrompt  effect  and 
check  the  pollutions.  The  prolonged  use  of  the 
preparations  of  bromide,  however,  as  is  well 
known,  produced  an  acne-like  eruption,  and  the 
use  of  the  remedy  had,  for  this  reason,  often  to 
be  discontinued.  Dr.  Thor  states  that  he  has 
found  antipyrin  an  excellent  substittite  for  the 
bromides.  He  gives  it  in  doses  of  from  half  a 
gramme  to  one  gramme,  to  be  taken  by  the  jjatient 
a  short  time  before  going  to  bed.  In  seven  cases 
it  had  proved  very  successful,  and  checked  the 
pollutions.  No  disagreeable  after-effects  were 
observed.  In  "  neuroasthenia  sexualis,"  in  the 
sense  of  Beard,  antipyrin  could  also  be  used  with 
good  results;  but  the  dose  had,  in  these  cases, 
to  be  sometimes  increased  from  one  gramme  to 
two  grammes  a-day. — British  Medical  Journal, 
Feb.   18,  1888. 


THINKS  THE    STANDARD  FOR    MATRI- 
CULATION IS  TOO  HIGH. 

The  following  letter  from  a  member  of  one  of 
the  learned  professions — a  "  Fizishan  "  practicing 
in  a  western  town — was  sent  to  us  by  a  wholesale 
firm  with  whom  the  doctor  desired  to  establish 
trade  relations.  The  writer  is  evidently  a  gentle- 
man of  manifold  attainments,  and  some  pleasing 
surprises  in  the  way  of  novelties  in  medicine  and 
perfumery  may  be  expected  when  the  new  labora- 
tory is  In  working  order. 

The  letter  is  printed  rerhatim. 

"  Sir,  as  i  am  goin  into  Patant  medison  this 
spring  quite  extensive  i  have  ben  advised  to  right 
to  you  and  geat  a  catloug  of  you  drugs  and  i  ame 
goin  to  keep  other  medison  as  well  as  make  my 
own  and  all  kinds  of  perfumery  to  day  i  am  makin 
7  kinds  of  medisons  and  i  can  make  as  meney  as 
will  sell  and  i  determan  run  a  wholesale  business 
and  if  you  will  send  me  a  catlog  of  druges  and  if  i 
can  do  bter  with  you  than  i  can  in  Montral  i 
will  deal  with  you  alltogelher  i  remain  youies  Truly 

Proff.  . 

"  I  send  you  a  refernce  from  a  drugist  at  home 
i  hav  delt  with  evry  sence  i  commence  to  make 
medison." — Com.  Phar.  Journal. 


160 


THE   CANADA   MEDtCAl.   RECORD. 


STERILITY  IN  THE  MALE. 

Dr.  Belfield  emphasizes  the  fact,  largely  ignored 
in  practice,  that  potence  does  not  secure  fecundity. 
Natural  desire,  complete  erection,  copious  and 
well-timed  ejaculation,  and  intense  orgasm,  may 
ail  be  exhibited  by  an  absolutely  sterile  man.  The 
responsibility  for  a  childless  marriage  is  popularly, 
and  hut  too  often  professionally,  attributed  to  the 
wife  ;  investigation  of  the  husband  is  omitted,  or 
limited  to  ascertaining  that  the  act  is  normally 
performed.  The  wife  is  treated  ;  iiitra-uterine  appli- 
cations are  made,  pessaries  ajjijlied,  the  cervical 
canal  enlarged  ;  yet  no  conception  takes  place, 
because  no  normal  s])ermatozoa  are  deposited. 

In  every  case  in  which  medical  advice  is  sought 
as  to  barrenness  in  marriage,  the  first  examination 
should  be  directed  to  the  semen,  no  matter  how 
vigorous  and  potent  the  husband  may  be.  Steri- 
lity without  impotence  may  be  due  to  the  absence 
of  normal  spermatozoa  from  the  semen — azoos- 
permism  ;  or  to  the  failure  to  ejaculate — asperma- 
tism.  The  most  frequent  cause  of  aspeimatism  is 
urethral  stricture  ;  a  contraction  which  may  offer 
no  serious  obstruction  to  urination,  may  from  the 
compression  during  erection  prevent  passage  of 
semen.  Gross  suggested  that  the  occlusion  is 
produced  wholly  or  partly  by  spasmodic  contrac- 
tion of  the  urethra  at  the  sensitive  point.  A  con- 
tracted meatus  or  tight  phimosis  in  the  same  way 
might  prevent  the  discharge.  Other  causes  are 
congenital  defects  or  malformations,  inflammatory 
occlusions,  concretions  k  rmed  in  the  seminal 
vesicles  or  prostate,  etc. 

Azoospermism  is  the  most  frequent  cause  of 
male  sterility,  and  is  by  no  means  rare.  This  cause 
was  assigned  by  Kehrer  to  fourteen  out  of  forty 
childless  marriages.  The  most  frequent  causes 
are  bilateral  obliteration  of  the  ejjididymis  and  vas 
deferens  ;  bilateral  orchitis  ;  arrest  of  growth  of 
the  testicles — the  latter  common  in  cryptorchids. 
Of  eighty-three  cases  of  double  gonorrhseal  epidi- 
dymitis, seventy-six  were  afterwards  without 
sperm-cells  in  the  semen.  The  facts  cited  show 
that  childless  marriages  are  often  referable  to  the 
rrale. — Indiana  Md.  Journal. 


THE  UTILIZATION  OF  ANTISEPTICS. 

We  often  neglect  the  use  of  antiseptics  because 
they  do  not  happen  to  be  in  convenient  form  at  the 
time  of  need.  The  following  method  I  have 
found  to  be  of  practical  utility. 

I.  Bichloride  of  Mircury  Solutions.- — R.  Cor- 
rosive sublimate,  gr.  232  ;  muriate  of  ammonia, 
gr.  xs.  ;  aqua,  fj.;  glycerine,  fiij.  Rub 
the  bichloride  and  ammonia  together  in  a  wedge- 
wood  mortar,  until  thoroughly  fine;  then  add  the 
water,  after  this  the  glycerine.  The  ammonia  is 
simply  added  to  produce  greater  solubility  of  the 
mercury.  Keep  in  a  bottle  with  the  prescription 
pasted  on.  One  drachm  of  this  solution  contains 
7  J4^  grains  of  the  bichloride.  One  pint  of  water 
added  to  one  drachm  of  this  solution  gives  i-iooo. 


One  drachm  of  the  solution  added  to  two  pints 
gives  1-2000.  One  drachm  to  three  pints  gives 
1-3000,  etc.  The  i-ioco  solution  may  be  used 
upon  the  skin  preceding  a  surgical  operation,  and 
for  washing  the  hands,  towels,  instruments,  and  to 
wash  out  the  wound  the  first  time  after  the  opera- 
tion. The  1-2000  is  used  in  irrigating  and  to 
rinse  the  sponges.  The  1-5000  may  be  used  as 
a  vaginal  wash  and  for  abdominal  operations. 

2.  Boracic  Acid. —  We  have  the  crystals  and 
the  impaljiable  powder.  A  solution  of  boracic 
acid  may  be  kept  for  general  use.  5.  Boracic 
acid,  cryst.,  3  jv.;  thymol,  pulvis.,  gr.  x.  Dissolve 
the  boracic  acid  in  a  pint  of  boiling  water.  Dis- 
solve the  thymol  in  an  ounce  of  alcohol,  then  mix 
the  two  and  add  glycerine  3  ij.  This  solution 
may  be  used  with  compresses  on  wounds,  and 
may  be  diluted  by  adding  one  to  eight  parts  of 
water,  according  to  the  case.  The  impalpable 
powder  I  use  in  surgical  operations  by  means 
of  a  pepper  box,  applying  it  with  impunity.  In 
the  extirjjation  of  tumors,  I  fill  in  the  cavity  and 
rub  it  into  the  walls  of  the  cavity  ;  I  inlay  gauze 
muslin  with  it  and  apply  as  a  dressing. 

3.  Oil  of  cade. — I  regard  this  as  an  excellent 
dressing  iu  surgical  wounds.  My  method  of  using 
is  as  follows  :  I  saturate  cheese  cloth  with  a  mix- 
ture of  one  part  of  cade  to  three  parts  of  pure 
olive  oil,  wringing  out  the  gauze  to  dryness.  A 
sheet  or  two  of  this  over  the  wounds  protects  the 
parts  and  corrects  all  foul  discharges.  The  adhe- 
sive i)rocess  or  the  granulating  process  proceed 
nicely  under  its  use. — Am.  Med.  Jour. 

WART  CURED  BY  ELECTRICITY. 

By  A,  L.  Smith,  M.  D. 

A.  B.,  medical  student,  set.  19,  had  a  large  "seed" 
wart  on  the  back  of  the  last  phalanx  of  the  right 
index  finger,  which  had  come  there  years  ago,  and 
for  which  he  had  tried  the  usual  well-known  reme- 
dies, such  as  nitrate  of  silver,  nitrate  of  niercury» 
and  various  acids,  without  effect. 

I  passed  a  steel  needle  attached  to  the  negative 
pole  of  the  galvanic  battery  well  into  the  substance 
of  it  on  three  different  occasions,  at  intervals  of 
three  or  four  days,  with  the  result  that  in  three 
weeks'  time  the  wart  was  entirely  gone,  leaving  so 
little  mark  behind  it,  that  it  is  now  almost  impos- 
sible to  see  where  the  growth  had  been  situated. 

Cocaine  in  Operation  for  Hydrocele. — Dr. 
Petit  writes  to  Le  Concoitrs  Medical,  that  before  in- 
jecting the  following  solution  into  the  tunica  vagi- 
nalis : 
Take  of 

French  tincture  of  iodine 45  parts 

Iodide  of  potassium 2  parts. 

Distilled  water 100  parts. 

He  first  injected  : 

Hydrochlorate  of  cocaine 2J  grs. 

Distilled  water   5  drs. 

In  this  way  no  pain  was  experienced  from  the 
operation. 


TIIK   CANADA   MEDICAL   RECORD. 


IGl 


ARTIFICIAl,  FEEDING  OF  INFANTS. 

Dr.  A.  jACor.i,  of  New  York,  in  .1  paper  on  the 
"  Tlier.i|)ciitics  of  Infancy  and  Childhood,"  piib- 
lislicd  in  the  Archives  of  Pediatrics,  says; 

Tlie  [)rincipal  siibstiliitcs  for  l)rcast-niilk  are 
those  of  the  cow  and  goat.  The  mixed  milk  of  a 
daily  is  preferable  to  that  of  one  cow.  Cow's 
milk  must  be  boiled  before  being  used.  Condensed 
milk  is  not  a  uniform  article,  and  its  use  preca- 
rious for  tiiat  and  other  reasons.  Goat's  milk  con- 
tains too  much  casein  and  fat,  bcsitles  being  other- 
wise incongruous.  Skimmed  milk,  obtained  in 
the  usual  way,  l)y  allowing  the  cream  to  rise  in 
the  course  of  time,  is  objectionable,  because  such 
milk  is  always  acidulated.  The  caseins  of  cow's 
and  woman's  milk  differ  both  chemically  and  phy- 
siologically. The  former  is  less  digestible.  There 
ought  to  be  no  more  than  one  per  cent,  of  casein 
in  every  infant  food.  Dilution  with  water  alone 
may  appear  to  be  harmless  in  many  instances,  for 
some  children  thrive  on  it.  More,  however,  ap- 
pear only  to  do  so ;  for  increasing  weight  and 
obesity  are  not  synonymous  with  health  and 
strength.  A  better  way  to  dilute  cow's  milk,  and 
at  the  same  time  to  render  its  casein  less  liable  to 
coagulate  in  large  lumps,  is  the  addition  of  de- 
coctions of  cereals.  It  has  been  stated  before, 
that  a  small  amount  of  starch  is  digested  at  the 
\ery  earliest  age.  But  cereals  containing  a  siTiall 
])ercentage  of  it  are  to  be  preferred,  Barley  and 
oatmeal  have  an  almost  equal  chemical  composi- 
tion; but  the  latter  has  a  greater  tendency  to 
loosen  the  bowels.  Thus,  where  there  is  a  ten- 
dency to  diarrhoea,  barley  ought  to  be  preferred  ; 
in  cases  of  constipation,  oatmeal.  The  whole 
barley-corn,  ground  for  the  purpose,  should  be 
used  for  small  children,  because  of  the  pro- 
tein being  mostly  contained  inside  and  near  the 
very  husk.  The  newly-born  ought  to  have  its 
boiled  milk  (sugared  and  salted)  mixed  with  four 
or  five  times  its  quantity  of  barley-water  ;  the  baby 
of  six  months  equal  parts.  Gum  arabic  and  gela- 
tin can  also  be  utilized  to  advantage  in  a  similar 
manner.  They  are  not  only  diluents,  but  also 
nutrients  under  the  influence  of  hydrochloric  acid, 
Thus  in  .acute  and  debilitating  diseases  which  fur- 
nish no,  or  little,  hydrochloric  acid  in  the  gastric 
secretion,  a  sniall  quantity  of  the  latter  must  be 
provided  for. 


THE  TARIFF  ON  SURGICAL  INSTRU- 
MENTS. 

Perhaps  the  statement  of  a  few  facts  will  assist 
the  reader  in  re.alizing  the  extent  of  the  grievance, 
and  the  justice  of  the  plea,  for  which  we  ask  co- 
operation. 

1.  Physicians  are  at  the  mercy  of  instrument- 
makers  in  regard  to  price,  make  and  quality  of 
finish  because  of  the  lack  of  sufficient  competition. 

2.  The  price  of  instruments  made  in  this  coun- 


try is  out  of  proportion  to  that  paid  for  similar  in- 
struments on  the  continent  of  luiropc. 

3.  Surgical  instruments  and  appliances  are  so 
costly  that  but  few  doctors  entering  the  profession 
can  provide  themselves  with  an  outfit  adequate  to 
carry  on  a  general  practice.  At  present  i)rices  it 
is  impossible  for  a  country  physician's  income  to 
sustain  his  investing  in  costly  instruments,  and  as 
a  result  many  simple  cases,  sui  h  as  retention  of 
urine,  foreign  bodies  in  nose  or  throat,  deep-seated 
abscesses,  etc.,  all  of  which  could  be  relieved  at 
once  with  the  ]jro[)er  instruments,  must  eiiher  die 
from  the  immediate  cause  or  from  the  effects  of 
time  lost  in  seeking  skifful  manipulation,  or  else 
they  are  frequently  crippled  and  disfigured  because 
the  most  intelligent  help,  though  p.itiently  given, 
is  itself  crippled  for  want  of  proper  instruments. 

4.  The  cheaper  grades  of  instruments  are  either 
.antiquated  or  so  poorly  made  thai,  they  may  prove 
a  cause  of  failure  in  (liberations,  sapping,  as  it 
were,  the  natural  inclinations  to  surgery  in  its  in- 
ception. 

5.  European  instruments  are  from  25  to  75  per 
cent,  cheaper  than  ours,  and  their  introduction 
into  the  market  will  enable  the  mass  of  doctors  to 
buy  those  of  prime  necessity,  will  bring  down  the 
price  of  home-made  a|)pliances,  and  oblige  .the 
makers  to  use  good  material  and  put  a  belter  finish 
to  their  work. 

6.  The  removal  of  im])ort  duties  on  surgical  and 
other  instruments  used  by  the  profession,  and  on 
medicines  in  general,  will  produce  the  same  re- 
sults, as  we  all  know  it  did  on  the  article  of  quinine. 
— Sout/ier?i  Practitioner- 

Savann.\h,  Ga.,  January,  iSSS. 


TREATMENT  OF  COLDS. 
Dr.  Whelan   gives    the  following   as  a  specific 
prophylactic  and  therapeutic  remedy  : 

R.     Quinite  sulph gr.  xviij. 

Liquor  arsenicalis Mxij. 

Liquor  astropina: M.j. 

Extract  gentianas gr.  xx. 

Pulv.  gum  acac q.  s. 

To  make  twelve  pills. 

Sig.— One  pill  every  three,  four  or  six  hours, 
according  to  circumstances. 

In  early  colds,  the  nose  and  pharynx  being 
alone  affected,  it  aborts  at  once. — Loru/o/i  Medi- 
cal Record. 


Dr.  Duncan,  in  the  London  Lm.cct  gives  three 
cases  of  entire  relief  from  vomiting  m  uterine 
pregnancy,  by  painting  the  roof  of  the  vagina  and 
the  cervix  with  a  fifteen  per  cent,  solution  of 
cocaine.  In  one  case  the  vomiting  returned  after 
a  week,  when  a  small  plug  of  cotton  wool  soaked 
in  the  solution  was  inroduced  into  the  cervix  for 
a  few  moments.  The  vomiting  did  not  .again 
return. 


162 


THE   CANADA   MEDICAL    RECORD. 


HOW  TO  TREAT  THE    EYE,.  WITH   CIN- 
DER, OR  DUST,  IN  IT. 

R.  W.  St.  Clair  writes  the  3I((I.  Summ'irj/  as 
follows  : 

Nine  persons  out  of  ten,  with  a  cinder,  or  any 
foreign  substance  in  the  eye,  will  instantly  begin 
to  rub  the  eye  with  one  hand,  wliile  hunting  for 
their  handkerchief  with  the  other.  'J'hey  may 
and  sometimes  do  remove  the  offending  cinder, 
but  more  frequently  they  rub  till  the  eye  becomes 
inflamed, bind  a  handkerchief  around  the  head  and 
go  to  bed.  This  is  all  wrong.  The  better  way  is 
not  to  rub  the  eye  with  the  cinder  in  at  all,  but  rub 
the  other  eye  as  vigorously  as  you  like. 

A  few  years  since,  I  was  riding  on  the  engine 
of  the  fast  express  from  13inghami)t()n  to  Corning. 
The  engineer,  an  old  schoolmate  of  mine,  threw 
open  the  front  window,  and  I  caught  a  cinder 
that  gave  me  the  most  excruciating  pain.  I  began 
to  rub  the  eye  with  both  hands.  "  Let  your  eye 
alone  and  rub  the  other  eye  "  (this  from  the  engi- 
neer). I  thought  he  was  chaffing  me,  and  work- 
ed the  harder.  "  I  know  you  doctors  think  you 
know  it  all,  but  if  you  will  let  that  eye  alone  and 
rub  the  other  one,  the  cinder  will  be  out  in  two 
minutes,"  persisted  the  engineer.  I  began  to  rub 
the  other  eye,  and  soon  I  felt  the  cinder  down 
near  the  inner  canthus,  and  made  ready  to  take  it 
out.  "  Let  it  alone,  and  keep  at  the  well  eye," 
shouted  the  doctor  pro  inn.  I  did  so  for  a  minute 
longer,  and  looking  in  a  small  glass  he  gave  me,  I 
found  the  offender  on  my  cheek.  Since  then  I 
have  tried  it  many  times,  and  have  advised  many 
otiiers,  and  I  never  have  known  it  to  fail  in  one 
instance  (unless  it  was  as  sharp  as  a  piece  of  steel 
or  something  that  cut  into  the  ball,and  required  an 
operation  to  remove  it).  Why  it  is  so,  I  do  not 
know.  But  that  it  is  so  I  do  know,  and  that  one 
may  be  saved  much  suffering,  if  they  will  let  the 
injured  eye  alone,  and  rub  the  well  eye.     Try  it. 


GRAVrrV  AS  AN  EXPECTORANT. 

It  is  claimed  in  T/ic  Polyclinic  that  in  cases  of 
pneumonia,  where  there  is  great  embarrassment  of 
breathing  from  accumulation  of  secretion  in  the 
bronchial  tubes,  great  benefit  may  often  be  de- 
rived by  inverting  the  patient  and  having  him 
cough  violently  while  in  this  position.  It  is  easily 
accomplished  by  a  strong  assistant  standing  on 
the  patient's  bed,  seizing  the  sick  man's  ankles, 
turnmg  him  with  his  face  downward,  and  then 
lifting  his  feet  four  or  five  feet  above  the  level  of 
the  mattress.  If  the  patient,  with  his  face  over 
the  edge  of  the  bed  and  his  legs  thus  held  aloft, 
will  cough  vigorously  two  or  three  times,  he  will 
get  rid  of  much  expectoration  that  exhaustive 
efforts  at  coughing  failed  to  dislodge  when  not 
thus  aided  by  gravity.  Life  has  been  saved  by 
repeated  performances  of  this  manceuvre  in  pneu- 
monia accompanied  with  great  cyanosis,  due  to 
inundation  of  the  bronchial  tubes  with  mucous 
secretion. 


READ  MEDICAL  JOURNALS. 

I  secured  a  very  important  case,  many  years 
ago,  and  through  this  one  case  a  number  of  others 
were  brought  to  me.  I  never  knew  until  months 
afterwards  how  I  happened  to  be  selected.  It  was 
in  this  way  :  One  night,  at  quite  a  late  hour,  I 
was  called  to  see  the  family  of  a  prominent  New 
Hampshire  official, temporarily  staying  in  our  town, 
to  whom  I  was  a  perfect  stranger.  After  I  had 
discharged  myself,  and  quite  a  while  afterwards, 
J  learned  that  as  soon  as  this  gentlemen  found 
that  he  required  a  physician,  instead  of  asking  the 
landlord  of  his  hotel,  or  ajipealing  to  some  drug 
store  for  the  name  of  a  doctor,  he  took  a  carriage 
and  drove  to  the  house  of  a  |)Ostmaster.  "  I 
want  a  doctor,"  said  he.  "  Tell  me  which  one  of 
the  doctors  of  this  city  takes  the  largest  number 
of  journals."  The  postmaster  referred  him  to  me. 
As  the  gentleman  was  leaving  the  house  he  said 
to  the  postmaster  :  "A  man  who  takes  the 
journals  of  his  profession  is  well  read  and  up  with 
the  time,  and  that  is  the  doctor  I  want,  to  treat  me 
and  my  family." — T.  L.  Brown,  in  the  Medical 
Ajhinced. 


SOLUTIONS    FOR    WASHING  OUT   THE 
BLADDER. 

Ultzman,  of  Vienna,  uses  the  following  with 
good  results:  For  an  irritable  bladder,  lukewarm 
water  with  a  little  tincture  of  opiuin  ;  or  solution 
of  cocaine,  y^  per  cent.;  or  resorcin,  "^  per 
cent.  ;  or  carbolic  acid,  i/6  per  cent.  When  urine 
decomposes  in  the  bladder,  solutions  of  potassium 
permanganate,  i^ro  per  cent.,  or  3  drops  of  amyl 
nitrite  to  a  pint  of  water.  F"or  phosphaturia  i/io 
per  cent,  salicylic  acid. — Ctntialblatt  fur  Clu- 
rurgie. 


F^CAL  ACCUMULATION. 

Worrall  {"Australasian  Med.  Gas."  Dec,  1SS7) 
reports  a  case  of  fscal  accumulation,  in  a  girl  thir- 
teen years  of  age,  which  presented  the  appearance 
of  a  solid  tumor,  hard  and  nodulated,  distending 
and  nearly  filling  the  abdomen.  The  rapid  growth 
and  stony  hardness  of  the  tumor,  together  with  the 
cachectic  appearance  of  the  patient,  seemed  to  in- 
dicate a  malignant  growth,  but  laparotomy  re- 
vealed the  true  condition  of  affairs.  The  patient 
recovered. 


Professor  Pancoast  showed  at  his  clinic,  a  kvi 
weeks  ago,  a  case  of  restored  hiji-joint.  In  this 
case,  that  of  a  young  woman,  the  femur  had  been 
dislocated  into  the  thyroid  foramen,  and  had  there 
become  anchylosed.  The  femur  was  much 
everted  and  displaced  laterally,  causing  great 
deformity.  Last  spring  Prof  Pancoast  dislodged 
the  neck  of  the  femur,  put  the  bone  in  place,  and 
the  operation  has  resulted  in  an  excellent  joint, 
with  the  leg  in  proper  position. 


I'UE  CANADA   MEDICAL   UECoRD. 


163 


SOMK     I'ORMS   OF    N  K  U  R  A  I.C  I  A 

'JRKATICD  WITH  TIIEINK.* 

Hy  Tmomas  J.  Mays,  M.D.,  of  Pliilailclpliia,  I'n. 

In  treating  this  case,  neuralgia  of  tlie  sciatic 
nerve,  I  would  suggest  the  hypodermic  injection 
of  theinc,  the  beneficial  action  of  which  in  such 
cases  you  have  rcjK'atedly  seen  at  this  clinic.  You 
will  remcmlier  that  in  the  experimentation  whi<  h 
I  did  in  working  out  the  jihysiological  action  of 
tliis  drug,  1  found  that  its  analgesic  or  anxsthetic 
influence  extends  from  the  central  origin  of  the 
nerve  along  its  trunk  to  the  peri[)hery  ;  therefore, 
in  order  to  get  its  remedial  effect,  it  must  be  intro- 
duced at  the  central  seat  of  ])ain — that  is,  over 
the  left  side  of  the  sacrum,  and  not  below  the  hip 
or  at  the  knee.  Another  fact  was  brought  out 
during  these  experiments,  and  that  is,  that  theine 
has  jiractically  no  narcotic  or  stupefyiiig  ])roper- 
ties,  even  in  large  doses,  and  seems  to  expend  all 
its  influence  on  that  portion  of  the  nervous  system 
which  is  located  below  the  seat  of  injection — leav- 
ing the  more  central  parts  intact.  You  will  observe, 
therefore,  that  theine  gives  you  the  analgestic  or 
anodyne  effects  of  morphia  and  atropine  without 
the  central  narcotic  effects  of  the  two  latter  agents. 
I  now  introduce  half  a  grain  of  the  drug  under 
the  skin  directly  over  the  origin  of  pain,  and  if  the 
drug  is  at  all  indicated  in  this  case,  you  will  find 
that  it  brings  relief  in  less  than  five  minutes.  Its 
introduction  causes  a  little  more  pain  than  the  in- 
jection of  morphine,  but  I  liave  never  known  it  to 
produce  any  inflammation  oraliscess.  'I'he  injec- 
tion has  now  been  made  two  minutes,  and  on  being 
questioned,  he  expresses  himself  as  being  relieved. 
On  being  asked  to  sit  down  and  then  to  rise,  he 
says  that  he  experiences  very  little  discomfort  in 
going  through  those  bodily  movements.  In  addi- 
tion to  the  theine  we  shall  order  him  ten  drops  of 
tincture  of  iron  and  one  grain  of  quinine  four  times 
a  day.  We  shall  let  him  go  now,  and  ask  him  to 
return  to-morrow.  As  a  rule,  the  pain  never 
returns  in  its  original  force,  and  if  the  treatment 
is  followed  up,  three  or  four  more  injections,  ad- 
ministered every  second  day,  will  relieve  him 
permanently.  It  is  important,  of  course,  to 
buildup  the  system  with  tonics  and  good  nutritious 
food.  The  action  of  theine  seems  to  be  most  sat- 
isfactory when  the  pain  is  of  a  nervous  rather 
than  of  a  muscular  nature,  although  I  have  seen  it 
act  very  well  in  painful  affections  of  the  back,  which 
are  commonly  believed  to  be  of  a  myalgic  character. 

On  account  of  the  low  solubility  of  theine,  it  is 
advisable  to  use  it  according  to  the  following  for- 
mula : — 


Thein., 

Sod.  benzoat., 

aa 

I] 

Sod.  chlorid. , 

gr.x 

Aqute  destillat.. 

f  Sj 

M. 

SiG. — Six  drops  equal  half  a  grain  of  theine. 
Dose,  from  three  to  twenty  drops. 

•Extract  from  Clinical  Lecture  in  T/ic  /*t»/jY//« /V.June,  1887, 


CHLORIDE     OF     AMMONIUM     IN     THE 

TREATMENT  OF  DISEASES  OF   THE 

LIVER. 

Surgeon-General  W.Stewart,  in  a  communication 
on  this  subject  to  the  Lnnat ,  October  22,  1887, 
refers  to  a  former  communication  of  his  in  which 
he  showed  that,  in  hepatic  congestion,  a  local 
deijletion  of  the  jiort.il  capillaries  is  effected  by 
each  succeeding  dose  of  chKjride  of  nimnonium, 
and  that  this  depletion,  unlike  that  obtained  by 
other  measures,  was  nol  attended  with  depression. 
After  stating  that,  with  the  exception  of  Professor 
Aitken,  the  other  men  in  England  who  had  used 
the  treatment  had  not  given  the  necessary  atten- 
tion to  diet  and  management,  without  which 
successful  results  could  not  be  obtained,  he  |)ro- 
ceeds  to  detail  the  characteristic  symptoms  pro- 
duced by  the  drug  in  hy]jera;Miia  of  the  liver. 
These  symptoms  occur  shortly  after  the  medicine 
is  taken,  in  from  five  minutes  to  half  an  hour. 
Sometimes  a  shock  is  fVlt,  as  if  "something  gave 
way"  in  the  side  ;  ;it  other  limes  a  succession  of 
shocks  is  experienced  in  the  hepatic  region, 
accompanied,  or  not,  by  a  pricking  sensation 
("pins  and  needles"),  or,  as  if  cold  water  were 
trickling  down  the  side;  or  the  action  is  described 
as  that  of  "  pulling"  from  one  hypochondrium  to 
the  other,  or  from  the  margin  of  the  right  costal 
arch  upward  and  backward,  as  if  through  the  liver  ; 
or  a  "  clawing,"  "  working,  "  or  "  gnawing  "  sensa- 
tion is  spoken  of  as  felt  by  the  patient.  With  the 
local  actions  excited  in  the  liver  and  related  jjarts 
motor  impulses  are  similarly  communicated  to  the 
muscles  of  the  intestinal  canal,  thus  increasing 
peristalsis. 

In  addition  to  the  administration  of  the  drug, 
the  patient  should  ba  put  to  bL'd,  and  should  have 
a  urinal  or  bed  pan  constantly  at  hand.  No  solid 
ood  should  ba  given  ;  and  wine,  beer,  or  other 
alcoholic  stimulants  must  be  strictly  prohibited. 
Small  quantities  of  milk  and  beef  tea  are  recom- 
mended, and  the  free  use  of  barley  water,  as  a 
drink.  If  diarrhoea  exist,  a  |)ill  of  two  grains  ot 
mercury  and  three  grains  of  Dover's  powder, 
repeated  every  two  hours  until  four  or  five 
are  taken,  willbe  found  the  most  effectual 
means  of  checking  it,  witliout  the  risk  of 
setting  up  gastrointestinal  irritation.  Looseness 
of  the  bowels  does  not,  however,  contra-indicate 
the  chloride  of  ammonium.  The  only  thing  which 
contra-indicates  the  immediate  use  of  the  drug  in 
acute  cases  is  the  existence  of  a  combined  hot  and 
dry  state  of  the  skin,  with  pyrexia.  Under  such 
circumstances,  its  use  should  be  preceded  by  a  few 
small  and  frequently  repeated  doses  of  solution  of 
acetate  of  ammonium,  till  the  skin  is  rendered 
moist.  Formentations  or  hot  bran  bags  applied 
to  the  seat  of  the  pain  in  the  side  will  be  of  use  in 
aiding  determination  to  the  skin  generally. 

The  author  gives  the  drug  in  doses  of  twenty 
grains  three  times  daily. — Reporter. 


164 


tHE   CANADA    MEDICAL   RECORD. 


A  NEW  METHOD  FOR  SUPPLYING  THE 
CONTINUOUS  OR  GALVANIC  CUR- 
RENT IN  THE  TREATMENT  OF 
FIBROID  TUMORS  OF  THE  UIERUS. 

liY  A.  B.  Carpf.nter,  M.D.,  Cleveland,  O. 

Every  physician  who  has  had  occasion  to  use 
electricity  knows  well  the  difficulty  lie  has  expe- 
rienced in  keeping  his  battery  in  working  order. 

Change  in  temperature,  the  dry  and  moist  con- 
dition of  the  atmosphere,  evaporation,  polariza- 
tion, the  frequent  inspection,  renewal  of  the  battery 
elements  and  fluids,  together  with  the  lal)or  and 
expense  incurred,  lias  placed  a  lax  upon  the  time 
of  the  busy  practitioner,  and  made  the  ojierating 
of  large  batteries  no  trivial  matter  and  withal  a 
burden. 

The  treatment  of  fibroid  tumors  of  the  uterus, 
according  to  the  Apostoli  plan  or  method,  necessi- 
tating, as  it  does,  a  large  number  of  cells,  has 
only  resulted  in  increasing  this  burden,  and,  I 
venture  to  predict,  that  after  the  renewal,  once  or 
twice  a  year,  of  the  battery  elements,  to  say  noth- 
ing of  the  labor  in  keeping  the  fluids  in  proper 
condition,  will  necessitate  not  a  few  physicians 
to  discard  this  valuable  form  of  treatment,  and 
result  in  expensive  iilanis  falling  into  comparative 
disuse. 

So  long  as  electrolytic  work  was  confined  to 
the  use  of  a  small  number  of  cells,  the  labor  and 
expense  of  keeping  in  order  was  proportionately 
light ;  but  with  our  increasing  knowledge  of  the 
subject,  together  with  the  more  general  use  of  the 
milliampere-metre,  whereby  we  are  more  intelli- 
gently, as  well  as  accurately,  informed  of  the 
strength  of  the  current  used,  and  thereby  giving 
us  the  knowledge  to  administer  this  foim  of 
treatment  in  great  strength  on  the  basis  of  exact 
dosage,  the  task  of  caring  for  battei  ies,  made  up 
of  from  seventy-five  to  one  hundred  and  fifty  cells, 
impose  a  task  that  is  something  formidable. 

Dr.  F.  H.  Martin  has  called  the  attention  of 
the  profession  to  a  small  dynamo  that  he  has  had 
constructed,  with  a  view  to  the  sui)i)lanting  of  the 
cumbersome  battery,  and  claims  for  it  both  the 
electrolytic  and  galvano-caustic  currents.  It  is 
designed,  to  be  run  by  an  electric  motor  or  any 
other  convenient  power.  I  had  the  pleasure  of 
witnessing  a  test  of  the  machine  while  on  a  visit 
to  Chicago  a  short  time  since,  and  must  say  that 
it  worked  most  admirably.  I  would  venture  the 
suggestion,  however,  that  the  noise  made  in  run- 
ning will  be  somewhat  objectionable  to  it  for  office 
use. 

The  device  which  we  have  the  pleasure  of  calling 
the  attention  of  the  profession  to  consists  simply  in 
that  of  using  the  current  of  the  incandescent  light- 
ing system  direct  from  the  street  wire  passing  the 
door — Thompson-Houston  or  Edison.  We  have 
the  wire  of  the  former  system  placed  in  our  office, 
and  by  the  means  of  a  rheostat  resistance  sufficient 
to  reduce  the  current  to  a  minimum  is  interposed 


then  by  the  use  of  an  ordinary  switch-board,  the 
current  is  increased  or  diminished  according  as 
resistance  is  cut  in  or  out.  A  milliamp<ire-metre 
is  made  use  of,  whereby  the  current  is  accurately 
measured  while  the  patient  is  in  the  circuit 

The  device  is  absolutely  safe,  as  the  entire  vol- 
tage of  the  wi:e  can  be  handled  without  the 
rheostat  being  used.  My  wire  furnishes  a  very 
smooth  continuous  or  galvanic  current,  with  an 
electromotive  force  of  one  hundred  and- ten  volts 
with  a  maximum  strength  of  11-20  of  an  ampere, 
equal  to  about  eighty  Leclanche  cells.  This  cur- 
rent is  constant,  does  not  vary  in  voltage,  and  is 
always  re.ady  night  or  day,  as  the  main  line  from 
which  my  connections  are  made  is  used  for  com- 
mercial purposes,  and  furnishes  lighting  for  base- 
ments, dark  shops,  and  rooms.  This,  I  am  in- 
formed, is  the  case  in  all  large  and  in  many 
small  cities,  so  that  little  trouble  will  be  met  with 
in  securing  a  wire  with  a  day  current.  When  a 
wire  is  once  placed  in  our  office,  the  task  of  caring 
for  a  battery  of  cells  is  at  an  end,  and  we  have  an 
apparatus  that  is  at  once  always  ready,  reliable, 
econbmical,  cleanly,  and  durable.  The  rapid  in- 
troduction of  the  incandescent  lighting  system, 
together,  will  place  within  the  reach  of  very  many 
physicians  this  current  for  electrolytic  work. 

The  charge  for  the  annual  rental  of  the  wire  is 
Sio,  not  including  the  cost  of  putting  in,  which,  if 
the  main  line  passes  the  door,  should  not  exceed  $5. 
This  device,  as  will  be  seen,  does  away  with  cells 
entirely,  as  well  as  the  time,  trouble,  and  expense 
of  keeping  them  in  order,  and  I  venture  to  express 
as  my  opinion  that  we  have  a  current  superior  to 
any  that  it  is  possible  to  have  generated  from  chem- 
ical action,  besides  economy  of  room,  which  is 
not  a  small  item  in  cramped  quarters. 

A  word  regarding  the  danger  from  contact  with 
the  electric-light  wire.  The  Thompson-Houston 
or  the  Edison  incandescent  system  of  an  electro- 
motive force  of  one  hundred  and  ten  volts,  and  of 
a  strength  of  11-20  of  an  ampere,  is  harmless,  and 
7nnst  not  he  cn»/ounded  with  the  arc  si/stcm  of 
Brush  and  others,  as  the  strength  of  the  latter  is  six 
amperes,  and  of  course  dangerous  and  must  NEVER 
he  used. 

For  the  purpose  of  meeting  and  providing 
against  any  unforeseen  conplications,  as  well  as 
to  anticipate  criticism,  I  have  placed  at  the  office 
terminal  of  the  wire  a  fuse  box,  the  connections 
of  which  are  so  constructed  that  they  will  instantly 
melt,  thus  breaking  the  circuit,  should  anything 
unusual  occur.  Then  if  it  is  remembered  that  the 
entire  voltage  amounts  to  only  about  eighty  Le- 
clanche cells,  I  think  it  will  be  recognized  that  we 
have  a  current  at  once  safe  and  practical. 

I  am  under  obligations  to  Mr.  William  D.  Gra- 
ves, of  this  city,  for  perfecting  and  superintending 
the  construction  of  my  apparatus,  which,  so  far  as 
I  can  now  see,  fulfils  the  object  for  which  it  was 
designed,  viz.,  that  of  supplying  the  continuous  or 
galvanic  current,  independent  of  battery  cells. 

I  may   say  that  I  have  had  the  apparatus   in 


TllK   CANADA    MKDICAL    KKCORD. 


1G5 


daily  use  since  its  complclion  some  weeks  since, 
and  my  expectations  iiave  been  fully  realized  by 
the  simplicity  and  beauty  of  its  action.  The  ap- 
paratus is  not  patented,  and  I  shall  endeavor  to 
place  the  models  in  the  hands  of  some  reputable 
electric  manufacturing  company  to  insure  the  pro- 
fession against  extortion. 


THK  TRKATMEN  r  OF  WOUNDS  1!Y  IODO- 
FORM TAMPON'S. 

Dr.  V.  Uramann  reporls(Arc/iizJ //i r  Klinialie 
Chinn-i^ic,  15erlin,  1S87)  the  results  of  treatment  of 
wounds  in  Von  Jiergmann's  clinic  for  some  years 
past.  The  gauze  employed  is  sterilized  by  means 
of  steam  at  212°,  and  after  drying  may  bt  prcg- 
natcd  with  an  antisejjlic  solution.  The  sterilized 
gauze  is  used  in  cases  of  trifling  operations  in 
small  wounds.  In  larger  wounds  with  more  pro- 
fuse secretion,  it  was  thought  best  to  obtain  what- 
ever advantage  could  be  derived  from  the  impreg- 
nation with  corrosive  sublimate,  especially  as  the 
jjatients  and  operators  are  in  immediate  vicinity 
of  an  audience  coming  direct  from  the  anatomical 
rooms.  The  cotton  emjiloyed  is  of  late  years 
merely  sterilized.  The  towels,  gum  cloths,  sponges, 
etc.,  are  treated  in  a  like  manner.  The  silk  in 
sutures  is  wound  on  glass  or  metal  siiools,  steri- 
lized by  steam,  and  inclosed  in  metal  caskets. 
The  catgut  used  for  deep  stitches  (stitches  of  re- 
laxation), and  for  ligatures,  is  kept  ten  to  fourteen 
days  in  a  solution  of  4  parts  bichloride,  800  of 
alcohol,  200  distilled  water.  This  is  frequently 
renewed.  The  catgut  is  then  changed  to  an  alco- 
holic sublimate  solution  of  i  to  800  alcohol  and 
200  parts  of  water,  and  is  taken  direct  from  this. 
The  preparation  of  the  patient  consists  in  giving 
full  baths,  washing  the  region  of  oi)eration  with 
soap  and  water,  shaving  the  part,  rubbing  the  skin 
with  ether,  and  disinfecting  it  with  from  i  :iooo  to 
I  :20oo  solution  of  sublimate.  The  instruments  are 
kept  in  a  three  per  cent,  solution  of  carbolic  acid. 
During  the  operation  the  wound  is  often  irrigated 
with  I  :2000  bichloride  solution.  In  operations  in 
the  abdomen,  the  pleural  cavity,  the  mouth  rectum 
and  bladder,  salicylic  acid  i  :iooo,  or  boric  acid 
I  :20oo  is  employed,  and  at  the  end  of  the  opera- 
tion a  solution  of  idoform  in  ether  is  generally 
used. 

Next  to  strict  antisepsis,  the  complete  stoppage 
of  bleeding  is  regarded  as  the  chief  agent  in  pro- 
curing union  by  first  intention. 

When  the  wound  is  dry,  and  the  smallest  bleed- 
ing vessels  have  been  tied,  the  suture  is  applied 
with  or  without  drainage,  but  only  in  those  wounds 
which  are  considered  absolutely  antiseptic,  and 
have  not  been  infected  through  previous  suppura- 
tion or  contact  with  unclean  materials.  Among 
the  cases  treated  in  this  manner  are  included  all 
extirpations  of  tumors,  removals  of  breasts,  ampu- 
tations, osteotomies,  etc. 

In  wounds  where  the  bleeding  can  not  be  en- 
tirely stopped,  the  formation  of  a  large  clot  is  ob- 


jectionable, not  only  on  account  of  the  pressure 
which  it  may  make,  as  in  fractures  of  the  skull, 
but  because  of  the  risk  of  decomposition  and  blood 
poisoning.  Although  such  clots  may.  through  .ab- 
sorption and  organization  into  connective  tissue, 
aid  in  the  process  (jf  repair,  they  sometimes  remain 
fluid  for  long  ])eriods,  and  during  that  time  are  a 
source  of  danger.  Therefore  when  it  is  imijossible 
to  dry  the  wound  absolutely,  or  where  theie  is  the 
least  suspicion  that  it  is  not  entirely  aseptic,  after 
thorough  disinfection  with  i  :  1000  bichloride 
solution,  and  with  an  ethereal  solution  of  iodoform 
up]ilicd  to  the  woimd  by  means  of  a  syringe,  it  is- 
loosely  packed  with  stri])S  of  iod(jform  gauze  of 
several  feet  in  length,  and  three  to  four  inches 
broad.  They  are  ajjplicd  so  that  the  larger  part 
of  each  strip  lies  in  the  wound,  and  the  ends  come 
out  at  the  angles.  The  sutures  were  formerly  put 
in  at  this  time,  but  this  has  been  abandoned  on 
account  of  the  difficulty  in  keefjing  them  disen- 
tangled, and  of  their  adhesion  to  the  iodoform 
gauze.  The  patient  is  now  anaesthetized  a  second 
time  for  the  application  of  the  sutures.  The  tam- 
poned wound  is  covered  with  sublimate  gauze  and 
cotton,  and  an  antiseptic  band.ige.  If  the  secre- 
tions make  their  way  through  the  dressings,  the 
suijerficial  layers  are  renewed,  but  the  iodoform 
gauze  is  allowed  to  remain  undisturbed  for  two 
days.  If  it  is  then  removed  by  gentle  traction  on 
the  ends  hanging  out  of  the  wound,  the  latter  is 
foimd  clean,  unirrigated,  not  reddened,  absolutely 
dry,  and  it  is  only  very  exceptionally  that  a  liga- 
ture is  required.  Careful  suturing, with  or  without 
drainage,  has  resulted  invariably  in  union  by  first 
intention,  even  in  those  cases  in  which,  for  any 
reason,  as  great  weakness,  or  for  the  stoppage  of 
bleeding  from  large  vessels,  the  tampon  has  beeu 
left  in  from  four  to  six  days.  His  report  of  his 
result  is  extremely  interesting,  includes  a  large 
number  of  important  cases,  and  appears  to  confirm 
his  estimate  of  the  value  of  this  method. — Aiwri- 
ain  Jijiniial  of  the  McdUal  Sciences. 


REMEDV  IN   ACUTE  CORYZA. 

A  correspondent  from  Prairie  du  Chien,  Wis., 
Dr.  A.  F.  Samuels,  writes,  recommending  highly 
the  following  preparation  in  acute  coryza  : 

R  Pulv.  camph.  -  -  3  j. 

Chloroform    -  -  -  3  j. 

Acidi  benzoic  -  -  3  ss. 

Adipis-         -  -  -  zj. 

To  be  applied  ad  libitum  in  the  nostrils  with 
the  little  finger.  The  above  differs  only  slightly 
from  a  pre[)aration  which  has  been  very  favorably 
received  of  late  in  certain  irritable  conditions  of 
the  skin,  consisting  of  equal  parts  of  cam|jhor  and 
chloral,  diluted  with  about  ten  times  its  weight  of 
vaseline  or  lard.  It  is  an  excellent  application 
on  the  skin,  and  we  should  expect  it  to  give  satis- 
faction also  in  the  nose.  Our  expectation  is 
increased  by  the  experience  of  our  correspondent. 


166 


THE   CANADA   MEDICAL    RECORD. 


The  Canada  Medical  Record 

A  Monthly  Journal  of  Medicine  and  Surgery- 


EDITORS  : 

FRANCIS    W.  CAMPBELL,   MA.,  M.D.,  L.K.CP.  LOND 

E'ttltjr  and  Proprietor. 

R.  A.  KENNEDY,  M.A.,  M.D.,  Managing  KJitor. 

ASSISTANT  EDITOR: 

A,  LAPTHORN  SMITH,  B.A.,  M.D.,  M  RC  S.  Ettg.,  F.OS. 
LONDON, 


tUllSCRirTlON    TWO    DOLLAKS    PER    ANNCM. 


All  communicttliojit!  and  Exelianr/es  vitist  be  addressed  tn 
the  Editors,  OrawerZoG,  Post   Office,  Mnnlreal. 


MONTREAL,  APRIL,  18S8. 


OF    THE    DUTIES    OF    PHYSICIANS    TO 
THEIR  PATIENTS,  AND  THE  OBLIGA- 
TIONS OF  PATIENTS  TO  THEIR 
PHYSICIANS. 

Art.  II. —  Obligations  of  paliculs  to  their  pJiijsi- 
cians. 

1.  The  members  of  tlie  medical  profession, 
upon  whom  is  enjoined  the  performance  of  so 
many  important  and  arduous  duties  toward  the 
community,  and  who  are  required  to  make  so 
many  sacrifices  of  comfort,  ease  and  health  for  the 
welfare  of  those  who  avail  themselves  of  their 
services,  certainly  have  a  right  to  expect  and 
require  that  their  patients  should  entertain  a  just 
sense  of  the  duties  which  they  owe  to  their  medi- 
cal attendants. 

2.  The  first  duty  of  a  patient  is  to  select  as  his 
medical  adviser  one  who  has  received  a  regular 
professional  education.  In  no  trade  or  occupa- 
tion do  mankind  rely  on  the  skill  of  an  untaught 
artist ;  and  in  medicine,  confessedly  the  most 
difficult  and  intricate  of  sciences,  the  world  ought 
not  to  suppose  that  knowledge  is  intuitive. 

3.  Patients  should  prefer  a  physician  whose 
habits  of  life  are  regular,  and  who  is  not  devoted  to 
company,  ])leasure,  or  to  any  pursuit  incompati- 
ble with  his  professional  obligations.     A  patient 


should  also  confide  the  care  of  himself  and  family, 
as  much  as  posible,  to  one  physician :  for  a  medi- 
cal man  who  has  become  acquainted  with  the 
peculiarities  of  constitution,  haBits  and  predispo- 
sition of  those  he  attends  is  more  likely  to  be  suc- 
cessful in  his  treatment  than  one  who  does  not 
possess  that  knowledge. 

A  patient  who  has  thus  selected  his  physician 
should  always  apply  for  advice  in  what  may 
appear  to  him  trivial  cases,  for  the  most  fatal 
results  often  supervene  on  the  slightest  accidents. 
It  is  of  still  more  importance  that  he  should  apply 
for  assistance  in  the  forming  stage  of  violent 
diseases  ;  it  is  to  a  neglect  of  this  precept  that  medi- 
cine owes  much  of  the  uncertainty  and  imper- 
fection with  which  it  has  been  reproached. 

4.  Patients  should  faithfully  and  unreservedly 
communicate  to  their  physician  the  supposed 
cause  of  their  disease.  This  is  the  more  import 
tant,  as  many  diseases  of  a  mental  origin  simulate 
those  depending  on  external  causes,  and  yet  are 
only  to  be  cured  by  ministering  lo  the  mind 
diseased.  A  patient  should  never  be  afraid  of 
thus  making  his  physician  his  friend  and  adviser; 
he  should  always  bear  in  mind  that  a  medical 
man  is  under  the  strongest  obligations  of  secrecy. 
Even  the  female  sex  should  never  allow  feelmgs  of 
shame  or  delicacy  to  prevent  their  disclosing  the 
seat,  symptoms  and  causes  of  complaints  pecu- 
liar to  them.  However  commendable  a  modest 
reserve  may  be  in  the  common  occurrences  of  life, 
its  strict  observances  in  medicine  is  often  attend- 
ed with  the  most  serious  consequences,  and  a 
patient  may  sink  imder  a  painful  and  loathsome 
disease,  which  might  jiavc  been  readily  prevented 
had  timely  intimation  been  given  to  the  physi- 
cian. 

5.  A  patient  should  never  weary  his  physician 
with  a  tedious  detail  of  events  or  matters  not 
appertaining  to  his  disease.  Even  as  relates  to 
his  actual  symptoms,  he  will  convey  much  more 
real  information  by  giving  clear  answers  to  inter- 
rogatorieS;  than  by  the  most  minute  account  of 
his  own  framing.  Neither  should  he  obtrude  upon 
his  physician  the  details  of  his  business  nor  the 
history  of  his  family  concerns. 

6.  The  obedience  of  a  patient  to  the  prescriptions 
of  his  physician  should  be  prompt  and  implicit. 
He  should  Jiever  permit  his  own  crude  opinion  as 
to  their  fitness  to  influence  his  attention  to  them. 
A  faikird  in  one  particular  may  render  an  other- 
wise judicious   treatment    dangerous^  and  even 


THE   CANADA    MEDICAL   RECORD. 


107 


fatal.  This  remark  is  equally  applicable  to  diet, 
drink  and  exercise.  As  patients  become  convales- 
cent, they  are  very  apt  to  sujjpose  that  the  rules 
prescribed  for  them  may  be  disregarded,  and  the 
c(jnsequence,  but  too  often,  is  a  relapse.  Patients 
should  never  allow  themselves  to  Ije  persuaded  to 
take  any  medicine  whatever,  that  may  be  recom- 
mended to  tiiem  by  the  self  constituted  doctors 
and  doctresses  who  are  so  frequently  met  with, 
and  who  pretend  to  possess  infallible  remedies  for 
the  cure  of  every  disease.  However  simple  some 
of  their  prescriptions  may  a|)pear  to  be,  it  often 
happens  that  they  are  i)roductive  of  much  mis- 
chief, and  in  all  cases  they  are  injurious,  by  con- 
travening the  ph.n  of  trialment  adopted  by  the 
jihysician. 

7.  A    ])atieiit     should,    if    possible,    avoid    the 
frienJIi/  visits  of  a  pliysician  who  is  not  attending 

him — and  when  lie  does  receive  them,  he  should 
never  converse  on  the  subject  of  his  disease,  as 
an  observation  may  be  made,  without  any  inten- 
tion of  interference,  which  may  destroy  his  confi- 
dence in  the  course  he  is  pursuing,  and  induce  him 
to  neglect  the  directions  prescribed  to  him.  A 
jiatient  should  never  send  for  a  consulting  physi- 
cian without  the  express  consent  of  his  own  medi- 
cal attendant.  It  is  of  great  importance  that 
physicians  should  act  in  concert;  for,  although 
their  modes  of  treatment  may  be  attended  with 
equal  success  when  applied  singly,  yet  conjointly 
they  are  very  likely  to  be  productive  of  disastrous 
results. 

8.  When  a  patient  wishes  to  dismiss  his  physi- 
cian, justice  and  common  courtesy  require  that  he 
should  declare  his  reasons  for  so  doing. 

9.  Patients  should  always,  when  practicable, 
send  for  their  physician  in  the  morning,  before 
his  usual  hour  of  going  out;  for,  by  being  early 
aware  of  the  visits  he  has  to  pay  during  the  day, 
the  physician  is  able  to  apportion  his  time  in  such 
a  manner  as  to  prevent  an  interference  of  engage- 
ments. Patients  should  also  avoid  calling  on 
their  medical  adviser  unnecessarily  during  the 
hours  devoted  to  meals  or  sleep.  They  should 
always  be  in  readiness  to  receive  the  visits  of  their 
physician,  as  the  detention  of  a  few  minutes  is 
often  of  a  serious  inconvenience  to  him. 

10.  A  patient  should,  after  his  recovery,  enter- 
tain a  just  and  endearing  sense  of  the  services  ren- 
dered him  by  his  physician  ;  for  these  are  of  such 
a  character,  that  no  mere  pecuniary  acknowledg- 
ment can  repay  or  cancel  them. 


SACCHARINE. 

The  article  of  sugar  enters  so  largely  into  our 
ordinary  diet  that  the  diabetic  patient  and  those 
suffering  from  polysarcia  find  it  a  terrible  hardshij) 
to  be  deprived  of  it.  The  chemical  curiosity  of 
the  laboratory,  saccharine  had  not  long  to  wait 
before  being  turned  to  useful  accoimt  in  the  treat- 
ment of  these  two  pathological  conditions.  Owing 
to  its  being  excreted  by  the  kidneys  in  exactly  the 
same  condition  in  which  it  is  ingested,  it  can  have 
no  injurious  effect  upon  the  [jatient,  and  in  any 
case  the  amoiuit  required  to  sweeten  food  is  ex- 
ceedingly minute.  Mr.  Dyer  of  Philip's  Square 
showed  us  the  other  day  some  little  tablets  each 
containing  one  grain  of  saccharine,  and  one  of 
which  he  assured  us  was  amply  sufficient  to  sweet- 
en a  large  cup  of  coffee. 


BICHLORDKOF  MERCURY. 

At  the  same  time  our  attention  was  called  to 
some  capsules,  each  labelled  poison,  packed  in 
boxes  of  twenty-five,  and  each  of  which  capsules 
containing  enough  corrosive  sublimate  to  make, 
when  added  to  one  pint  of  warm  water,  a  1  in 
1000  solution.  We  have  for  some  time  past  been 
using  tablets  of  the  saine  size  and  strength  in  our 
obstetric  and  gynecological  practice,  and  have 
ound  them  very  convenient,  but  these  labelled 
capsules  add  the  element  of  safety  to  that  of  con- 
venience. 


COMPOUND  MEDICINES. 

Sir  Dyce  Duckworth,  M.D.,  of  London,  says: 
There  is  a  great  tendency  now  to  employ  concen- 
trated preparations  and  to  use  drugs  singly.  This 
results  from  laboratory  rather  than  from  bedside 
research.  There  is  less  polypharmacy  now  than 
formerly,  but  I  am  satisfied  that  there  is  also  less 
good  prescribing  than  in  my  student  days.  The 
art  of  combining  drugs  has  been  much  lost,  and  I 
think  the  practice  of  physic  is  by  so  much  the 
poorer. 

I  have  no  doubt  that  these  opinions  will  prove 
shocking  in  some  quarters,  but  I  simply  state  what 
I  believe  to  be  true.  It  is,  I  think,  certain  that 
some  drugs  are  more  effectual  in  combination  with 
others  than  when  given  by  themselves. 


1G8 


TUE   CANADA   MEDICAL    UECORD. 


PERSONAL. 

Dr.  Rollo  Campbell  (M.D.,  Bi.shop's  College, 
1887)  passed  the  first  portion  of  the  examination 
for  the  Licentiate  Diploma  of  the  Royal  College 
of  Pliysicians,  London,  on  the  4th  and  13th  of 
this  month.  Last  month  Dr.  Campbell  was 
elected  one  of  the  attending  staff  of  the  Montreal 
Dispensary,  and  granted  leave  of  absence. 

Dr.  McClure,  late  .Superintendant  of  the  Mont- 
real General  Hospital,  intends  to  devote  his  life 
to  the  work  of  a  Medical  Missionary  in  India. 
Dr.  McCiure  intends  visiting  England  the  first 
week  in  June,  but  will  return  to  Montreal,  before 
taking  his  final  departure  for  the  scene  of  his 
future  labors. 

Dr.  Cam]3bel!,  the  Editor  of  this  Journal,  left 
for  England  on  the  31st  March  by  the  Canard 
SS.  Umbria.  He  will  return  early  in  May.  This 
will  account  for  the  want  of  attention  which  some 
business  letters  have  received. 

Dr.  Gardner,  Professor  of  Gynaecology,  who  has 
been  quite  ill,  is,  we  pleased  to  know,  on  a  fair  way 
towards  convalescence.  At  present  he  is  sojourn- 
ing at  Atlantic  City,  U..S. 

Dr.  Clarke  (M.D.,  Bishop's  College,  1888)  has 
left  for  Edinburg,  where  he  proposes  presenting 
himself  for  the  triple  Scotch  qualification. 

Mr.  Jack  of  Bishop's  College  has  been  appoint- 
ed Resident  Clinical  Assistant  at  the  Western 
Hospital,  Montreal. 


NOTICES  OF  BOOKS. 

We  beg  to  acknowledge  the  receipt  from  the  enter- 
prising firm  of  publishers,  Messrs. Geo.  Davis  &  Co., 
of  Detroit,  a  very  neat  and  interesting  little  work  en- 
titled "  AJ^few  Treatment  of  Chronic  Metritis  and 
Endometritis  by  Intra-Uterine  Chemical  Galvano 
Cauterizations,"  by  Apostoli,  of  Paris,  and  trans- 
lated into  English  by  A.  Lapthorn  Smith,  lecturer 
on  gynecology  in  Bishop's  College,  Montreal.  The 
book  contains  chapters  on  electrical  tools,  opera- 
tive procedure,  general  consideratigns,  cgnc'usions, 


and  appendix.  The  first  part  of  the  work  is  really 
an  exposition  of  Apostoli's  method  of  applying  the 
continuous  current,  either  positive  or  negative 
according  to  the  indications  to  fii'broids  as  well  as 
toother  hy[iertro]jhic  and  hemorrhagic  diseases  of 
the  uterus,  while  tiie  aijpendix  gives  one  a  very 
fair  idea  of  the  uses  of  the  interrupted  current  in 
the  various  fimctional  dirangemeuts  of  tliat  organ. 

We  clip  the  following  reference  to  it  from  the 
Cincinnati  Medical  Journal  [or  April  :  "  Apostol, 
claims,  and  justly,  too,  that  he  has  endowed  intra- 
uterine therapeutics  with  one  more  arm,  which  is 
precise,  mathematical,  dosable,  and  localizable, 
which  may  be  administered  in  the  smallest  doses 
and  increased  without  danger,  at  the  will  of  the 
operator.  Owing  to  Dr.  Smith's  familiarity  with 
the  language,  the  translation  is  a  most  excellent 
one." 

It  is  for  sale  by  Ashford,  bookSeller,  Dorchester 
St„Montreal,  price  $1.00. 


NEW  PUBLICATION. 


THE  NOVELI.ST. 

(A  Novel  Enterprise.) 

Novel  in  name,  form,  purpose  and  method  is  T/ie 
Ncnv/isI,  Alden's  new  weekly  magazine  of  Am.-rican 
fiction. 

It  undertakes  to  give  the  worthiest  fiction  that  AlMERl- 
C./A^autliors  can  \x  tempted  to  produce.  Foreign  authors 
not  .admitted.  It  is  not  sentimental  talk  about  justice  to 
American  authors,  but  is  bold,  practical  action. 

It  is  certainly  handy  in  form,  beautiful  in  diess,  excellent 
in  all  mechanical  qualities,  and  low  in  price  ;  well  suited 
in  all  respects  to  meet  the  wants  of  the  intelligent  millions 
who  are  capable  of  appreciating  "  the  best  " — it  will  nut 
stoop  to  compete  with  the  "  gutter -fiction  "  of  the  sensa- 
tional periodicals  and  libraries. 

Terms,  |i  a  year,  at  which  rate  it  will  give  over  2,500 
pages,  equal  to  from  eight  to  twelve  ordinary  American 
dollar  novels. 

The  stories  will  follow  successively,  one  at  a  time,  a 
novel  of  ordinary  length  tlius  being  completed  in  from  four 
to  eight  weeks.  If  one  story  does  not  please,  you  will  not 
have  long  to  wait  for  the  next.  For  a  ten-cent,  subscrip- 
tion (if  you  don't  wish  to  enter  for  all  at  §1),  you  will  re- 
ceive the  first  chapters  of  every  story  published  during  the 
year,  which  you  can  then  order  separately,  if  you  wish .  A 
specimen  copy  of  77^1^  A'iw^/;rf  will  be  sent  free  on  re- 
quest. Address,  John  B.  Alden,  Publisher,  393  Pearl  St. 
New  York  ;"  P.O.  Box  1227. 


THE  CANADA  MEDICAL  RECORD. 


Vol.  XVI. 


MONTREAL,    MAY,    1888. 


No-g 


COIsTTElNrTS. 


ORIGINAL  COMMUNICATIONS. 

Oliytctri.'s  aiul  (iyncrology 

PROGRESS  OF  SCIENCE. 
Thf  Troatincnt  of  Carbuncle  with  Car- 

l)'ili/,e(i  Spray 

lUMiiaiks  on 
Acnt 


Koetlieln. 


fttijji'aine  in  i'liiliiren 

Tlio  'Jrcalment  of  Bronchitis. ,. 

lirentliing  Kxert-isei  in  the  Prevention 
and 'i'rualnieiit  of  I.ung  Diseasea.  ... 

Placenta  Previa 

Note-i  oil  the  Treatment  of  Acute  Ton- 
sillitis in  Children 


liyftoilerinic  Use  of  N'itro;,Mycerinc  in 

'ik-art  Failure 183 

(laivaiiism  in  the  Treatment  of  Fibrous 

•riiiiiors  of  th.;  Uterus 184 

Tim    KtVocts    of     Antipyrctica    in    the 

Tn-atnit-nt  ««f  Disfasc  185 

Piitholojiy  of  Abortion  in   Relation  to 

Treatment ■     186 

When  to  open   a  Felon,  ami  How  to 

Abort  it 180 

Tasteless  Quinine 187 

A  New  Treatment  of  .sleeplestness.  ...  IHS 
Peppemiint  Water  in  Pruritus  Pudetuli.  18.S 

Treatment  of  Wart?!. 189 

Advances  in  the  Treatment  of  Syphilis.  Is9 


Tincture  of  Iron  ;  Its  Admhiistratinn  .  189 

For  Chilblains 186 

Jaborandj  in  Obsfri-trie  Praclice. 188 

Treatment    of    Post-Partum    Hemorr- 
hage  190 

Poiwniiing    by    a    Ten-Grain    Dose    of 
Antipyrin 190 

EDITORIAL. 

Burial  Reform 190 

Western  Hospital  191 

Iniproveinenis  in  Pliarniacy li»I 

The  C'ode^)f  Kthies  ol   the  American 

Medical  Association 192 

Personal   192 


drioinal  Bommunicaiiatd. 

OBSTETRICS  AND  GYNECOLOGY. 
By  Lapthorn  Smith,  Lecturer  on  Gynecology  Bishop's 
College,  Montreal. 

At  the  Bronipton  and  Sussex  Medico-Chiniigi- 
cal  Society,  a  paper  was  read,  {N.  Y.  Alcd.  Record, 
9th  June,  '88)  by  Sir  Spencer  Wells,  one  of  the 
greatest  living  abdominal  surgeons,  or  perhaps 
indeed  the  greatest  who  has  ever  lived,  on  the 
electrical  treatment  of  diseases  of  the  uterus. 

He  stated  that  after  visiting  Apostoli's  clinic, 
and  carefully  examining  60  of  his  cases,  the  con- 
viction was  irresistible  that  though  the  metliod 
might  not  have  reached  perfection,  the  work  so  far 
as  it  went  was  good.  If  the  women  were  not  radi- 
cally dispossessed  of  their  tumors  they  were  symp- 
tomatically  cured.  After  enumerating  the  various 
forms  of  uterine  disease  under  Apostoli's  care,  he 
says  :  "  In  the  treatment  of  these  conditions, instead 
of  scraping  and  cauterizing  the  cavity  with  the 
curette,  or  caustics,  or  fire,  Apostoli  does  the  same 
thing  with  a  pole  of  the  galvanic  battery.  We 
give  ergot,  or  mercury,  or  iodine,  or  bromine, in  the 
hope  of  altering  the  nutrition  of  the  diseased  mass  ; 
he  sends  a  disintegrating  current  through  it.  We 
castrate  to  cut  short  a  woman's  sexual  existence; 
he  seeks  to  quiet  down  neurotic  sensibility,  and 
induce  regularity  of  ovarian  function.  Where  we 
proceed  to  a  root  and  branch  extermination,  he 
proposes  a  denutritive  paralysis  of  the  uterine  sub- 
stance. Time  will  show  whether,  and  how  far,  he 
surpasses  us  in  his  results." 


"  Where  the  object  is  mainly  to  suppress  hem- 
morrhages,"  he  says  "electrical  treatment  has  de- 
cided advantages  over  other  practices.  Should  the 
tumor  be  growing,  but  not  advanced  beyond  the 
limits  of  reasonable  surgical  interference,  balanc- 
ing the  comparative  risk  I  should  be  disposed  to 
put  the  matter  to  the  test ;  since,  in  case  of  failure, 
tlic  more  hazardous  operation  of  removal  can  still 
be  done.  In  my  opinion  with  tlie  option  before 
her,  It  would  be  neither  wise  nor  charitable  to  give 
a  patient  strong  advice  in  favor  of  immediate  cut- 
ting operation." 

My  own  experience  fully  bears  out  his  opinion 
when  he  says  :  "  Experience  seems  to  show  that 
there  is  a  group  of  cases,  numarous  as  they  are 
troublesome,  of  chronic  metritis  with  enlargement 
and  surrounding  deposits,  which  may  be  cited  as 
pre-eminently  eligible  for  electrical  treatment;  they 
are  as  regards  thepatient,painful  and  exhausting  to 
the  judicious  surgeon,  they  are  exhausting  by  their 
rebelliousness,  and  in  some  rash  hands  they  have 
opened  the  way  to  practice  more  lamentable  than 
the  disease.  It  will  be  one  of  the  crowning  merits  of 
electro  therapeutics,  if  proved  to  be  equal  to  brfng 
relief  to  these  patients.  Recent  reports  give  good 
reason  to  hope  that  this  end  may  be  realized  by  a 
careful  use  of  the  positive  galvano  pimcture." 

In  a  late  issueof  this  Journal  was  published  the 
magnificent  testimony  of  Keith,  the  greatest  of 
Scotch  abdominal  surgeons  in  favor  of  Apostoli's 
method.  As  I  was  the  first  in  Canada  to  put  his 
method  into  practice,  this  testimony  of  Sir  Spen- 
cer Wells  is  especially  pleasing  to  me.  When 
such  men  as  Spencer  Wells  and  Keith  believe  in 
it,  I  can  hardly  find  any  room  for  doubt. 


170 


THE   CANAbA  MEDtCAt  tlfedOSO. 


I  have  at  present  a  number  of  cases  under 
treatment  of  hyperplasia  uteri,  and  of  chronic 
metritis  and  endometritis,  in  many  of  which  the 
most  urgent  symptoms  was  hemorrhage,  wliich  the 
positive  galvano  cautery  has  never  failed  to  cure, 
on  the  one  condition  however  of  using  it  strong 
enough. 

In  obstructive  dysmenorrhcea  it  affords  a  safe, 
easy  and  almost  painless  method  of  opening  the 
stricture  at  the  internal  os.  I  hope  shoitly  to 
publish  a  number  of  these  cases  in  detail. 

It  has  often  been  stated  that  the  dangers  of 
sp  .'cialism  are  to  be  found  in  the  tendency  of  its  de- 
votees to  so  concentrate  their  attention  on  the  dis- 
eases of  their  special  organ  that  they  fail  to  see  the 
general  disorders  of  the  whole  system,  on  which 
very  often  the  special  disease  depends.  It  is  a 
healthy  sign  therefor  of  the  progress  of  Gynecology 
to  see  in  the  Centralblatt  fur  Gynecologic,  March 
31,  1 888,an  article  by  a  leading  writer  entitled  "  the 
Cure  of  Prolapsus  Uteri  by  Exercise  of  the  Pelvic 
Afuscles  and  Methodical  F'levation  of  the  Uterus." 
It  is  known  as  the  method  of  Brandt  of  Stockholm . 
The  movements  are  of  three  kinds,  elevation  of  the 
uterus,  opposed  movements  of  the  hipjoint,  and 
percussion  of  the  lumbar  and  sacral  regions.  The 
patient  is  placed  on  a  couch  in  the  lithotomy  posi- 
tion ;  the  operator  stands  at  her  left  side  facing 
her,  and  presses  the  palms  of  his  hands  dee])ly 
between  the  symphisis  and  the  fundus  uteri,  while 
at  the  same  time  an  assistant  keeps  the  uterus 
anteflexed  by  his  finger  introduced  into  the  vagina. 
The  operator  grasps  the  uterus  and  draws  it  up- 
wards, then  allows  it  to  sink  back  into  its  place  ; 
at  the  same  time  the  finger  of  the  assistant  follows 
the  organ  upward,  and  by  pressing  on  the 
anterior  fornix,  prevents  it  from  becoming  retro- 
verted.  This  manctuvre  is  repeated  three  times 
at  each  seance. 

The  patient  being  in  the  same  position,  adducts 
the  thigh,  bringing  the  knees  and  heels  in  close 
contact ;  the  operator,  sitting  beside  her,  abducts 
the  limb,  while  the  patient  opposes  him  as  strongly 
as  possible.  When  abduction  is  complete,  he 
seeks  to  adduct,  the  patient  opposing  as  before- 
The  percussion  movements  consist  in  light  taps 
given  with  the  edge  of  the  open  palm. 

A  successful  case  is  reported  of  a  woman  with 
complete  procidentia  of  31  years  standing.  Pes- 
saries had  been  tried  in  vain,  and  the  patient 
would  not  consent  to  an  operation.  From  the 
first  day  on  which  this  treatrnent  was  adopted  the 


uterus  remained  within  the  vagina,  after  three 
and  a  half  months  the  uterus  remained  in  its  nor- 
mal position,  and  the  cure  was  apparently  perma- 
nent. (I  reported  a  case  a  month  ago  in  American 
Jourtial  of  Obstetrics,  in  which  the  same  result  was 
obtained  by  putting  the  pelvic  muscle  through  a 
course  of  gymnastics,  by  means  of  the  faradic  cur- 
rent of  quantity.) 

The  writer's  observations  led  him  to  the  follow- 
ing conclusions  :  the  opposed  movements  of  the 
hip  are  the  most  important  factors  in  promoting  a 
cure.  Elevation  of  the  uterus  tends  simply  to  cor- 
rect the  retro-displacement  which  is  always  present 
in  cases  of  prolapsus,  and  not  to  fix  the  organ  in 
its  natural  plane  in- the  pelvis.  During  opposed 
adduction  there  is  an  undoubted  contraction  of 
the  muscles  forming  the  pelvic  diaphragm.  This 
may  be  readily  demonstrated  in  the  case  of  the 
levator  ani,  especially  when  the  patient's  hips  are 
elevated.  When  this  muscle  contracts  strongly, 
not  only  is  the  vaginal  opening  in  the  diaphragm 
narrowed  from  behind  forward,  but  the  distance 
between  the  portio  vaginalis  and  this  opening  is 
increased.  Through  the  action  of  the  levator  ani 
the  vagina  is  separated  into  an  upper  horizontal 
and  a  lower  oblique  portion  ;  the  former  sustains 
the  cervix,  so  that  the  more  horizontal  and  elong- 
ated it  becomes,  the  firmer  is  the  support  furnished 
to  the  cervix.  In  other  words  the  contraction  of 
the  levator  not  only  narrows  the  vagina,  but  pre- 
vents the  uterus  from  sinking  downward.  If  the 
uterus  becomes  retroverted,  the  abdominal  pressure 
will  tend  to  force  the  cervix  forward  until  it  reach- 
es the  oblique  descending  portion  of  the  vagina, 
when  any  considerable  increase  of  the  vis  a  tergo 
will  cause  the  uterus  to  become  procident.  When 
on  the  other  hand  the  organ  is  anteverted,  the 
abdominal  pressure  will  simply  crowd  the  cervix 
downward  more  firmly  upon  the  barrier  formed 
by  the  contracted  levator  ;  hence  the  importance 
of  keeping  the  uterus  anteverted  while  practising 
the  opposed  movements,  the  latter  tend  directly  to 
restore  the  tone  of  the  relaxed  levator  in  cases  of 
longstanding  procidentia. 

Another  writer  in  the  same  Journal  recommends 
the  following  method  of  diagnosing  and  tieating 
peritoneal  adhesions  of  the  displaced  uterus.  It 
may  be  performed  at  the  office  without  an  anasthe- 
tic.  The  anterior  lip  of  the  cervix  is  seized  with  a 
volsella  and  is  drawn  downward  and  forward, 
being  held  in  position  by  an  assistant.  The  ex- 
aminer  can    then  map    out  the    entire  posterior 


ftti5   CAi^ADA    \fEDICAL   REOOilifi. 


171 


surface  of  the  uterus  as  high  as  the  fundus  can 
detect  any  adhesion,  and  can  tear  it  if  it  is  not  too 
strong.  '1  he  uterus  may  then  be  lifted  on  the 
finger  while  the  external  liand  is  inserted  behind 
the  fundus,  so  as  to  draw  it  forward.  If  the  organ 
cannot  be  replaced  in  this  manner,  the  portio 
vaginalis  is  drawn  backward  and  downward,  and 
is  held  in  this  position,  while  the  operator  pushes 
the  fundus  upward  with  his  left  index  linger,  assis- 
ted by  manipulation  through  the  abdominal  wall. 
It  is  sometimes  possible  to  hook  the  tip  of  the  fore 
finger  over  the  cicatricial  b.mds,  and  to  draw  them 
downward  and  forward  so  as  to  stretch  or  tear 
them.  If  this  fails,  the  cer\ix  is  again  pulled  down, 
and  the  index  finger  is  pressed  against  the  right 
corner  of  the  uterus,  while  the  external  hand 
pushes  the  fundus  over  to  the  left  as  far  as  possible 
reversing  the  manceuvre  if  necessary. 

The  following  is  a  brief  report  of  the  cases  suc- 
cessfully treated  by  the  writer. 

Case  I.  The  patient,  a;t.  twenty-three,  suffered 
from  dysmenorrhcea,  vesical  irritation,  and  dyspar- 
eunia.  The  uterus  was  retroverted  ;  a  broad  band 
could  be  felt  extending  from  the  upper  part  of  the 
posterior  aspect  of  the  organ  to  the  sacrum. 

After  preliminary  treatment  with  "absorbifa- 
cients,"  attempts  were  made  twice  weekly  to 
replace  the  organ,  with  ultimate  success,  the 
symptoms  above  mentioned  disap|)earing  entirely. 
Case  II.  A  woman,  ;et.  thirty,  wIid  had  had  two 
children  by  her  fust  husband,  married  again,  and 
remained  sterile  after  four  years.  Her  uterus  was 
retroverted  and  attached  by  tliick  bands  to  the 
left  sacro  iliac  synchondrosis.  After  preparatory 
treatment,  the  adhesions  were  torn  in  two  attempts, 
and  the  uterus  was  restored  to  its  normal  position, 
the  patient  eventually  became  pregnant. 

Case  III.  The  patient,  twenty-four  years  of  age 
had  suffered  with  pains  in  the  rectum  and  abdomen 
of  six  years  standing.  The  uterus  was  adiierent 
in  a  position  of  left  retrolateral  flexion.  It  was  res- 
tored to  its  normal  [losirion  after  two  applications 
of  the  treatment  above  described.  The  patient 
was  entirely  relieved,  and  became  pregnant. 

Case  IV.  The  patient,  ret.  twenty-three,  was 
married  at  twenty-one  and  had  borne  one  child  ; 
she  had  septic  trouble  after  confinement,  and  on 
convalescing  developed  pains  in  the  back  and  ab- 
domen, menorrhagia,  and  hysterical  attacks  before 
he  menstrual  periods,  which  recurred  at  irregular 
intervals.  The  uterus  was  enlarged,  retrotlexed, 
and  adherent  to  the  right  border  of  the  pelvic  brim. 


After  repeated  efforts,  the  adhesions  were  separa- 
ted and  the  organ  was  brought  to  the  median  line. 
Hemorrhage  followed  the  oj^eration,  but  this 
ceased  spontaneously.  In  the  course  of  two  weeks 
the  uterus  was  in  its  normal  positi.in,  so  that  a 
Hodge  pessary  could  be  inserte  1.  In  two  weeks 
more  the^ymptoms  disappeared,  and  the  pessary 
was  eventually  removed.  The  patient~remained 
under  observation  for  a  year,  and  there  was  no 
recurrence. 

In  several  instances  adhesions  were  broken  up 
at  the  writrr's  office  without  prejjaratory  treatment. 
Ordinarily  two  attempts  wnc  make  weekly,  but  if 
much  pain  resulted,  only  once  a  week.  If  the 
bands  are  very  thick,  one  must  be  content  with 
simply  stretching  them  a  little  each  time,  instead  of 
endeavouring  at  once  to  tear  them.  If  the  entire 
posterior  surface  of  the  uterus  is  adherent,  or  the 
organ  is  buried  in  a  mass  of  adhesions,  he  does 
not  try  to  detach  it. 

3^r^Q4'ceU  of  Science. 

THE  TREATMENT   OF   CARBUNCLE 
WITH  CARBOLIZKD  SPRAY. 

By  I'ROFESSOR  V'liRiNEiili.,  Palis. 

For  nearly  forty  years,  during  which  time  I  have 
been  practicing  surgery,  I  have  seen  agreat  variety 
of  methods  employed  in  the  treatment  of  carbun- 
cle, and  have  observed  that  these  methods  tend 
to  become  less  surgical  or  operative,  but  are  no 
less  efficacious  on  that  account.  At  the  beginning 
of  my  practice,  like  others,  1  treated  this  affection 
with  very  dee]i  and  long  incisions.  But  I  soon 
observed  that  this  cruel  practice  was  not  at  all  ne- 
cessary, that  it  was  even  dangerous  sometimes, 
and  that  in  the  majority  of  cases  recovery  was 
just  as  rapid  without  this  proceeding.  I  then  re- 
commended, some  time  ago  at  the  Societie  de 
Chirurgie,  to  use  the  knife  only  in  cases  where  the 
pain  was  violent,  and  when  the  disease  showed  a 
tendency  to  spread  rapidly,  leaving  to  themselves 
those  which  were  not  very  painful,  or  in  which  the 
affection  was  circumscribed. 

As  soon  as  Paquelin's  thermo-cautery  was  intro- 
duced into  practice,  I  substituted  its  use  for  that 
of  knives,  which  often  aggravates  the  disease  by 
leading  to  septicemia,  hemorrhages,  etc.  I  made 
deep  and  multiple  openings,  disposed  in  rings 
over  the  alTected  parts,  plunging  the  cautery  into 
the  healthy  parts  all  round.  The  dressing  was  an 
antiseptic,  carbolized  one.  The  objection  to  this 
method  was  the  time  required.  When  the  lesion 
was  extensive,  as  many  as  one  hundred  and  fifty 
cauterizations  were  sometimes  necessar}',  and  they 


172 


THE   CANADA  MEDICAL   RECORt). 


took  at  least  twenty  or  thirty  minutes  to  carry  out 
— the  patient  being,  of  course,  obMged  to  be  put 
under  the  influence  of  chloroform. 

In  i88i  I  had  established  the  following  rule  : 
"  Exceptional  intervention  only  in  grave  and  well- 
marked  cases;  but  applied  with  energy."  I  varied 
my  modus  operandi,  however,  according  to  circum- 
stances ;  and  instead  of  using  both  the  cautery 
knife  and  the  cautery  point,  I  used  only  the  latter. 

Such  was  my  practice  when,  in  1883.  I  saw  a 
very  grave  case  of  carbuncle  situated  at  the  poste- 
rior region  of  the  neck,  in  a  man  of  strong  consti- 
tution, who  was  suffering  from  well-pronounced 
diabetes.  The  carbuncle  was  opened  at  its  cen- 
ter, and  was  progressing  rapidly,  notwithstanding 
numerous  incisions  had  been  made  with  the  cau- 
tery, and  the  wound  had  a  very  bad  color.  On 
my  first  visit  I  decided  that  additional  openings 
would  be  required,  and  that  I  would  make  them 
the  next  day.  In  the  meanwhile  I  ordered  the 
wound  to  be  twiced  sprayed  for  one  hour  with  two 
per  cent,  solution  of  carbolic  acid.  On  the  next 
day  the  wound  had  no  odor,  and  considerable 
chminution  of  the  redness  and  swelling  had  taken 
taken  place.  I  then  resolved  to  try  this  method 
further. 

Since  then  I  have  used  the  sprays  exclusively  a- 
gainst aU  carbuncles-small,  medium  or  large;  dia- 
betic or  not ;  painful  or  painless ;  still  closed,  or 
opened  naturally,  or  by  artificial  means.  This  very 
simple  mode  of  treatment  I  found  superior  to  all 
others,  in  stopping  the  sufferings  soon  and  in  ra- 
pidly limiting  the  extension  of  the  disease. 

Amongst  the  cases  I  have  treated,  I  may  cite 
that  of  a  young  professor  of  the  Paris  Faculty  of 
Medicine,  who  died  lately  of  diabetes  complicated 
with  albuminuria.  He  had  a  very  large  fClruncle 
or  boil,  on  his  left  cheek,  with  diffuse  and  deep 
extension  and  considerable  surrounding  cedema. 
The  prognosis  was  grave,  not  only  on  account  of 
the  seat  of  the  trouble,  but  also  on  account  of  the 
presence  of  sugar,  3.5  per  cent.  Cardiac  and 
pulmonary  lesions  rendered  the  administration  of 
chloroform  dangerous.  I  resorted  to  the  carboli- 
zed  spray.  After  the  first  application  the  cedema 
disappeared,  the  pain  diminished  and  disappeared 
entirely  in  forty-eight  hours  ;  and  after  seven  or 
eight  days,  in  six  of  which  the  spray  was  used 
four  times,  the  large  furuncle  was  reduced  to  a 
medium-sized  ecthyma  pustule  ;  and  it  was  entirely 
healed  by  the  seventeenth  day. 

Of  course  this  treatment  will  not  prevent  acci- 
dents, which  may  occur  when  the  carbuncle  has 
given  rise  to  an  extensive  sphacelus  in  extremely 
cachetic  patients.  But  in  the  majority  of  cases, 
if  taken  early,  we  have  in  the  spray  an  abortive 
treatment  for  carbuncle. 

The  manner  of  using  the  carbolized  spray  is 
known  to  every  surgeon.  A  convenient  apparatus 
is  the  atomizer,  which  is  hea  ed  by  alcohol,  and 
which  will  work  for  twenty-five  minutes.  Such  a 
oneissufticient  for  small  or  medium-sized  carbun- 
cles, and  for  those  which  are  already  opened.   For 


the  large  tumors,  where  the  skin  is  not  broken,  it 
is  better  to  use  a  more  powerful  apparatus,  which 
gives  off  a  more  abundant  vapor  and  has  a  more 
considerable  force  of  penetration.  The  apparatus 
is  placed  from  one  to  two  feet  from  the  .skin, 
regulating  the  spray  according  to  the  sensation  of 
the  patient.  I  gener.ally  place  nothing  between 
the  carbolized  vapor  and  the  wound,  or  I  place 
there  only  a  single  thickness  of  transparent  gauze. 
Up  to  this  date  I  have  used  only  the  two  per  cent, 
solution  of  carbolic  acid.  I  have  not  tried  other 
antiseptic  solutions,  being  contented  with  tlie 
results  obtained  with  carbolic  acid,  which,  in  my 
experience,  has  never  irritated  the  skin  nor  produ- 
ced any  symptoms  of  general  disturbance.  The 
number  of  applications  of  the  spray  is  variable. 
Usually  three  or  four  sittings  of  half  an  hour  each, 
every  day,  are  quite  sufficient.  Between  the  times 
of  spraying,  an  antiseptic,  carbolic  dressing  should 
be  applied  to  the  lesion.  The  patient  might  find 
so  much  relief  from  the  spraying  that  the  sittings 
could  be  made  much  more  numerous — six  or  eight 
a  day.     The  following  precautions  must  be  taken  . 

1.  Carefully  protect  the  normal  parts  surrounds 
ing  the  carbuncle  with  compresses,  rolled  napkins 
perforated  cushions,  or  pieces  of  adhesive  plaste*^ 
perforated  at  the  centre,  according  to  the  region 
which  is  occupied  by  the  lesion  ;  at  the  same  time 
protecting  the  patient's  linen  and  bed-clothes  from 
becoming  wet. 

2.  Place  tne  patient  in  an  easy  position,  so  that 
he  shall  not  be  tired  by  the  spraying.  When  the  boil 
or  carbuncle  is  at  the  back  of  the  neck,  or  on  the 
back,  the  patient  should  be  seated  on  a  chair,  so 
that  he  can  rest  his  folded  arms  on  the  back  of 
the  chair.  When  the  disease  is  situated  in  the 
perineum,  or  near  the  anus,  the  lithotomy  position 
is  the  best;  and  when  it  is  in  the  lateral,  lumbar 
or  gluteal  regions,  the  patient  should  lie  on  the 
side  with  the  lower  limbs  flexed. 

The  treatment  by  the  carbolized  spr.ay  is  not 
only  very  simple,  but  also  adapted  to  all  forms  or 
phases  of  the  disease,  being  the  same  from  the  first 
to  the  last.  When  used  at  the  beginning  for  a 
small  carbuncle  or  boil,  it  has  a  good  chance  of 
aborting  it  entirely.  Later,  when  the  swelling  is 
voluminous  or  has  a  tendency  to  increase,  it  will 
stop  its  progress.  Later  still,  when  mortifica- 
tion and  perforations  of  the  skin  have  begun,  it 
limits  the  sphacelus,  helps  to  the  separation  of  the 
mortified  tissues,  disinfects  the  wound,  kee]3s  it 
clean,  and  by  so  doing  reduces  the  temperature 
and  symptoms  of  general  disturbance.  Its  advan- 
tages are  increased  by  the  fact  that  its  application 
does  not  demand  the  use  of  chloroform,  and  that 
there  is  no  need  to  touch  the  tumor,  or  irritate  it 
in  any  way.  I  have  said,  and  I  repeat,  that  the 
old  method  of  incision  with  the  lancet  was  far  from 
being  innocent,  that  these  incisions  produced  in 
enfeebled  patients  severe  hemorrhages,  which  were 
difficult  to  arrest,  and  which  necessitated  the  use 
of  painful  hemostatics  ;  and  that  they  were  capable 
of  developing  septicaemia,  of  propagating  gangrene, 
and  of  favoring  the  absorption  of  putrid  matter. 


THE   CANADA   MEDICAL   RECORD. 


173 


Many  surgeons,  after  liaving  opened  a  carbun- 
cle, freciy  scrape,  excise  or  press  the  siiongy  mass 
to  evacuate  tlie  pus  and  gangrenous  materials. 
]5ut  these  proceedings  are  at  the  same  time  dan- 
giTous  and  painful,  and  should  be  absolutely 
avoided  ;  for  the  use  of  carbolized  spray   renders 

■      them  unnecessary,  by  disinfecting  the  wound. 

F  In  order  to  appreciate  the  danger  of  using  force 

on  a  carbuncle  or  furuncle,  one  must  remember 
that  the  infection  is  of  an  infectious  character, 
and  that  the  tumor  contains  pathological  microbes 
capable  of  extending  on  the  surface,  or  of  coloniz- 
ing in  the  interior,  by  auto-inoculation,  or  by 
entering  the  general  circulation. 

'I'his  last  lact  is  not  as  well  known  as  it  might 
be,  although  it  is  known  that  a  carbuncle,  and 
even  a  boil,  is  cajiable  of  giving  rise  to  fever, 
general  symptoms,  and  even  visceral  manifesta- 
tions— albuminous  nephritis  and  deep  abscesses, 
for  example. 

In  conclusion,  I  would  state  the  following 
views: 

1.  Furuncle  and  carbuncle  are  only  different 
stages  of  one  infectious  disease,  and  are  to  be 
treated  by  the  same  therapeutical  means. 

2.  The  treatment  consists  in  surgical  interfe- 
rence or  medical  applications.  The  first  was 
formerly  thought  to  be  indispensable,  or  at  least 
was  resorted  to  in  a  majority  of  cases.  The  se- 
cond were  thought  to  be  efficacious  only  in  mild 
cases,  and  were  employed  as  secondary  measures 
of  relief. 

3.  To-day  surgical  intervention  is  becoming  less 
and  less  necessary,  and  should  be  reserved  for 
exceptional  cases  ;  on  the  other  hand,  antiseptic 
solutions  of  carbolic  acid,  of  boric  acid,  etc.,  used 
in  a  peculiar  way,  and  especially  under  the  form  of 
prolonged  and  repeated  atomization,  are  remark- 
ably efficacious,  while  they  are  at  the  same  lime 
very  simple  and  free  from  danger. 

4.  .Sprayings,  with  very  few  exceptions,  lead  to 
a  rapid  recovery  from  the  manifestations  of  fur- 
uncle or  of  a  small  carbuncle,  and  they  check  the 
disease  in  graver  cases.  They  very  rapidly  put 
an  end  to  the  pain,  the  fever  and  the  general 
symptoms  ;  they  disinfect  the  purulent  and  gan- 
grenous spots,  and  assist  the  cleansing  of  the  lesion 
and  the  formation  of  granulation  tissue. 

5.  Sprayings  may  be  used  in  any  region  of  the 
body  for  all  forms,  and  in  all  stages  of  the  disease. 
They  a'e  never  dangerous,  and  will  alone  bring 
on  a  cure  in  the  majority  of  cases.  They  would 
also  help  greatly  to  the  success  of  surgical  inter- 
ference, if  such  should  be  deemed  necessary. 

6.  Finally,  they  prevent  auto-inoculations  and 
the  i)henomena  of  general  infection. — Jlcd.  and 
Surg.  Ri-porter.  

REMARKS    ON    ROETHELN. 

By  Henry    D.wis,    L,  K.  Q.  C.   P.,  L.   R.  C.   S.    I., 
Tuam,  IieLind. 

Roetheln  frequently  resembles  ordinary  measles  ; 
occasionally  it  still  more  closely  resembles  scarlet 


fever  ;  yet  roetheln  is  not  a  hybrid.  Measles  alone 
or  scarlet  fever  alone,  or  both  diseases  in  the  same 
subject,  will  not  jKotect  against  it  ;  and,  on  the 
other  hand,  roetheln  confers  no  immunity,  neither 
against  measles  nor  against  scarlet  fever,  nor,  I  am 
persuaded,  in  the  least  degree  against  a  recurrence 
of  iiself.  During  the  continuance  of  a  lingering 
epidcmi( ,  I  have  seen  every  member  of  a  large 
family,  nine  months'  of  perfect  healtii  intervening, 
twice  attacked  by  roetheln.  From  what  I  have 
observed  of  this  affection,  it  would  surprise  me 
little  to  see  it  seriously  put  forward  that  an  attack 
of  roetheln  rather  increases  than  diminishes  the 
liability  to  recurrence  and  to  the  invasion  of  other 
diseases.  I  had  once  the  opportunity  of  observing 
roetheln  in  a  parturient  woman  ;  it  was  but  a  single 
instance  and  insutScient  as  an  argument,  still  it  is 
worthy  of  note  that  the  complication  in  no  way  in- 
terfered with  the  normal  course  of  labour,  nor  did 
it  give  rise  to  any  unpleasantness  afterward,  such 
as  would  be  expected  to  follow  an  attack  of  measles 
or  scarlet  fever. 

Some  years  ago,  in  Manchester,  I  saw  a  good 
deal  of  an  epidemic  of  roetheln.  The  invasion 
was  suggestive  of  measles,  accompanied  by  sneez- 
ing, lachrymation,  photophobia,  fever,  general 
malaise,  a  slight  sore  throat,  and  cough.  About 
the  end  of  the  second  day,  the  eruption  appeared 
without  amehoration  of  the  other  syraptons  ;  on 
the  contrary,  the  throat  was  much  complained  of, 
the  temperature  rose  often  to  105  °  ,  and  pros- 
tration was  pronounced.  The  character  of  the 
eruption  was  not  usually  the  same  on  the  face  and 
over  the  body.  On  the  face,  especially  the  prom- 
inence of  the  cheek,  it  appeared  as  a  number  of 
dusky,  circular  or  oval,  slightly  elevated  blotches 
grouped  without  regularity.  Over  the  body  and 
lunbs  it  was  fairly  uniform,  much  the  color  of 
scarlatina  efflorescence,  with,  upon  close  inspection, 
inany  minute  elevations.  The  palate,  fauces  and 
tonsils  were  of  a  deep  red,  also  presenting  minute 
elevations  ;  the  tonsils  were  swollen.  About  the 
fourth  day  of  the  disease,  with  quickened  breathing 
increased  cough  and  restlessness,  with  accelerated 
pulse  and  burning  skin,  it  was  usual  to  find  at  one 
or  both  sides  of  the  spine  a  distinct  area  of  bron- 
cho-pneumonia. I  believe  it  was  this  compli- 
cation which  gave  to  the  epidemic  its  very  serious 
nature.  The  deaths  which  occurred  during  the 
continuance  of  the  primary  affection  were,  in  my 
experience,  all  to  be  referred  to  broncho-pneumonia 
The  eruption  faded  in  about  five  days,  and  was 
followed  by  coarse,  branny  desquamation  and 
shedding  of  the  hair.  Convalescence  was  sbw. 
Dangerous  sequela;  were  very  apt  to  ensue. 

As  a  very  curious  coincidence,  if  not  something 
more,  I  remarked  that  many  of  those  who  recover- 
ed from  roetheln  immediately  contracted  a  set  of 
.syinptoms  exactly  resembling  the  paroxysms  of 
whooping  cough. 

This  epidemic  left  upon  my  miml  the  imi^es- 
sion  that  roetheln  was  a  very  serious  mdady — 
more  serious  than    either  me\iles  or  scarlet    fever 


174 


THE   CANADA   MEDICAL   RECORD. 


as  they  are  usually  seen.     How  different  the  epi- 
demic which  I  have  now  briefly  to  describe. 

About  twenty  cases  of  sore  throat,  collected 
from  the  sam-'  locality,  were  brought  under  my 
notice.  They  were  all  very  similar  in  appearance. 
I'hey  came  one  after  another.  They  were  com- 
municated from  one  to  another.  Age  seems  to 
make  no  difference  whatever  in  the  liability.  Sick- 
ness was  hardly  complained  of,  only  considerable 
])ain  and  difiiculty  of  swallowing.  On  the  throat 
alone  was  there  any  rash;  the  palate,  fauces,  ton- 
sils and  the  root  of  the  tongue  were  closely  stud- 
ded with  minute,  bright-red  elevations  ;  the  tonsils 
were  swollen. 

I  diagnosed  epidemic  heriietic  sore  throat,  and 
I  heard  of  eiiitlemic  tonsillitis  in  the  jiractice  of 
others.  I  watched  my  cases  closely.  The  throat 
symptoms  soon  subsided.  There  was  no  suppura- 
tion. In  a  few  instances,  there  remained  for  a  long 
time  enlargement  of  several  small  glands  of  the  neck. 
In  one  case,  the  skin  peeled  from  the  inde.\  and 
middle  fingers  of  both  hands.  Distinctly  trace- 
able to  these  there  soon  began  to  flow  in  upon  me 
a  straggling  list  of  patients,  all  wiih  sore  throats 
showing  the  characteristic  elevated  points ;  some 
with  yellow  patches  on  the  tonsils.  Many  of  these 
latter  complanied  of  rheumatism,  both  fugitive 
and  stationary,  and  in  not  a  few  swollen  joints 
were  exhibited.  In  several  there  was  a  distinct 
rash,  which  generally  occurred  as  patches  of  a 
rose-red  miliary  eruption,  es])ecially  on  the  fore- 
arms or  beneath  the  knees.  These  patches  might 
appear  in  the  morning  and  be  gone  before  the  end 
of  the  day,  or  they  might  remain,  tmdergoing  little 
change,  for  several  days  ;  occasionally  they  faded 
and  came  out  again  ;  they  seldom  appeared  upon 
the  face. 

In  cases  of  this  type,  desquamation  of  the  cu- 
ticle was  not  uncertain.  It  did  not  seem  at  all  to 
depend  upon  the  eruption.  It  occurred  just  as 
frequently  when  there  was  none,  and  the  presence 
of  an  eniiition  was  no  indication  that  desquama- 
tion would  follow.  Again,  the  fingers  alone  miglit 
peel  in  the  case  where  the  rash  had  appeared  only 
only  on  the  legs.  Desquamation  from  the  body 
was  usually  in  light  scales  ;  from  the  hands,  in  en- 
tire pieces.  The  disease  was  roetheln.  One  of 
my  sore-throat  patients  brought  me  to  his  house, 
where  every  stage  of  roetheln  was  fully  developed. 
Subsequently  I  saw  enough  of  the  epidemic  to  en- 
able me  with  contidence  to  enumerate  the  follow- 
ing distinctive  appearances  which  the  disease 
might  assume : 

1.  Slight  sore  tliroats,  without  malaise,  eru[!tion, 
desquamation  or  sequele. 

2.  Severe  sore  throat,  with  moderate  fever,  rheu- 
matic pains,  sometimes  desquamation  of  the  hands 
and  fingers,  a  liability  to  chronic  glandular  enlarge- 
ment (frequently  sub-occipital),  but  no  eruption. 

3.  Symptoms  similar  to  the  last,  with  patches 
of  rose-colored  miliary  eruption,  generally  on  the 
limbs,  sometimes  e-xtcuding  over  the  trunk  and 


face,  uncertain  in  duration  ;   sometimes   decided  y 
itchy  and  often  followed  by  branny  desquamation. 

4.  Considerable  fever,  some  coryza, .cough,  ag- 
gravated sore  throat,  a  general  eruption  scarcely 
to  be  distinguished  from  that  of  scarlatina(the 
longue  in  nianv  cases  also  becoming  scarlet),  often 
outlasting  both  tlie  so''e  ih  oat  and  malaise  ;  des- 
quamation, branny  on  the  body,  in  whole  pieces 
Ircini  the  hands ;  health  impaired  for  some  time 
atler  the  attack. 

5.  Lastly,  the  attack  m.iy  be  ushered  in  by 
severe  rigors  and  vomiting,  or  even  by  convul- 
sions and  protracted  unconsciousness.  The  tem- 
perature may  range  above  106  °  .  The  eruption 
may  assume  the  .qjpearance  of  jjurple  blotches 
on  the  face  and  over  the  body.  'I'here  may 
lie  a  foul  tongue,  with  red  papilla;  projecting ; 
acute  sore  throat,  with  regurgitation  of  liquids 
through  the  nose;  a  distressing  cough  ;  great  pros- 
tration; desquamation,  both  branny  and  in  pieces; 
a  tendency  to  dropsy  and  to  chest   complications. 

According  to  my  e.\iierience  of  this  e[)idemic, 
roetheln  may  be  followed  by  delicacy  of  the  throat 
and  chronic  enlargement  of  the  tonsils  ;  delicacy 
of  the  eyes ,  chronic  enlargement  of  many  small 
sub-occipital  and  cervical  glands,  two  or  more  of 
which  may  unite  to  form  a  considerable  swelling ; 
moist  eruptions  over  the  face  and  ears:  protracted 
suppression  of  the  catamenia.  In  one  case,  there 
was  a  distinct  relapse,  with  appearance  of  the 
eruption  after  fourteen  days.  In  another,  the 
attack  was  followed  by  eryth\-ma  nodosum,  which, 
however,  may  have  been  an  affection  independent 
of  the  roetheln,  or  possibly  brought  on  by  men- 
strual derangement,  the  consequence  of  roetheln. 
In  two  cases,  I  thought  I  detected  the  character- 
istic eruption  on  the  throat.  I  then  lost  sight  of 
my  patients.  Subsequently  I  learned  that  they 
both  had  had  rheumatic  fever,  and  that  the  skin 
had  jieeled  from  their  hands  during  the  course  of 
the  fever. 

I  will  conclude  this  sketch  with  a  brief  notice 
of  four  cases  of  undoubted  roetheln  i  1  two  adjoining 
rooms.  The  first  in  sequence  was  a  little  boy  who 
lay  perfectly  unconscious,  passing  froin  one  attack 
of  convulsions  into  another  ;  terajieralure,  106°  ; 
a  foul  tongue  ;  an  eruption  of  livid,  slightly  eleva- 
ted blotches,  and  a  running  pulse.  Beside  him, 
his  sister  i)resented  almost  thety])e  of  scarlet,  uni- 
form rash  ;  scarlet  tongue  ;  swelling  of  the  neck, 
and  burning  skin.  In  the  ne.\t  room  the  parents 
were  lying  almost  as  sick  as  the  children,  com- 
plaining bitterly  of  their  throats  ;  the  mother,  with- 
out a  i)article  of  eruption,  and  without  any  des- 
([uamation  following;  the  father,  with  patches  of 
the  rose-colored  rash  on  his  arras,  his  chest  and 
his  legs,  and  subsequently,  the  skin  peeled  in  large 
pieces  from  his  hands. 

Now,  supposing  that  these  four  cases  had  occur- 
red independently  of  one  another,  and  unconnect- 
ed with  an  e]iidemic,  would  they  have  been  recog- 
nized as  examples  of  the  same  disease  ? — Brit, 
Mai.  Jour, 


THE   CANADA    MEDICAL   RECORD. 


175 


ACNE. 

Acne,  or  acne  vulgaris,  as  it  is  sometimes  called, 
is  one  of  the  most  common  of  the  diseases  of  the 
skin.  It  constitutes  (juite  a  respectable  percentage 
of  the  grand  total,  but  relief  is  not  sought  as 
often  as  its  frecjuency  would  seem  to  indicate.  It 
consists  essentially  in  an  infianini.ilory  condition 
of  the  sebaceous  glands,  and  manifests  itself  in  the 
foim  of  papules,  pustules  and  tubercles  distributed 
for  the  most  part  about  the  face,  neck,  back  and 
shoulders.  The  most  common  forms  are  the 
papidar  and  |)ustular,  so  named  from  the  predo- 
minance of  the  lesions  existing  at  the  time.  The 
forehead  is  perhaps  the  portion  of  the  face  most 
frequently  attacked,  other  portions  being  also 
implicated,  however,  quite  frequently.  There  are 
no  subjective  symptoms  connected  with  this 
disease,  unless  it  be  a  slight  pain  upon  ])ressure 
when  the  disease  is  in  its  acute  form,  'i'ho 
trouble,  generally,  begins  as  a  papule,  varying  in 
size  from  a  pinhead  to  a  split  pea,  and  this  may 
remain  as  such  or  become  a  pustule  through  tlie 
inflammatory  action  which  is  present.  Should  it 
remain  a  pa])ule  it  undergoes  more  or  less  resolu- 
tion, or  may  enlarge  and  become  a  little  more 
indinated,  and  infiltrate  a  portion  of  the  underlying 
tissues  and  thus  become  a  tubercle.  When  a 
pustule  forms  it  develops  to  its  acme,  the  pus  is 
discharged,  a  small  crust  forms,  and  it  heals 
spontaneously.  Successive  crops  are  continually 
making  their  appearance,  so  that  it  may  happen 
that  the  patient  is  never  entirely  free  of  the  disease 
for  years. 

Acne  occurs  in  both  sexes  about  ei^nally,  and, 
as  a  rule,  first  makes  its  appearance  at  puberty. 
At  this  time  the  whole  cutaneous  system  under- 
goes a  greater  or  less  disturbance,  the  hair  in 
various  ]5ortions  of  the  body  begins  to  grow,  and 
the  sebaceous  glands  are  prejjared  Un  a  greater 
functional  activity  than  they  have  hitherto  pos- 
sessed. 

The  causes  of  acne  are  varied  and  numerous. 
Among  those  which  hold  a  first  place,  however, 
may  be  mentioned  disturbances  of  the  gastro-in- 
testinal  tract.  Constipation  especially  is  a  very 
fruitful  cause  of  this  disease,  a.?  also  dysjjepsia  and 
allied  disorders.  These  are  conditions  very 
often    found  more   es])ecially    in   young   women. 

Besides  this  we  have  uterine  disorders,  such  as 
dysmenorrhcea,  amenorrhea  and  genito-urinary 
disturbances.  Renal  troubles  ace  as  exciting 
causes  of  acne,  at  times.  There  seems  also  to  be 
a  certain  tendency  to  the  disease,  in  certain  fam- 
ilies, so  that  it  would  almost  seem  as  if  some 
hereditability  was  attached  to  it.  In  addition  to 
the  internal  causes,  a  few  of  the  principal  ones 
ha\ing  only  been  mentioned,  we  have  external 
agencies  producing  the  so-called  ncne  artiJiciiiUa. 
Tar  and  similar  agents  are  the  active  agents  in  its 
production,  whilst  the  internal  use  of  certain 
remedies,  notably  iodide  of  potassium,  produces 
an  artificial  acne  generally  classified  under  the 
medinical  eruptions, 


The  diagnosis  of  acne  is  not  very  difficult  It 
must  be  distinguished  from  ezcema,  syjjhilis  and 
small-pox.  From  the  first  mentioned  disease  it 
is  easily  distingushed  by  the  absence  ofitching, 
and  from  the  fact  that  eczema  of  the  face  is  rarely 
papular  or  pustular  in  character.  The  history, 
moreover,  would  serve  to  distinguish  the  two  very 
easily.  The  ])a|)ular  and  pustutar  syphilodermata 
must  be  examined  a  little  more  closely,  especially 
the  acne-form  sjphiloderm  which  sometimes 
occurs  u|)on  the  forehead  as  the  corona  Vannris. 
The  history,  the  ))resence  of  other  lesions,  the 
tendency  of  syphilitic  lesions  to  group,  and  the 
length  of  time  the  lesions  exist,  if  carefully  consi- 
dered, will  make  the  diagnosis  clear.  As  to 
variola,  the  history  would  be  suflicient.  The 
chronic  natiu-e  of  acne,  the  comparatively  short 
]3eriod  of  time  betweigai  successive  crops,  the 
locality  attacked,  the  age  of  the  patient,  the 
infl  nnnuUory  nature  of  the  lesions,  the  absence 
of  subjective  symptoms,  and  the  anatomical  seat 
of  the  disease  ( the  sebaceous  glands )  should 
never  be  forgotton. 

It  is  an  uncommon  thing  to  see  acne  in  a  child 
before  puberty  or  in  a  person  beyond  the  forty- 
fifth  year. 

The  treatment  of  this  disease  should  be  consti- 
tutional and  local.  The  general  measures  employ- 
ed should  be  such  as  will  tend  to  bring  the  jiatient 
to  as  normal  a  condition  as  is  possible  by  thera- 
peutic means.  The  condition  which  is  most  com- 
mon and  most  constantly  demands  attention  is  the 
constipation  which  exists.  To  overcome  this,  the 
diet,  in  the  first  place,  should  be  so  regulated  as  to 
insure  the  greatest  amount  of  nutrition  with  the 
least  amount  of  labor  on  the  part  of  the  stomach, 
and  arranged  so  as  to  preclude  the  condition  of 
constipation  or  a  tendency  thereto.  To  make  the 
bowels  more  regular,  fluid  extract  of  cascara  sagra- 
da,  or  the  aperient  mineral  waters,  are  useful.  An 
occasional  dose  of  calomel  will  be  of  benefit.  The 
following  aperient  mixture  given  by  Duhring  gives 
excellent  results  : 

R     IMagnesire  Sulphatis- 3  jss 

Ferri  .Sulphatis gr.  xvj 

Acidi  Sulphuric!  dil I  \] 

AquK 3  viij 

M. 

Sig.     Tablespoonful  in  a  tumbler  of  water. 

This  should  be  taken  about  twenty  minutes 
before  breakfast  or,  if  necessary,  before  supper 
also. 

Besides  the  general  remedies  indicated  in  the  case 
we  have  some  which  do  good  occasionally.  Sulphide 
of  calcium,  in  quarter  grain  doses  four  times  a  day, 
is  sometimes  indicated  in  suppurative  form.  Ar- 
senic is  useful  in  the  indurated  forms  or  where  the 
papules  are  imperfectly  develo|)ed,  and  may  be 
given  in  two  or  three  drop  doses  of  Fowler's  solu- 
tion in  wine  of  iron,  or  in  one  drop  doses  ofa  one 
per  cent,  alcoholic  solution  of  bromide  of  ar-senig, 
thrice  daily  after  meals. 


176 


TUE   CANADA   MEDICAL   RECORD. 


The  local  treatment  is  to  be  either  soothing  or 
stimulating,  according  to  the  indications  which  are 
present.  In  the  greater  number  of  cases  the  latter 
plan  must  be  adopted.  Soothing  applications  and 
lotions  and  bland  ointments  should  be  employed 
where  there  is  a  high  grade  of  inflammation.  The 
methods  of  stimulating  are  numerous.  Sapo  viri- 
dis  pure  or  diluted  may  be  applied  at  niglit,  fol- 
lowing this  with  a  bland  ointment.  The  pustules 
should  be  opened  and  their  contents  squeezed  out. 
Hot  water  cloths  applied  at  night,  and  followed  in 
the  morning  with  cold  douches  and  frictions  are 
valuable.  Sulphur  is  a  very  good  remedy  to 
apply,  and  may  be  prescribed  in  ointments  or 
lotions,  in  strength,  varying  from  twenty  grains  to 
two  drachms  to  the  ounce. 

The  following  lotion  recommended  by  Bulkley  is 
good  : 

R     Sulphuris  Loti 3j 

,4itheris 3  vj 

Alcoholis  3  iijss 

M 

Sig.     Apply  as  a  lotion. 

Sulphuret  of  potassium  may  be  used  as  also 
Vleminckx's  lotion.  Where  more  active  stimula- 
tion is  required  biniodide  of  mercury  or  corrosive 
sublimate  or  protoiodide  of  mercury  or  ammoni.i- 
ted  mercury  can  be  used. 

The  surgical  treatment  is  often  of  greater  value, 
more  especially  in  the  indutated  and  tubercular 
forms,  and  care  should  be  taken  to  cut  well  into 
these  lesions,  passing  through  the  centre,  and  apply- 
ing warm  cloths  so  as  to  induce  free  hemorrhage. 
In  conjunction  with  this,  the  sul[)iiur  and  mercury 
ointment  mentioned  in  the  "  Talk "  on  Comedo 
will  prove  serviceable. 

One  point  which  should  not  be  forgotton  is  to 
examine  male  patients  for  urethral  stricture.  If 
such  exists  bougies  should  be  introduced,  or  other 
means  employed  to  enlarge  the  calibre  of  the 
urethra  at  the  part  of  constriction.  In  a  number 
of  cases  the  beneficial  effects  of  this  treatment  will 
be  observed  in  an  amelioration  of  the  skin  trou- 
ble. 

The  prognosis  of  acne  depends,  in  a  great 
degree,  upon  the  cause  producing  it.  It  has  a 
tendency  to  be  chronic,  and  is  generally  stubborn 
to  all  treatment  to  a  greater  or  less  degree.  There 
is  a  tendency  to  spontaneous  recovery  at  about 
the  twenty-sixth  year,  but  if  the  cause  of  the 
disease  be  corrected  and  appropriate  local  treat- 
ment instituted,  success  will  be  pretty  fair. 


MIGRAINE  IN   CHILDREN. 

At  a  recent  meeting  of  the  Philadelphia  County 
Medical  Society,  Dr.  Wharton  Sinkler  read  a  pa- 
per on  Migraine  in  Childhood.  He  said  "  Mi- 
graine is  more  common  in  children  than  is  generally 
realized.  Popularly  the  attacks  of  '  sick-head- 
aehe,'  which  many  children  have,  are  attributed 
to  disorder  of  the  stomach  from  some  indiscretion 


in  diet,  and  many  physicians  hold  the  same  view. 
The  fact  that  migraine  is  a  disease  especially  likely 
to  begin  about  the  time  of  iniberty  has  long  been 
recognized,  and  this  point  has  been  insisted  upon 
by  Anstie.  Many  children  begm  to  suffer  from 
characteristic  attacks  as  early  as  7  or  8  years  of 
age  (Eulenberg  speaks  of  a  girl  who  suffered  from 
excessively  severe  attacks  from  her  fourth  year), 
and  continue  to  have  them  until  adult  life  is  reach- 
ed ;  or,  indeed,  the  attacks  may  continue  all 
through  life.  Still,  it  is  most  often  the  case  that 
when  migraine  begins  in  early  childhood,  it  be- 
comes more  severe  at  puberty,  and  ceases  by  the 
time  full  develojiment  is  attained. 

The  influence  of  hereditation  is  often  seen  to  a 
marked  degree  in  migraine,  and  the  affection  often 
seems  to  be  directly  handed  down  from  one  gene- 
ration to  the  next.  It  is  transmitted  from  parent 
to  child,  and  may  follow  either  the  male  or  female 
line,  descending  from  father  to  son,  or  from  mother 
to  daughter.  The  children  who  suffer  from  mi- 
graine often  belong  to  neurotic  families,  and  it  is 
common  to  find  among  the  near  relatives  instan- 
ces of  other  nervous  disorders.  It  is,  then,  im- 
portant for  us  to  be  on  the  lookout  for  niigraine 
in  children  who  belong  to  families  of  nervous  ten- 
dencies. I  have  now  under  my  care  for  sick-head- 
ache a  lad  of  14  years,  whose  mother  has  violent 
attacks  of  neuralgia,  and  one  of  his  sisters  is  a 
well  marked  example  of  hysteria.  It  is  a  well 
recognized  fact  that  children  who  suffer  from  this 
disease  at  and  before  the  time  of  puberty  may,  in 
later  life,  become  the  subjects  of  some  01  the  grave 
neuroses,  such  as  epilepsy  or  insanity.  The  great 
value  of  early  recognition  and  cure  of  the  disease 
is,  therefi)re,  apparent. 

In  addition  to  the  influence  of  heredity,  there 
are  many  other  causes  which  may  induce  migraine 
in  children.  The  manner  in  which  a  child  is 
brought  up  has  much  to  do  with  the  production 
of  these  attacks.  Impro|jer  food,  bad  atmosphere, 
and,  above  all,  an  insufficient  amount  of  sleep 
with  overtaxing  of  the  brain,  all  tend  topredispoes 
to  or  directly  bring  on  migraine.  When  a  child 
first  begins  school  he  often  complains  of  more  or 
less  headache.  The  close  air  of  the  school-room, 
and  too  little  exercise  are  enough  to  account  for 
some  of  these  headaches. 

In  other  children,  mere  mental  effort  brings  on 
attacks  of  pain  in  the  head.  The  same  thing 
holds  good  of  migraine  that  I  have  observed  in 
chorea,  namely,  that  it  is  the  studious,  ambitious 
children,  who  stand  at  or  near  the  head  of  their 
classes,  who  suffer  from  both  of  these  affections. 
In  many  instances  there  are  ocular  defects,  which 
cause  eyestrain,  and  in  these  cases  the  attacks  of 
migraine  contiime  to  become  more  and  more  fre- 
quent, in  proportion  as  the  eyes  are  used,  until  the 
eye-defect  is  corrected  by  glasses.  It  is  not  in  all 
cases,  however,  that  the  headaches  which  follow 
excessive  use  of  the  eyes  are  due  to  ocular  defect. 
Migraine  from  eye-strain  is  not  uncommon  in 
children.     Dr.  de  Schweinitz  has  kindly  furnished 


THE  CANADA  MEDICAL  RfiCORD 


l?7 


me  with  a  c:;ise,  wliich    is   also  of  interest  on   ac- 
count of  tlic  sii|ieifi('ial  optic  neuritis  wliicli  exists. 

Migraine  does  not  appear  to  alTect  one  sex 
more  than  tile  other,  but  if  any  difference  does 
exist  the  preponderance;  is  in  boys.  Precocious 
sexual  devel()]inient  in  either  sex  often  leads  to 
this  form  of  headache.  It  is  astcjiiisliing  at  what 
an  early  age  evidences  of  sexual  iiriiation  may 
a])pear.  Bad  associations  and  influences  lead  a 
child  into  thoughts  and  |)ractices  that  are  un- 
wholesome in  the  extreme,  and  bring  about  disor- 
ders of  the  whole  nervous  system.  Even  before 
puberty  the  nervous  system  undergoes  a  prepa- 
ratory change,  and  if  there  be  evil  conditions  in 
the  surroimdings  of  the  child  to  excite  sexual  ir- 
ritaiion,  puberty  is  hurried  forward.  Under  these 
influences  a  child  becomes  hypochondriacal  and 
mopy,  coai|ilains  of  various  ailments— some  of 
wliich  are  real  and  some  fancied — and  may  suffer 
from  real  neuralgias.  It  is  very  seldom  that  we 
meet  with  migraine  in  robust  and  hearty  children  ; 
but  it  is  seen  in  those  who  do  not  get  enough  fresh 
air,  and  who  are  thin  and  pale  ;  or  in  children  who 
think  and  read  too  much,  and  who  do  not  romp 
and  play,  but  prefer  to  sit  with  older  people  and 
drink  in  conversation  far  beyond  their  years. 

The  symptoms  of  migraine  in  yoimg  children 
are  not  far  different  from  those  in  adults.  The 
attacks  are  markedly  paroxysmal,  occurring  from 
two  to  six  weeks  apart,  and  become  more  or  less 
frequent,  according  as  the  conditions  for  their 
development  are  favorable  or  otherwise.  There 
may  be  only  one  or  two  attacks  a  year.  The 
attacks  may  be  preceded  by  premonitory  symp- 
toms, such  as  chilliness  and  a  form  of  lassitude, 
and  the  child  is  dull  and  indisposed  to  play. 
Sometimes  there  are  subjective  ocular  symptoms 
in  the  form  of  specks  floatiiiji  before  the  eyes, 
muscse  volitantes,  or  balls  of  fire,  and  bright  zig- 
z.ags.  Occasionally  the  child  complains  of  hemio- 
pia.  These  sym|)tonis  last  a  half  hour  or  more 
and  may  be  followed  by  subjective  numbness  of 
the  tongue,  lips  or  of  the  entire  half  of  the  body. 
Putnam  had  a  ])atient  in  whom  in  boyhood  mi- 
graine w'as  represented  by  rejieated  attacks  of 
numbness  and  tingling  of  the  right  side  of  the  face 
and  right  half  of  the  budy,  with  aphasia,  and 
hemianopsia,  followed  by  but  trifling  headache,  or 
none  at  all.  Later  in  lite  there  were  severe  attacks 
of  pain.  Usually  as  soon  as  the  sulijective  auras 
disappear  the  pain  begins.  .'\t  first  the  pain  is 
dull,  and  it  may  be  confined  to  one  side  of  the 
head  ;  generally,  in  children  the  jjain  is  on  both 
sides  of  the  head,  at  least  they  complain  of  the 
pain  as  being  general,  and  it  may  be  either  frontal 
or  occipital  ; most  frequently  it  is  frontal,  .'\nstie 
says  this  is  common  of  all  neuralgias  of  children 
—  i.  c,  to  be  frontal,  and  to  aftect  both  sides  si- 
multaneously. There  is  often  nausea  throughout 
the  attack,  or  it  may  terminate  in  vomiting,  or  a 
free  flow  of  urine,  or  sometimes  there  are  two  or 
three  diarrheic  stools.  After  the  crisis  is  reached 
the  child  may  fall  asleep,  and  after  a  nap   waken 


well.  The  attack  does  not  always  terminate  in  a 
crisis  ;  after  a  gradually  increasing  headache  lor 
several  hours  it  gradually  subsides.  The  face  in 
the  beginning  of  an  attack  may  be  pallid,  and  as 
the  jiain  increases  the  face  bec(jmes  deeply  flushed, 
and  the  eyes  sufl'uscd. 

'I'he  treatment  must  be  preventive  and  curative.. 
If  a  child  is  of  a  neurotic  family,  in  which  there 
are  already  instances  of  neuralgia  and  migraine, 
we  should  urge  the  parents  to  see  that  he  has  as 
wholesome  a  life  as  possible.  Insist  on  ten  hours' 
sleep  at  night,  and  keep  him  from  too  prolonged 
ajiplication  to  his  books.  Six  or  seven  hours  of 
study  in  the  twenty-four  is  enough  for  a  growing 
child.  Encourage  out-door  sports  of  all  kinds, 
and,  if  possible,  kee])  such  a  ciiild  in  the  country 
for  many  months  in  the  year.  The  diet  should 
be  abundant  and  nutritious,  milk,  eggs,  soups  and 
broths,  with  meat  in  moderation,  and  the  various 
cereals,  and  plenty  of  vegetables  and  iVuit.  Such 
children  I  an  eat  l.irgely,  and  p  lenty  of  fatty  arti- 
cles of  food  is  well  borne  and  is  of  great  advantage. 
There  is  a  great  tendency,  in  the  education  of 
both  girls  and  boys,  to  over-cramming,  and  to 
over-stimulation,  to  reach  a  high  educational 
standard  ;  but  it  is  encouraging  to  see  the  effort 
wliich  is  now  being  m  ide  in  our  schools  to  vary 
and  widen  the  course  of  study.  The  introduction 
of  manual  art  into  the  public  schools  is  of  inesti- 
mable value  to  the  children,  not  only  because  it 
gives  them  dexterity  and  skill  in  the  use  of  the 
hands,  which  becontes  of  juactical  advantage  later 
in  life,  but  it  trains  the  minds  in  studies  which  are, 
so  to  speak,  external  in  their  kind.  .As  physicians, 
we  cannot  too  strongly  discourage  the  taking  of 
young  children  to  the  theatres,  where  not  only  the 
late  hours  and  bad  air  are  injurious,  but  the  im- 
pressions produced  by  the  plays  must  be  perni- 
cious to  an  extreme.  One  cannot  go  to  the  theatre 
now  w  ithout  seeing  children  of  all  ages  looking  on 
at  every  variel)  of  performance,  from  the  most 
decollete  spectacular  ballet  to  a  melodrama  of  the 
highest  intensity. 

]f  a  child  has  already  begun  to  have  attacks  of 
migraine,  nothing  is  of  more  value  than  attention 
to  the  general  health.  Such  children  are  often 
pale  and  thin,  and  have  but  little  appetite.'  If 
change  of  air  can  be  seemed,  it  is  often  enough 
to  obtain  relief  from  the  attacks.  If  we  cannot 
send  the  patient  away,  we  must  resort  to  tonics 
and  good  feeding.  Cod  liver  oil,  if  it  can  be  borne 
by  the  stomach,  is  of  the  greatest  possible  use  in 
such  cases.  If  the  child  cannot  take  oil,  we  must 
introduce  fat  into  the  system  in  some  other  way. 
Cream  and  plenty  of  butter  may  be  given.  De- 
vonshire clotted  cream,  which  is  now  to  be  obtai- 
ned at  the  Alderney  dairies,  is  relished  very  much 
by  children. 

Special  anti  neuralgic  drugs  are  seldom  indica- 
ted in  these  cases,  but  sometimes  the  bromides 
may  be  given  with  great  advantage,  especially  in 
those  children  who  are  of  a  very  nervous  tempera- 
ment, and  in  whom  any  effort  at  brain-work  causes 


m 


I'HE  CANADA  MEDICAL  RECOItft. 


headache.  It  should  be  given  in  small  doses,  and 
continuously  for  some  weeks. 

In  many  cases  some  ocular  defect  will  be  found 
which  will  require  correction  by  glasses,  and  many 
cases  of  migraine  in  children  have  been  cured  by 
this  means  alone.  In  all  cases  of  migraine  we 
should  look  carefully  into  the  condition  of  the 
teeth  and  have  any  unsound  ones  filled  or  remo- 
ved."—  Western  Medical  Ji!erini\  St.  Louts,  Mi>. 


THE  TREATMENT  OF  BRONCHITIS. 

By   J.    MiLNER   FOTHERGILL,    M.D., 

Physician  to  ttie  City  of  London  Hospit.il  for  Diseases  of  the 

Chest. 

Bronchitis  in  its  varying  degrees  of  gravity  is  a 
very  common  malady  in  general  practice.  In  its 
acute  form  it  is  rarely  serious  with  healthy  adults  ; 
but  when  the  powers  are  already  enfeebled,  and  at 
the  extremes  of  life,  it  is  a  malady  which  freqtient- 
ly  proves  fatal. 

It  has  two  distinct  stages,  (i)  the  first  of  dry, 
swollen  mucous  membrane,  and  (2)  free  secretion. 
The  treatment  of  the  first  stage  is  widely  different 
from  that  of  the  second  stage.  In  the  first  stage 
our  aim  is  to  procure  free  secretion  ;  in  the 
second  stage  our  chief  object  is  to  have  the  secre- 
tion coughed  up.  We  want  to  follow  Nature's 
processes  and  to  hasten  them,  if  possible,  but  not 
to  traverse  them.  No  ordinary  malady  requires 
this  more  certainly  than  bronchitis.  In  the  first 
stage,  the  dry  swollen,  irritable  bronchial  lining 
membrane  provokes  a  great  deal  of  useless  cough. 
The  skin,  too,  is  dry,  thotigh  the  temperature  as  a 
rule  does  not  run  high.  There  is  often  a  good 
deal  of  pain  down  the  sternum,  and  the  patient 
complains  of  the  chest  "  feeling  raw."  Say  the 
patient  is  an  adult,  it  will  be  well  to  give  some 
Plummer's  pills  at  bed  time,  with  a  grain  of 
opium  ;  and  if  the  tongue  be  coated  a  Seiditz  pow- 
der, or  a  black  draught  next  morning.  A  good 
mixtue  will  be  found  in. 

6     Vin.  Antimon.  Mx. 

Liq  amm.  acet.    f  j. — ter  in  die. 

Steam  inhaled  soothes  the  dry  bronchial  mem- 
brane, and  the  steam  can  be  medicated  w,th 
advantage.  A  jug  of  boiling  water  with  some 
terebene,  or  terpentine,  or  tincture  of  iodine,  or 
Friar's  balsam  poured  on  the  top,  will  furnish  an 
excellant  mhalant.  Sometimes  the  first  stage  is 
prolonged  ;  and  in  one  case  seen  long  ago  in  gen- 
eral practice  venesection  only  could  relieve  it. 
This  occurred  several  times.  Counter  irritation 
over  the  front  of  the  chest  affords  great  relief; 
and  nothing  is  better  than  croton  oil  liniment, 
provided  proper  precautions  are  taken  to  see  that 
the  liniment  only  touches  the  part  it  is  intended 
for  and  nowhere  else.  Many  and  painful  are  the 
consequences  of  carelessness  in  this  matter,  so 
much  so  that  it  is  rarely  prtident  to  let  a  patient 
aiDply  it  to  himself.  If  the  skin  can  be  acted  upon 


by  vapour,  the  natural  course  can  be  materially 
hastened. 

Such  then  is  the  line  of  attack  in  the  first  stage. 
If  a  bronchitis  kettle  is  at  hand,  set  it  agoing  at 
once.  If  not,  put  a  kettle  full  of  water  on  the 
fire,  without  a  lid,  so  that  the  steam  can  escape 
into  the  room.  Where  the  patient  is  of  the  neu- 
rosal  temperament,  the  congested  mucous  mem- 
biaiie  often  starts  up  a  certain  amount  of  true 
spasmodic  asthma.  The  fuming  remedies,  so  good 
in  uncomplicated  asthma,  rarely  agree  here.  They 
irritate  the  dry  bronchial  lining,  and  so  do  more 
harm  than  good.  An  emetic  of  a  quarter  of  a 
grain  of  tarter  emetic,  with  fifteen  grains  of  ipeca- 
cuanha powder,  taken  about  seven  in  the  morn- 
ing, will  often  produce  a  beneficial  change,  and 
start  bronchial  secretion. 

In  bronchitis  the  dauger 2)ar  excellance  is  exhaus- 
tion, and  inability  to  cough  up  the  phlegm  which 
acctimulates  in  the  air  tubes,  and  if  not  expelled 
stiffocates  the  patient.  Never  let  that  fact  escai)e 
the  field  of  vision.  A  time  of  trial  and  endurance 
has  to  be  undergone  sooner  or  later,  if  the  attack 
be  at  all  severe.  Consequently  the  patient  must 
be  fed  ;  and  especially  is  this  the  case  with  delicate 
children.  Milk  thoroughly  well  boiled  (half  an- 
hour)  is  the  food  for  either  young  or  old.  Then 
it  may  contain  some  Mellin's  food,  a  table-spoon- 
ftil  to  the  pint  of  milk.  Beef  tea  or  mutton  broth 
should  be  prepared  with  some  broken  biscuit,  or, 
as  of  old,  the  sole  of  a  loaf.  This  makes  it  a  food 
which  ordinary  beef-tea  is  not.  And  if  a  little  of 
the  stringy  muscular  fibre,  so  constantly  spoken  of 
disrespectfully  as  "  the  remains  of  the  beef,"  be 
pounded  in  a  mortar  and  returned  to  the  beef-tea, 
it  will  be  all  the  better.  The  popular  impression 
is  that  beef-tea  is  a  nourishing  food.  This  is  a 
mistake,  and  a  very  murderous  mistake  it  is.  In 
the  houses  of  the  humble,  treacle  and  milk  may 
be  boiled  together,  and  is  well  taken  by  infants. 
Probably  it  is  in  the  feeding  of  bronchitic  persons, 
old  and  young,  where  the  cases  slip  through  the 
doctor's  fingers.  It  is  all  very  well  to  generate 
steam,  give  medicine,  wrap  the  child  up  in  cotton 
wool,  or  a  linseed  poultice  ;  but  it  must  be  fed;  its 
poweis  must  be  conserved  for  the  time  of  trial  ; 
and  it  is  well  to  remember  that  the  remedial  agents 
indicated  in  the  first  stage  are  of  a  depressant 
character. 

When  secretion  has  been  secured,  and  the 
phlegm  begins  to  come  up  readily,  the  aspect  of 
the  case  changes.  It  is  like  a  dissolving  view 
with  the  magic  lantern;  one  is  seen  p-ssing  into 
another.  The  skin  becomes  moist,  like  the  bron- 
chial lining  membrane.  Relaxant  remedies,  hav- 
ing served  their  turn,  give  place  to  stimulent 
expectorants.  The  carbonate  of  ammonia  takes 
the  place  of  the  acetate.  The  sudorific  is  no 
longer  needed  ;  but  the  stimulant  to  the  respira- 
tory centre  becomes  essential.  Carbonate  of 
ammonia  is  a  respiratory  stimulant.  So  is  stry- 
cliina.  These  are  the  main  constituents  of  a 
cough  mixture  in  the  second  stage  of  bronchitis. 


THE   CANADA    MEDICAL    RECORD. 


179 


Senega  is  largely  in  use  ;  hut  probably  if  medical 
men  made  a  practice  of  tasting  themselves  what 
they  prescribe  for  others,  it  would  soon  fall  into 
r  disuse.  If  there  i)e  any  strain  on  tiie  riglit  ven- 
tricle, and  especially  if  there  exist  any  old  stand- 
ing mitral  mischief,  digitalis  must  be  added,  as  in 
the  following  draught  whicli  may  be  repeated 
every  four  hours. 

5     Am.  carb.  gr.  iv. 
Tinct.  nuc.  vom.  Mx. 
Sp.  chloroform  M.xx. 
Inf.  cinch,  flav.    3  j. 

Such  is  an  efficient  combination  when  the  bodi- 
ly powers  are  being  subjected  to  the  strain  of  a 
severe  attack  of  bronchitis.  Then  the  liquid  food 
must  be  accompanied  by  some  alcohol.  If  the 
doctor  be  timid  or  the  nurses  negligent,  death, 
with  his  scytiie,  will  not  be  far  distant.  Tiie 
medical  man  must  stand  up  to  the  c'isease  like  a 
swordsman  to  his  antagonist.  If  the  trial  be  a 
severe  one,  he  must  rise  to  the  oci  asion.  Recently 
fifteen  minims  of  tincture  of  nux  vomica  every 
four  hours  did  me  yeoman  service,  where  the  res- 
]>iratory  centre  was  getting  distinctly  drowsy. 
When  the  phlegm  accumulates  in  the  air  lubes  of 
the  basis  of  the  lungs,  the  breath  becomes  very 
short,  as  the  breathing  area  of  lung  becomes  reduc- 
ed. In  the  case  of  children  an  emetic  of  ipeca- 
cuanha is  indicated,  and  the  act  of  vomiting  gets 
rid  of  the  accumulation  in  a  very  efficient  way. 
The  child  looks  as  if  it  w-ere  going  to  die,  as 
it  fights  for  breath ;  but  it  does  not  die,  and 
shortly  falls  into  a  calm  sleep,  breathing  easily. 
The  same  may  be  done  for  a  healthy  adult  ;  but 
is  not  safe  with  old  persons  with  rotten  tissues. 
All  the  time  keep  up  the  powers.  Add  some 
brandy  to  the  milk  and  treacle,  or  milk  and  malt 
extract,  but  do  not  give  it  alone.  The  stimulent 
must  carry  with  it  some  food,  otherwise  the  powers 
are  only  worn  out  all  the  sooner.  This  is  a  very 
important  matter,  never  to  be  forgotten.  As  the 
case  drags  on  the  patient  becomes  worn  out  from 
"lack  of  sleep,"  and  begs  for  a  narcotic.  His 
prayer,  however  |)iteous,  must  fall  on  a  deaf  ear. 
To  sleep  is  to  die.  The  breathing  can  only  be 
maintained  by  voluntary  effort.  Watch  the 
patient  dropping  off  to  sleep,  nodding,  to  awake 
■with  a  start  from  a  horrid  dream.  The  carbonic 
acid  gas  accumulates  in  the  imperfectly  aerated 
blood,  till  tlie  drowsy  res])iiatory  centre  wakens 
up  with  a  start,  and  throws  the  accessory  muscles 
of  respiration  into  violent  action.  The  subjective 
sensations  of  the  patient  are  those  of  suffocation, 
which  takes  the  form  of  a  horrible  dream. 

At  last  the  battle  is  either  won  or  lost.  The 
amount  of  secretion  decreases,  in  some  portion  of 
the  lung  at  least,  and  the  much-tried  patient  gets 
snatches  of  sleep.  On  awakening  a  "  coughing 
bout "  clears  the  air  tubes,  so  that  soon  the 
patient  drops  off  to  sleep  again,  ^s  soon  as  the 
fit  of  coughing  is  over,  give  the  fo3'J,  and,  if  the 
hour,  the  niedi(;jne  also.     Loose  no  lii^fi  i  it  is  pre- 


•  ions.  Ry  such  management  the  strength  will  be 
rapidly  regained.  And  finally  there  is  one  thing 
which  the  senior  student,  or  yoimg  practitioner, 
nnist  not  do.  Very  likely  there  is  some  conges- 
tion of  the  lung  bases  at  the  back.  If  the  ])atient 
be  found  sitting  up  it  may  be  well  to  take  the 
opportmiity  to  go  over  the  back  ;  but  this  must  be 
done  rapidly.  To  get  the  patient  up  and  expose 
the  back  for  the  purpose  of  careful  examination 
is  a  foolish  proceeding  fraught  with  great  danger. 
The  physician  can  count  the  respirations  ;  the  man 
who  daily  examines  the  backs  of  the  lungs  in  a 
severe  case  of  bronchitis — where  the  skin  is 
bedewed  with  sweat,  i.e.,  the  cutaneous  respira- 
tion is  heljjing  out  the  embarrassed  jjulmonary 
respiration — is  not  fit  to  be  a  physician,  and  will 
be  much  less  murderous  if  engaged  as  a  dissect- 
ing-room porter.  .'\t  critical  times  every  action 
must  be  carefully  thought  out  ;  when  life  is  trem- 
bling in  the  balance  a  trifle  may  cast  it,  and  re- 
gret is  unavailing.  Some  things  must  be  done 
and  .some  must  not  be  done.  Even  if  the 
bowels  are  not  moved  for  several  days,  do 
not  administer  a  purgative.  Exposure  in  getting 
up  to  the  night-chair  often  entails  most  serious 
consequences.  There  are  sins  of  coinmission  as 
well  as  sins  of  omission,  and  a  thoughtless  practi- 
tioner is  apt  to  commit  both. — JJospital  Gazette. 


BREATHING   EXERCISES   IN   THE   PRE- 
VENT1(.)N  AND  TREATMENT  OF  LUNG 
DISEASES.^l^ 
By  John  L.  Davis,  A.  B.,  M.  D., 

Professor  of  Thenipeiitics  in  the  Medical  College 
of  the  University  of  Southern  California,  Los  An- 
geles, Cal. 

*\  pa]ier  vead  before  the  Los  Anjjles  County  Medical 
Society  6th  .April,  1SS8. 

I  desire  this  evening  to  bring  before  the  Society 
some  considerations  as  to  the  value  of  systematic 
breathing  exercises  in  the  treatment  and  in  the  pre- 
vention of  diseases  of  the  respiratory  tract. 

There  is  no  question  that  regular  general  exercise 
is  of  prime  importance  in  maintaining  the  bodily 
organs  and  their  functions  in  a  state  of  health.  This 
is  one  point  upon  which  all  physicians  agree.  Not 
only  does  exercise  tend  largely  to  the  maintenance 
of  health  and  general  well-being,  but  it  leads  to 
tiiat  bodily  vigor  which  resists  disease.  In  other 
words,  through  properly  regulated  exercise,  a  re- 
serve force  is  accumulated  which  may  be  drawn 
upon  when  needed. 

This  energy  may  be  directed  toward  the  devel- 
opment of  special  functions  or  organs,  and  one 
part  or  system  of  the  body  becomes  conspicuously 
stronger  or  more  active  than  the  rest.  It  is  con- 
tinued exercise  that  produces  the  blacksmith's 
muscle,  the  touch  of  the  blind,  the  dexterity  of  the 
juggler,  the  endurance  of  the  athlete.  Strong 
muscle,  a  sensitive  touch,  dexterity  and  endurance 
are  all  (idmirri!  elements,  particilliirly  J!)  a  souftcj 


180 


THE   CANADA   MEDICAIRECORD. 


body.  But  it  is  far  too  often  the  case,  that  the 
very  foundation  of  strength  and  endurance  and 
vigor  is  neglected  ;  and  the  lungs,  which  of  all  or- 
gans rank  first  in  importance,  whether  we  consider 
the  functions  of  health  or  the  danger  of  disease, 
are  too  apt  to  remain  undeveloped;  their  fullest 
functional  service  is  not  carefully  sought  after. 

There  is  no  question  that  if  the  care  that  is  given 
toward  developing  the  muscular  and  nervous  sys- 
tems were  devoted  to  strengtheninL'  the  breathing 
apparatus  and  increasing  lung  capacity,  an  infi- 
nitely greater  benefit  would  be  obtained  by  the 
individual ;  a  greater  factor  in  preserving  health 
and  withstanding  disease.  This  is  especially  the 
case  with  persons  wliose  lungs  are  below  par 
through  weakness,  either  inherited  or  acquired. 

In  this  connection  there  are  three  projwsitions, 
which,  hardly  need  demonstraiion  : 

1.  In  the  ordinary  individual  the  lungs  are  not 
fully  developei  ;  many  of  the  air-cells  have  only  to 
the  slightest  extent  been  brought  into  use.  'I'his 
fact  is  repeatedly  illustrated  m  [Jost  mortem  exam- 
inations of  these  organs. 

2.  Proper  breathing  and  muscular  exercises 
will  bring  these  cells  into  use  and  enlarge  the 
breathing  capacity  (i.  e.,  "  I'lVir/  capacity.")  By 
way  of  proof,  leference  may  be  made  to  the  effei:t 
of  training  in  vocalists  and  adiletes. 

3.  Individuals  whose  lungs  are  well  developed 
are  less  liable  to  pulmonary  diseases  than  are  those 
whose  lung  capacity  is  less  developed.  In  support 
of  this  proposition  I  may  refer  to  the  valuable  pa- 
per of  Dr.  Balfour  {Med.  Chirarij.  Trans.,  i860, 
p.  263),  in  which  he  shows,  from  a  large  number 
of  recruits  for  the  English  army,  that  among  those 
whose  lung  capacity  was  below  the  average,  there 
was  over  four  times  the  sickness  that  prevailed 
among  recruits  whose  capacity  was  above  aver- 
age. One  of  the  highest  authorities  upon  the 
science  of  life  insurance  (Sieveking,  Med.  Adviser 
in  Life  Ins.,  p.  42)  says  :  "  Respiration  and  life 
may  be  regarded  as  synonymous,  and  we  find  that 
vital  power  may  be  measured  by  the  manner  in 
which  the  functions  of  respiration  are  carried  on. 
Hence  the  stress  that  medical  men,  and  even 
popular  opinion,  lays  upon  the  value  of  a  well 
developed  chest,  which  affords  an  indication  of 
the  vital  capacity  of  the  lungs.  In  ordinary  quiet 
respiration,  the  thorax  is  neither  fully  expanded 
nor  fully  emptied  of  the  contained  air.  To  meas- 
urejits  entire  capacity — i,  c.,to  determine  the  who!e 
amount  of  air  which  it  is  capable  of  taking  in  and 
discharging  in  one  respiratory  act— it  is  necessary 
that  a  forced  inspiration  and  a  forced  expiration 
be  made." 

The  average  vital  capacity  is  225-250  cubic 
inches  for  a  man  of  ordinary  height  at  thirty  years 
of  age.  The  capacity  increases  with  the  individ 
ual's  height ;  and  it  also  increases  from  the  age  of 
fifteen  to  thirty-five.  In  latier  life,  however,  it  is 
found  to  decrease. 

The  average  of  expar.gion  for  the  "  normal"  man 
jsjhre9iache.s  ;  that  is,  the  djffere  ice  in  chest  cir- 


cumference between  the  most  complete  expiration 
and  the  fullest  inspiration.  If  it  falls  much  below 
this  figure,  life  companies  agree  that  the.individual 
is  an  unsafe  risk  for  insurance,  because  he  is  not 
likely  to  live  out  his  "  exi)ectancy." 

But  systematic  exercise  will  increase  theexpan- 
sion  considerably.  I  have  often  examined  [latients 
and  applicants  for  insurance  whose  expansion  was 
over  four  inches,  and  in  a  few  cases  the  expan- 
sion has  reached  five  inches.  In  most  if  not  all 
cases  of  unusually  large  expansion,  ihe  indivi- 
duals were  either  vocalists  or  players  on  wind- 
instruments,  or  they  had  taken  special  pains 
to  develop  their  vital  capacity.  Son>e  years  ago 
when  I  fust  made  application  for  life  insurance, 
my  chest  expansion  was  four  inches  ;  and  this 
amount  was  (in  a  few  weeks)  increased  to  live 
inches  by  careful  exercises,  vocal  and  respiratory. 
But  the  greatest  benefits  to  be  derived  from 
lung  exercises  are  not  in  the  cases  of  healthy  indi- 
viduals, but  rather  in  those  whose  vital  capacity 
is  below  the  normal — who  are  hollow-chested, 
stooping,and  feeble  in  their  breathing.  The  imper- 
fect development  of  their  respiratory  fun  :tion 
invites  disease  ;  tfieir  lungs  are  vulnerable.  Pro- 
per exercise  will  throw  off  this  debility  and  lender 
them  le  .s  liable  to  disease.  We  may  go  even  a 
step  further  and  say,  that  in  many  cases  where 
lung  disease  actually  exists,  breathing  exercise  is 
one  of  the  most  valuable  elements  in  treatment. 
I  have  often  been  gratified  with  the  way  in  which 
a  consolidated  lung  in  chronic  pneumonia  of  long 
standing  and  slow  progress  would  improve  under 
]7ioper  lung  exercise.  Indeed,  in  some  of  these 
cases  it  has  seemed  that  properly  regulated  exer- 
cises have  rendered  greater  service  than  could  be 
derived  from  ordinary  drugs. 

The  exercise  which  I  have  found  of  most  value 
in  developing  the  lungs  m.iy  be  desjribcd  as 
follows  : 

Standing  as  erect  as  possible,  with  shoulders, 
thrown  back  and  chest  forward,  the  arms  hanging 
close  to  the  body  ;  the  head  up,  with  lips  firmy 
closed,  inhalation  is  to  be  taken  as  slowly  as  may 
be  ;  at  the  same  time  the  extended  arms  are  to  be 
gradually  raised,  the  back  of  the  hands  upward, 
until  they  closely  approach  each  other  above  the 
head.  The  movement  should  be  so  regulated 
that  the  arms  will  be  extended  directly  over  the 
head  at  the  moment  the  lungs  are  completely  filled. 
This  position  should  be  maintained  from  five  to 
thirty  seconds,  before  the  reverse  process  is  begun. 
As  the  arms  are  gradually  lowered,  the  breath  is 
exhaled  slowly,  so  the  lungs  shall  be  as  nearly 
iVeed  iVom  breath  as  possible  at  the  time  the  arms 
again  reach  the  first  position  at  the  side.  By 
these  movements  the  greatest  expansion  possible 
is  reached  ;  for,  upon  inspiration,  the  weight  of 
the  shoulders  and  pectoral  muscles  is  lifted, 
allowing  the  thorax  to  expand  fully  ;  while  upon 
exhalation,  in  lowering  the  arms,  we  utilize  the  ad» 
ditional  force  of  this  pressure  upon  the  upper  tho; 
Ia^  to  render  ex|iii'fl!i<^'i  ^'^  complete  aspo,«ii)le, 


TlIK    CANADA    MKDICAL    RKCORD. 


ISl 


These  deeii  res|iitalions  should  l)c  rcpiMli-il  live 

or  six  times  ;  and  tiie  exercise  j;one  through  with 

several    liiii.s   a   day.      It   is  liardiy  necessary  to 

^       remark  dial  die  clothing  must  in  no  way  interfere 

with  the  exercise. 

In  some  va^e-  this  exercise  is  more  advantage- 
ous when  taken  lying  Hal  on  the  back,  instead 
of  standing.  In  this  position  the  inspiratory 
muscles  become  rapidly  strengthened  by  opposing 
the  additional  pressure  exerted  by  the  abdominal 
organs  against  the  exi)anding  lungs.  And  on  the 
other  hand,  expiration  is  nioie  perfect  and  full  on 
account  of  the  pressmx  of  these  organs.  This  is 
an  exercise  now  advocated  by  several  leading  vo 
cal  teachers  of  ICmojie. 

In  coni-lusion,  I  wdl  mention  the  exercises  pro- 
posed by  ur.  Dally  (Bui.  linn,  de  'I'herap.,  Sept. 
20,    1881),  for  enlarging  hmg  capacity  : 

"  I.  'I'he  first  or  normal  is  the  verticd  position 
perfectly  erect,  as  if  standing  against  a  wall,  the 
arms  hanging  by  the  side.  This  position  should 
be  taken  and  kept  ten  minutes  at  a  time,  a  number 
of  times  a  day. 

"  2.  The  two  arms  and  the  hands  are  extended 
horizontally  forward,  the  palms  facing.  The  hands 
are  separated  slowly,  whilst  the  chest  is  inclined 
forward.  Remain  in  this  1  osilion  thirty  seconds, 
and  inspire  deeply  by  the  nose.  Reuirn  to  the 
initial  [losition  and  expire.  Execute  this  move- 
ment six  times. 

"  3.  The  arms  hang  by  the  side  ;  raise  them  up- 
ward— the  fingers  well  extended — above  the  head, 
the  palms  looking  forward.  Take  a  deep  inspira- 
tion. Let  fall  the  arms  alongside  the  body,  palms 
ojjen  and  expire  slowly. 

"4.  l')ouble  rotation  at  the  side.  The  subject 
being  in  the  normal  position  (first,)  executes  as 
large  as  possible,  the  arm  well  extended,  double 
rotation  laterally,  and  inclining  the  trunk  forward 
each  time  that  the  arms  are  thrown  behind,  and 
never  projecting  the  abdomen  forward.  This  move- 
ment is  executed  entirely  by  the  scaipo-humeral 
articulation. 

"  5  The  arms  are  crossed  horizontally,  the  palms 
looking  backward.  Flexion  lateral,  alternately, 
of  the  trunk.  The  flexion  will  then  be  regular, 
transverse,  the  abdomen  drawn  in,  the  legs  exten- 
ded apart,  the  pelvis  fixed.  The  limit  of  the 
flexion  is  the  vertical  position  of  the  elevated  arm. 
Mild  inspiration  during  the  flexion,  at  its  termin- 
ation expiration.  Execute  these  movements  six 
or  eight  times. 

"  These  exercises,   if  faithfully  carried  out  im- 
prove the  shape  and  capacity   of  the  thorax  and 
'        check  the  development  of  incipient  phthisis. 

"  According  to  Dr.  Dally,  dyspnce,  polysarca, 
and  arthritic  conditions  are  removed  or  sensibly 
ameliorated.  Venous  states,  varicose  dilatations, 
and  infarctions  are,  after  some  weeks  of  such 
movements,  much  improved,  when  the  circum- 
stances are  favorable.  The  great  obstacles  to  this 
(       hygienic  medication  jii  Qijr  civiligatiQji   are    th? 


h.djitual   la/,ine>s  and    idleness,  and  the  indisjiosi- 
tion    to  devote  time  and  interest  to    such  means." 

Soiillii'ia  ('iilif'diiii'i   I'liiililiiinii'. 


PLACENTA  I'KEN  lA. 

Dr.     Robert    liarnes    says  that    the    conflii  ting 
ideas    regarding    the   trc'atment  of  this  dangerous 
condition  justify    him    in    pointing  out    the    true 
theory  which  should  govern  our    procedure.      The 
mediods  advocated    are  as  follows :  Accoacln'meiit 
force,    to  which    S])iegelberg   lends   his  authority. 
"  Rupture  ihe  membr.mes,  (b'.iw  down    afoot  and 
wai   during   exiiaclion.  "^.S<:liioeder.      Bimanual 
version,  tamijoning.      It  has  been  uigi-d  that  rapid 
and    forcible    delivery,     while    <l.ingeroiis    to    the 
chdd,  is  justifiable,  as  the  condititui  is  .so  i]erilous 
that  the    child    need    not    be  considered.     Barnes 
believes  that  it  is   no    longer   permitted,    without 
clear  necessity,   to  sacrifice  the    child,  and  he  has 
found  that  the  methods  which  are    most    success- 
ful in  saving  the  mother  are  those   which  give  the 
child  the  best  chance.     He    ba,es   his    theory  of 
placenta   previa  on  a  division  of  the    uterus    into 
three   regions;  The  fundal,    which  is  the   typical 
normal    attachment   of   the   [jlacenta;  the   equa- 
torial, which    is    the    seat  of  lateral    attachment, 
and   predisposes   to    accidental   hemorrhage ;  the 
lower   uterine    segment.     This,   which    was    first 
described  by  the  author  in  1847,  is   d.ivided  from 
the  equatorial  zone  by  what  is  variously  known  as 
Braun's  os   internum,    Bandl's   ring,  and   Schroe- 
der's  contractions-ring,  at  a  point  which  generally 
corresponds  to  the  equator  of  the   fetal   head  and 
frequently  to  the     pelvic  brim.     When    the   pla- 
centa invades  this  lower  segment,  danger  begins, 
as   the    part  so   situated    is    liable   to    premature 
detachment.     He    believes    that    the  anatomical 
differences     between    the    middle     and     inferior 
zones,    which    have    been      described   by    some 
authors,     are    exaggerated.     The    source   of  the 
hemoirhage  is  the  uterine    vessels  which  are  torn 
across  by  the  detachment  of  the   placenta  from  its 
walls.     The  cause  of  this  rupture   cannot   always 
be  muscular  contraction,    as  it   sometimes    takes 
place  before  any  contraction  has  occurred.     From 
its  frequent  coincidence   with  a  menstrual   period, 
vascular  tension  must  be    considered  as  a  factor. 
The   spongy   cellular    structure   of  the   placenta 
favors   accumulation    of  blood  ;  from  this  disten- 
sion there   may  be  ru[)ture  of  vessels  and   hemor- 
rhage within   the   structure    of  the   organ.     The 
bulk  of  the   distended   placenta    becomes  greater 
than  its  area  of  attachment,  and  separation  takes 
place,    and   hemorrhage     persists    if  contraction 
does  not  set   in.     This    condition    must   also    be 
considered   a   factor.     The   form  of  contraction 
which   prevails  in  the   inferior    uterine    segment  is 
retraction,  longitudinal  muscular  fibres    continued 
from  the  mid  lie  zone,  inill  up  or  retract  the    lower 
zone,   thus  dilating  the  cervix   and    infacilitating 
expulsion.     When   the  reaction  is  retarded  there 
is  hemorrhage,     An  obstacle  to  this   retraction  is 


182 


THE   CANADA    MEDICAL   RECORD, 


i 


the  partial  adhesion  of  the   placenta,  which,  when 
detached,  if  the  vital  power  is  not  too  low,  admits 
of  retraction.     Aktration  of  the  structure  of  the 
placenta,   as  fibrinous  or  fatty  degeneration,  espe- 
cially apt  to  occur  in  the  previal  flap,  predisposes 
to     self-detachment.     The     placenta    may     grow 
more    rapidly   than    the   seat  of  its   attachment, 
and   thus    separation   may   take   place.     In    the 
jjrogress  of  many  labors  there  is  a  stage  when  flood- 
ing   is   spontaneously     arrested;  this    is   due    to 
contraction  of   the  uterus   and    clot    formation  in 
the  orifices  of  the    vessels.     The    arrest   of  flood- 
ing is   neither   permanent   nor   secure    until    the 
whole  of  that  |5ortiiin   of  the  placenta  ndheiingto 
the  lower  zone  is    detached.     The  limit  ol  dan.ii;c- 
rous   attachment   coiresjiDiids    to  the   line    before 
mentioned  ;  below  this  the    uterine   segment  must 
dilate  to  allow  the  passage  of  the  child.     Above  it 
the  uterus  does  nut  dilate.     AVhen  the  placenta  is 
detached  from  this    segment  there  is  no  physiolo- 
gical reason  why  further  detachment  or  hemorrhage 
should  take  place   until    after    the    birth    of  the 
child.     The   portion   which    remains   adherent  is 
commonly   sufficient    to    preserve    the  life   of  the 
child,  and  it  is  only  in  cases  of  central  attachment 
or    ]3remature     labor    that    its    life    is    sacrificed. 
Adhesion  over  the  os  internum  impedes  the  regu- 
lar dilatation  of  the  part      Injury   and  inflamma- 
tion of  the  uterine   structures,    particularly  of  the 
cervix,    are  especially  likely  to  ensue    upon    deli- 
very in  placenta  |)revia.     The  greatest  amount  of 
hemorrhage  frequently  takes  [tlace  at  the  commen- 
cement  of  labor,    frequently    before  there  is  any 
c  ear    indication  of  labor.     The  cervix  is  always, 
f,om  its  being   near   the  seat  of  placental    attach- 
ment,   highly    vascular,  and    is    frequently    very 
rigid  ;  any  attempt  to  force  the  hand  through  it,  to 
detach  the  whole  placenta  or  to   deliver,  must  be 
made  at    the    risk    of  injuring   the   womb.     The 
dragging  of  the    child  through  the  cervix,  even 
when  it  has  not  been    necessary  to  introduce   the 
hand    into   the    uterus,  is  a  proceeding  of  peril  to 
both  cliild  and  mother.   It  is  desirable  to  expedite 
the    stage  of  dilatation,   avoiding   violence.     The 
arrest  of    flooding,    and    the    expansion   of    the 
OS    may    be    promoted    by    rupturing   the  mem- 
branes   and     the    use    of     tents.      Since     cross 
presentation    or   other    unfavorable    position    of 
the  child  is  apt  to  impede  or  destroy  the  regular 
contractions  of  the    uterus    which   are    necessary 
to  arrest  the    flooding,   it  is  mostly   desirable    to 
deliver  as  soon  as    the   condition  of  the   os  will 
permit.     In  some  cases  rupture  of  the  membranes 
and     the     employment    of  galvanism    (?)    may 
suffice    to  arrest   the  hemorrhage   at  the   critical 
period  when  the  total  detachment  of  the  placenta 
or  lorcible  delivery  is  dangerous  or  imjjracticable, 
the  introduction  of  the  index  finger  through  the  os, 
and   the   forcible  separation  of  the  jjlacenta  from 
the   dangerous   zone,    is  a    safe    and  practicable 
operation,  and  will  convert  the  labor  complicated 
by    placenta   i)revia   inio  a  normal    labor.     If  the 
UteiUi  does  not  assmuv  the  vigorous  action  neces- 


sary to  effect  delivery,  it  will  be  necessary  to  dilate 
the  cervix  artificially.  This  can  be  readily  done 
by  the  caoutchouc  water  dilator  (''  Barnes'  bag  "). 
Sufticient  dilatation  being  obtained  delivery  may, 
if  necessary,  be  accelerated  by  forceps  turning  or 
embryotomy,  according  to  the  special  indications 
dictated  by  the  condition  of  the  child.  In  case 
of  turning,  he  insists  strenuously  upon  the  impor- 
tance of  the  deliveiy  of  the  after-coming  head  by 
the  forceps,  if  there  be  any  difliculty  or  delay  in 
the  passage  of  the  head  under  manual  traction. 
He  sums  up  the  measures  that  come  into  succes- 
sive use  as  follows :  (  i  )  Rupture  of  the  mem- 
branes. (2)y\pplya  firm  binder  over  the  uterus. 
(3)  A  plug  may  be  used  to  gain  time,  but  it 
must  not  be  trusted —  watch  closely.  (4)  Sepa- 
rate all  the  placenta  that  adheres  within  the  lower 
zone,  and  observe  closely.  If  no  hemorrhage, 
wait  awhile.  The  uterus  may  do  its  own  work ; 
if  not  dilate  the  cervix  by  the  water  bags.  Again 
pause  and  observe.  If  Nature  fails  to  deliver, 
resort  to  the  forceps,  which  gives  the  best  chance 
to  the  child,  or  turn.  "  In  following  this  order  of 
procedure,  we  strictly  follow  the  law  of  ])hysiology. 
We  do  not  force  Nature  but  obey  her." — British 
M<:dicii1  Journul,  March  31,  18S8. 


NOTES  ON  THE  TRE.\TMENT  OF  ACUTE 

TONSILLITIS  IN  CHILDREN. 

By  frank  iiamiltn  opotter,  M.  U., 

Lecturer  on   Laryngology,  Meilic.il  Uepartment,  Niagara 

University. 

When  an  inflammation  attacks  the  tonsil,  it  is 
influenced  in  its  progress  by  those  constitutional 
stales  that  so  markedly  afi'ect  the  natural  history 
of  disease.  Hence,  it  is  important  to  recognize 
the  presence  of  syphilis,  tuberculosis,  rheumatism, 
etc.,  in  the  constitution  of  any  patient  we  may  be 
treating  for  a  tonsillitis.  , 

In  children,  these  diseases  may  be  latent,  butr 
none  the  less,  they  have  a  potent  influence  ove. 
the  course  of  the  malady  under  consideration. 
Therefore,  we  should  always  make  ourselves  fami 
liar  with  the  natural  history  of  the  parents,  and,  if 
any  of  these  diseases  are  found,  so  modify  our 
treatment  as  to  meet  and  counteract  whatever  of 
baleful  influence  may  have  been  transmitted  to  the 
child. 

In  the  suggestions  to  follow,  on  the  management 
of  an  acute  tonsillitis  in  children,  it  must  be  under- 
stood that  no  routine  practice  is  proposed.  1'he 
plan  detailed  must  be  so  modified  as  to  meet  the 
hereditary  and  acquired  variations  from  health  in 
the  jiarticular  case  under  consideration. 

In  order  to  obtain  a  clear  idea  of  what  is  requi- 
red in  a  rational  treatment  of  a  tonsillitis,  let  us 
see  how  an  inflammatioii  may  behave  when  attack- 
ing that  organ.  In  our  opinion,  there  has  been 
too  much  refinement  in  this  matter,  Bearing  in 
mind  its  anatomical  structure,  we  observe,  in  the 
first  place,  that  an  inflammation  may  limit  itself 
entirely  to  the  ti?§ue  immetlifttely  surrounding  the 


Tttft  CANAl)A   MfcDtCAL  RECORD. 


183 


tonsil,  and  then  we  have  the  peritonsillitis  of  some 
authors  ;  it  may  express  itself  in  the  superficial 
parts,  and  become  tlie  erythematous  tonsillitis  of 
others  ;  it  may  be  deep  seated,  involving  the  paren- 
chyma, and  we  have  the  i)arencl))nKitous  tonsilli- 
tis, or  the  true  i[uinsy  of  the  older  writers  ;  ,ind  a- 
gain,  the  brinU  of  the  inllannnation  may  be  confi 
ned  lo  die  laciUKU,  and  dien  the  disease  is  called 
folliculous  tonsillitis.  Now,  in  our  oijjnion,  this 
is  ihe  same  intlamniation,  modified  according  to 
the  constitutional  state  of  the  patient,  the  kind  and 
severity  of  the  exposure,  and  so  on.  As  an  illus- 
tration, it  has  been  observed  that  the  variety  of 
tonsillitis  called  parenchymatous,  occurs  with  great 
frequency  in  rheumatic  subjects,  and  treatment 
followed  in  recognition  of  this  fact — as  the  exhibi- 
tion of  the  salicylates,  salol,  etc., — has  resulted  in 
prompt  relief  Other  instances  could  be  cited  in 
proof  of  this  position,  but  it  would  carry  us  too 
far  from  the  immediate  purpose  of  this  paper.  The 
question  before  us  is,  how  to  treat  a  case  of  simple 
tonsillitis,  by  which  is  meant,  one  uncomplicated 
by  any  other  disease,  and  uninfluenced  by  the  pre- 
sence of  any  diathesis.  Such  cases  are  not  rare, 
and,  in  our  opinion,  can  be  greatly  modified  in 
their  duration  and  severity  by   proper  treatment. 

We  have  to  deal  with  a  sthenic  inflammation — • 
one  that  develops  very  rapidly,  and  continues  at 
a  great  height  for  some  days.  The  plain  indica- 
tion, then,  is  to  control  the  production  of  this  heat, 
to  so  influence  the  nerve  centers  as  to  make  a 
high  temperature  impossible.  This  is  done  by  the 
exhibition  af  antipyretics.  So  much  for  the  gene- 
ral treatment.  The  next  indication  is  to  relieve 
the  local  distress.  When  the  mucous  membrane 
of  the  mouth  and  throat  is  inflamed,  the  secretion 
therefrom  is  highly  acid.  This  acid  secietion 
acts,  in  time,  as  an  irritant,  and  keeps  up  the  local 
disturbance.  The  indication  is  to  apply  alkalies 
to  the  surface  of  the  tonsil,  to  neutralize  the  acidity 
of  the  secretions,  and  relieve  the  inflamed  surface 
of  this  great  source  of  irritation. 

This  is  the  general  plan  proposed  ;  the  details 
of  its  application  are  as  follows  : 

The  doses  given  are  for  adults,  for  the  reason 
that  we  then  have  a  definite  standard  to  go  by, 
which  can  be  modified  to  meet  the  age  of  each 
individual  case. 

First,  to  keep  down  the  temperature  : 

The  various  antipyretics  may  be  used  according 
to  personal  choice,  but  we  have  come  to  rely 
principally  upon  antifebrin.  This  is  to  be  given 
in  five  grain  doses  every  hour  until  the  tempera- 
ture falls  to  nearly  normal,  and  then  at  intervals 
necessary  to  prevent  it  rising  again.  We  have  ne- 
ver been  obliged  to  give  more  than  three  doses  in 
order  to  accomplish  the  first  indication,  generally 
two  doses  have  been  sufticient.  In  children,  the 
minimum  dose  according  to  age  should  be  given, 
and  the  patient  carefully  watched.  Occtsionally, 
it  will  be  found  to  have  a  depressant  efl'ect,  and 
must  be  abandoned  for  one  of  the  other  antipyre- 
tics. 


The  local  treatment  can  be  applied  in  s;.'veral 
ways.  Bicarbonate  of  sodium  can  be  dusted  upon 
the  tonsils  by  means  of  an  ordinary  powder-blower, 
or  a  solution,  ten  grains  to  the  ounce  of  water,  can 
be  sprayed  on  the  parts  by  means  of  an  atomizer, 
or,  where  the  patient  is  of  sufficient  age,  he  can 
be  instructed  to  dip  the  finger  into  the  powder 
and  touch  the  surface  of  the  tonsil  wish  it,  or  he 
can  hold  the  solution  in  the  mouth,  allowing  it  to 
b.uhe  the  parts  for  a  few  moments.  This  local 
treatment  should  be  used  fretpiently,  say  at  inter- 
vals of  an  hour,  during  the  day, 

Our  notes  show  that,  with  this  plan  of  treatment, 
four  c.ises  of  severe  tonsillitis,  seen  within  the  last 
(ew  months,  were  limited  to  two  days  each.  On 
the  third  day,  there  remained  simply  the  general 
malaise,  which  is  apt  to  follow  cases  of  this  kind. 
The  temperature  of  these  cases,  when  first  seen  by 
the  writer,  ranges  from  102°  to  104°   F. 

Professional  friends,  to  wh.jm  this  treatment 
was  suggested,  have  reported  e(|ually  good  results. 
It  is  not  necessary  to  report  these  cases  in  detail, 
but  we  content  ourselves  by  formulating  the  con- 
clusions of  this  paper  as  follows  ; 

I.  When  an  inflammation  attacks  the  tonsil,  it 
is  greatly  influenced  in  its  course  by  the  presence 
of  any  diathesis. 

II.  The  treatment  must  be  so  arranged  as  to 
meet  and  counteract  the  influence  of  this  diathesis. 

HI.  In  all  cases,  simijle  as  well  as  complicated, 
the  general  indications  are  to  keep  down  the  tem- 
l)eratiire  and  to  relieve  the  local  irritation. 

IV.  The  first  indication  can  be  met  by  the  ex- 
hibition of  antifebrin  in  proi)er  doses;  the  second 
by  the  frequent  application  of  bicarbonate  of  sodi- 
um, either  in  powder  or  in  solution,  to  the  surface 
of  the  tonsil. 

V.  This  plan,  properly  followed,  will  generally 
limit  the  disease  from  one  to  three  davs. 


HYPODERMIC    USE    OF    NITROGLY- 
CERINE IN  HEART  FAILURE. 

By  M.  Howard  Fussell,  M.D.,  Philadelphia. 

The  results  of  the  hypodermic  use  of  two  drops 
of  a  one  per  cent,  sol  itionof  nitro-glycerine,  in  the 
following  cases  of  he.irt  failure,  were  so  satisfac- 
tory that  it  seems  a  matter  of  importance  to  the 
writer  to  place  them  on  record. 

Case  I. — Mrs.  G.,  aged  63,  subject  to  dyspncea, 
palpitation  and  recurring  cedema  tor  several  years, 
had  a  slight  cerebral  hemorrhage  two  years  ago. 
Examination  at  that  time  showed  disease  of  the 
mitral  valve.  Under  treatment  with  digitalis  and 
strophanthus,  the  case  progressed  favorably  until 
January,  1888.  Suddenly  on  the  night  of  January 
2,  the  patient,  after  having  passed  an  unusually 
good  day  on  the  first,  was  seized  with  urgent  dysp- 
noea, so  that  she  was  unable  to  lie  down,  and 
she  became  so  sii  k  that  I  was  summoned  about  3 
o'clock  in  the  morning.  I  found  the  patient  un- 
conscious, both  her  lungs  full  of  bubbling  rales, 


184 


THE  CAKA&A  MEDICAL    RECORD. 


her  pulse  ninety,  and  weak,  but  remarkably  regular 
considering  the  patient's  general  condition.  Her 
breathing  was  stertorous,  and  could  be  heard  in 
the  next  room. 

The  patient  having  previously  had  cerebral 
hemorrhage,  I  at  first  thought  this  attack  was  a  re- 
currence of  the  same  trouble ;  but  the  fact  that 
there  was  no  recognizable  paralysis  caused  me  to 
doubt  this  diagnosis.  The  patient's  condition  was 
so  bad,  however,  that  1  told  the  family  she  was  the 
subject  of  heart  fiiilure,  and  in  all  human  proba- 
bility would  die  in  a  short  lime. 

At  this  juncture  I  remembered  a  remark  made 
to  me  by  Dr.  John  H.  Musser,  of  West  Philadel 
phia,  to  the  effect  that   he  was  certain  he  had  in 
such  cases  saved  life,  at  least  temporarily,  by  hypo- 
dermic injections  of  amyl  nitrite. 

The  patient  had  been  taking  nitio  glycerine 
before  the  attack,  so  I  procured  the  bottle,  gave  a 
hypodermic  injection  of  two  drops,  and  retired 
from  the  room  to  await  the  death  of  the  patient. 
In  just  twenty  minutes  from  the  time  of  the  injec- 
tion the  attendants  called  out  that  our  patient  was 
dying.  I  went  into  the  room,  and  instead  of  find- 
ing her  dead,  saw  that  she  had  raised  herself  in 
the  chair  in  which  she  was  i)ropped,  and  vvas  evi- 
dently conscious.  I  spoke  to  her,  and  received  an 
intelligent  answer.  Her  pulse  had  become  still 
more  regular  than  it  had  been  before,  and  her 
breathing  less  labored.  I  immediately  repeated 
the  injection  of  nitro-glycerine,  and  in  the  course 
of  an  hour  had  the  satisfaction  of  seeing  my  pa- 
tient's condition  so  much  improved  that  she  was 
able  to  talk,  and  could  lie  down  without  trouble, 
while  the  rales  had  disappeared  from  all  parts  of 
her  chest,  except  the  extreme  bases  of  the  lungs. 
In  a  few  days  the  condition  of  the  woman  was 
quite  as  good  as  it  was  before  the  attack,  and  she 
was  able  to  go  about  the  house  comfortably. 

C'ise  2  was  one  of  typhoid  fever.  The  patient, 
a  man  45  years  old,  had  had  a  remarkably  light 
attack  of  the  fever,  his  temperature  never  rising 
above  102  °  ,  and  by  the  end  of  the  second  week 
it  had  reached  the  normal  |>oint. 

On  the  sixteenth  day  of  the  disease  tlie  patient 
awoke  in  the  morning,  saying  he  felt  better  than  he 
had  felt  on  any  previous  day.  Notwithstanding 
the  repeated  w.irnings  he  had  received  not  to  make 
any  undue  exeitioii,  he  arose  suddenly  from  his 
bed,  reached  under  it  for  the  commode,  and  im- 
mediately fell  back  in  a  faint.  I  was  sent  for,  and 
on  my  coming  found  the  patient  in  a  de|)lorable 
condition.  His  juilse  exceedingly  irregular  and 
weak,  and  so  rapid  that  it  could  not  be  accurately 
counted  ;  his  face  cyanosed  ;  his  hands  and  feet 
cold  ;  his  lungs  full  of  rales.  I  immediately  ad- 
ministered two  drops  of  nitro-glycerine  hypoder- 
mically,  and  ap[)lied  heat  externally.  In  a  few 
minutes  I  had  the  satisfaction  of  seeing  my  patient's 
condition  begin  to  improve.  His  pulse  became 
more  regular,  though  still  exceedingly  rapid,  and 
his  breathing  less  labored.  Stimulants  were  then 
administered,  and  he  gradually   improved  for  two 


days,  when  death  took  place  from  another  attack 
of  heart  failure,  following  a  persistent  straining  at 
stool. 

€we.  3. — A  man,  59  years  old,  an  habitual 
drinker,  and  the  subject  of  mitral  disease  of  the 
heart.  After  retiring  on  the  evening  of  May  i,  he 
was  suddenly  attacked  with  urgent  dyspnoea.  He 
arose,  was  propped  in  a  chair,  and  tried  vainly  to 
obtain  relief  fr<)ni  his  oppression.  I  saw  him  one 
hour  after  the  beginning  of  his  attack,  and  found 
his  pulse  irregular,  rapid  and  weak.  His  breath- 
ing was  rapid,  his  face  cyanosed,  and  his  lungs 
filled  with  bubbling  rales.  He  was  concious,  but 
unable  to  speak  connectedly.  Remembering  my 
former  success  with  nitro-glycerine,  I  immediately 
injected  two  drops  hypodermically.  This  was 
followed  in  a  few  minutes  by  marked  relief.  In 
half  an  hour  I  injected  one  drop.  At  the  end  of 
three-quarters  of  an  hour  the  patient's  pulse  was 
regular  ;  he  could  talk  easily  ;  his  breath.ing  was 
almost  normal.  I  then  ordered  whiskey  and  digita- 
lis to  be  given  during  the  night,  and  in  the  morn- 
ing found  him  exhausted,  but  almost  in  his  normal 
condition. 

In  all  of  the  above  cases  death  seemed  immi- 
nent. In  the  first  case  the  woman  would  certain- 
ly have  died  very  soon  had  she  not  received  prompt 
relief.  The  treatment  by  the  hypodermic  use  of 
nitro-glycerine  acted  so  promptly  that  the  bystand- 
ers were  very  much  impressed,  and  the  physician 
was  almost  as  much  astonished  as  they  were. 

I  have  treated  similar  cases  with  stimulant  hypo- 
dermics of  whiskey  and  digitalis,  but  somtimes 
death  was  not  averted,  and  when  it  was  the  relief 
was  long  delayed. 

One  who  has  seen  cases  of  heart  failure  treated 
in  the  usual  way  can  have  no  conception  of  the 
brilliant  results  which  may  be  obtained  by  the  hy- 
[■odermic  use  of  nitroglycerine.  The  treatinent 
has  the  great  advantage  that  it  is  harmless  in  any 
event;  and  I  believe  it  should  alavvys  be  tried, 
though,  of  course,  not  to  the  exclusion  of  other 
well-known  methods  of  relief. — Philailetphia  31eil. 
Rcpiirt. 


GALVANISM    IN    THE    TREATMENT   OF 
FIBROUS  TUMORS  OF  THE  UTERUS. 

Martin,  of  Chicago,  read  a  paper  before  the 
American  Medical  Association  in  Cincinnati,  May 
g,  regarding  "  .\iiostoli's  Treatment  of  Uterine  Fib- 
romata."    His  general  conclusions  are  as  follows  : 

1.  A  means  of  generating  a  continuous  current 
of  electricity  of  steady  and  uniform  character,  that 
can  give  an  actual  current  strength,  through  a 
resistance  of  two  hundred  ohms,  of  five  hundred 
milliamperes,  is  necessary  to  obtain  all  the  benefits 
of  this  treatment. 

2.  Fibroid  tumors  of  small  size  can  be  com- 
pletely absorlied  by  the  proper  application  of 
strong  currents  of  galvanism. 

3.  Hemorrhages  from  fibroid  tumors  can  be 
promptly   cured  by  the  local  coagulating  eftect  of 


TllK   CANADA    MEOICAL    KECORD. 


185 


the  positive  pole  applied  to  the  interior  of  the 
uterus.  Severe  neuralgias,  so  often  accoini>anying 
these  Irouhles,  can  invariably  be  relieved  liy  three 
or  four  appHcations  of  this  treatment. 

4.  When  the  cervical  canal  cannot  be  entered 
by  any  form  of  intra-uterine  elecirode,  ile.'cible  or 
otherwise,  after  repeated  trials,  a  negative  ga'vano- 
]iimcture  should  be  made  into  the  presenting  part  of 
the  obstructing  mass  of  the  tumor,  and  an  artificial 
canal  opened,  which  is  to  take  the  place  of  the 
imperineal)le  uterine  canal  in  all  subseijuenl  Ireal- 
nients. 

5.  The  intraiilerine  electrode  should  iiialN.isrs 
be  negative,  unless  there  is  hemorrhage  or  exces- 
sive leucorrhcca,  when  the  positive  jiole  is  retiuired. 
The  same  patient  may,  however,  present  symptoms 
demanding  the  use  of  both  poles  at  successive 
operations. 

6.  The  strength  of  the  current  should  depend 
entirely  upon  the  area  of  active  surface  of  the 
internal  electrode,  and  should  be  twenty-five  mil- 
liamperes  for  each  square  centi  metre  of  active 
surface  iii  actual  contact  with  the  edometrium. 
If  more  is  used,  the  concentration  of  the  current 
w  ill  be  sufficient  to  cause  troublesome  cauterization. 
If  less  is  used,  the  concentration  at  any  one  [wint 
will  not  be  enough  to  cause  the  necessary  coagula- 
tion for  checking  hemorrhage. 

7.  The  duration  of  each  sitting  should  be  five 
minutes  when  the  maxiir.iuu  current  required  is 
employed. 

8.  The  number  of  operations  is  necessarily  de- 
]iendent  upon,  and  infiuenced  by,  the  result  to  be 
accomplished.  A  severe  hemorrhage  can  be 
checked,  and  relief  to  the  sym|jtoms  often  accom- 
jilished,  by  four  or  five  stances,  while  a  general 
reduction  of  the  tumor  necessitates  many  optra- 
tions,  varied,  of  coarse,  according  to  the  size  and 
location.  In  some  cases  of  large  multiple  tumors 
a  relief  of  the  symptoms,  or  a  symptomatic  cure, 
must  be  accepted  as  a  substitute  for  an  actual 
cure. 

9.  The  operation  should  be  intermenstrual,  if 
possible,  but  if  the  hemorrhage  is  continuous,  it 
will  be  necessary  to  operate  during  the  flow.  The 
seances  may  be  held  every  day,  with  the  system  of 
concentration  adopted  that  enables  one  to  attack 
different  portions  of  the  canal  at  succeeding  treat- 
ments, or  they  can  be  given  with  advantage  as 
seldom  as  once  a  week. 

10.  Since  the  adoption  of  the  flexible  intra- 
uterine electrodes,  and  Apostoli's  method  of 
vaginal  galvano-puncture,  extra-uterine  puncture 
should  be  practiced,  if  at  all,  only  as  a  last  resort. 

11.  Galvano-puncture  needles  and  the  internal 
electrodes  should  be  constructed  of  material  that 
is  not  injured  by  coming  in  contact  with  strong 
carbolic  acid,  or  i  to  1000  bichloride  of  mercury 
solution.  All  electrodes  for  internal  use  should 
be  thoroughly  scrubbed  with  a  nail-brush  and 
soap  and  water  after  each  application,  and  allowed 
to  remain  in  one  or  another  of  these  standard 
antiseptic  solutions  until  they  are  to  be  employed 


again,  when  they  should  be  washed  in  a  weaker 
solution  of  the  same  before  using.  Before  a  vagi- 
nal puncture  is  made,  the  vagina  should  be  tho- 
roughly wiped  out  with  a  one  to  3000  bichloride 
solution. 

12.  There  is  no  excuse  for  any  percentage  of 
mortality  in  the  jiroper  ajiplication  of  this  treat- 
ment. While  Dr.  Apostoli  has  had  two  deaths  in 
two  hundred  and  seventy-five  cases,  he  candidly 
admit.-)  that  they  were  due  to  avoidable  accidents, 
and  should  not  be  considered  as  legitimate  conse- 
quences of  the  operations. 

13.  In  experienced  hands,  and  by  the  adoption 
of  the  present  means  of  concentration,  the  most 
delicate  and  sensitive  patient  can  receive,  without 
experiencing  any  severe  discomfort,  all  the  benefits 
to  be  derived  from  this  vaiuable  treatment. — Nrw 
York  MtdicaL  Rtcord. 


THE     EFFECTS    OF    ANTIPYRETICS    IN 
THE  TREATJVIENT  OF  DISEASE. 

By  Alfred  L.  Loomis,  M.D.,  New-YorR. 

Before  New-York  State  Med.  Soc: — I  think 
one  whose  experience  is  at  all  extensive  in  the 
use  of  antipyretics  in  treattnent  of  acute  infec- 
tious diseases  will  not  for  a  moment  claim  that  they 
have  any  power  in  shortening  their  duration  or 
greatly  modifying  their  severity.  Time  will  not 
allow  me  to  enter  into  a  detailed  account  of  the 
different  antipyretics  now  in  use,  to  compare  their 
relative  merits,  nor  to  theorize  as  to  their  mode  of 
action.  In  a  general  way,  they  may  be  divided 
into  two  classes — the  application  of  cold  to  the 
surface,  and  the  internal  administration  of 
antipyretic  drugs.  The  mode  of  action  of  the  two 
cases  is  evidently  not  the  same,  although  they 
may  both  effect  the  reduction  of  temperature. 
Whether  they  act  by  diminishing  heat  production 
or  by  increasing  heat  dissipation,  is  still  undeter- 
mined ;  for  every  day's  experience  teaches  that 
sometimes  when  antipyretic  drugs  act  badly  or 
efficiently,  cold  applied  to  the  surface,  in  the 
form  of  baths  or  packs,  often  accotnplishes  the 
desired  results  in  the  most  satisfactory  way,  and 
vice  versa.  It  has  seemed  to  me  that  the  beneli- 
cial  action  of  antipyrine  and  antifebiine  is  not  so 
much  due  to  their  power  of  controlling  tempera- 
ture as  to  their  tranquilizing  effects  upon  the 
nervous  system.  Dr.  VVood,  from  his  experience 
on  animals,  concludes  that  antipyrine  dimin- 
ishes heat  production  and  heat  dissipation,  and 
that  its  action  on  the  bodily  heat  is  entnely  inde- 
pendent of  any  influence  on  the  circulation — that 
it  probably  acts  through  nervous  system  directly 
upon  the  chemical  movements  of  the  organism. 

Clinical  experience  has  tauehi  me  that  opium  is 
often  one  of  our  most  efficient  and  reliable  anti|iy- 
retics.  The  old  custom  of  administering  Dover's 
powder  in  small  doses,  at  stated  intervals  through- 
out the  course  of  a  typhoid  fever,  undoubtedly 
had  its  origin  in  the  power  of  opium  to  control 
temperature  by  its    tranquilizing    effects  upon  tb« 


186 


THE   CANADA   MEDICAL    RECORD. 


nervous  system.  As  all  discussions  in  this  line  mus 
present  be  theoretical  and  unsatisfactory,  I  close 
the  consideration  of  this  problem  with  the  practi- 
cal question:  If  temperature  reduciion  docs  not 
shorten  the  duration,  mitigate  the  severity,  or 
avert  serious  com|ilication  in  disease,  and  if  the 
ratio  of  mortality  is  not  so  diminished  as  to  encou- 
rage us  th.U  we  are  maknig  advances  by  antipyre- 
tic measureSi-on  whdt  b.incs  arc  wc  justified  in  their 
tisu  f  Evidently,  only  on  the  basis  that  by  their 
use  we  relieve  one  of  the  many  phenomena  of 
fever.  If  this  can  be  accomplished  without  seri- 
ous loss  of  vitality,  or  at  the  expense  of  the  reserv- 
ed force  of  the  patient,  we  are  justified  in  their 
use  ;  but  do  not  let  us  imagine  that  by  reducing 
temperature  we  are  controlling  fever. 


PATHOLOGY     OF    ABORTION  IN  RELA- 
TION   TO    IREAIMENT. 

In  a  paper  read  before  the  Section  of  Obstetrics 
of  the  British  Medical  Association,  Dr.  Murdoch 
Cameron  emphasizes  the  necessity  of  a  careful 
examination  of  the  discharged  clots  in  every  case, 
as  the  medical  attendant  too  frequently  accepts 
the  patient's  description  of  the  discharge.  In  the 
first  month  the  embryo  may  escape  detection, 
but  after  that  it  can  usually  be  found  surrounded 
by  its  membranes,  the  amnion  and  chorion  with 
its  villi,  some  of  which  are  found  penetrating  the 
decidua  reflexa.  To  avoid  the  "  manuf;icture  of 
complications,"  he  leconmiends  that  the  membra- 
nes be  left  intact  and  encouragement  given  to 
complete  the  expulsion.  In  the  early  periods  of 
pregnancy  if  the  membranes  are  ru])tured,  theie 
need  be  no  hurry  ;  but  special  attention  should 
be  paid  to  maintaining  an  antiseptic  condition  of 
the  passages  by  frequent  injections.  U  the  pla- 
cenla  were  retained  he  had  seldom  any  difficulty 
in  removing  it  with  the  finger.  He  had  little  faith 
in  the  use  of  instruments,  unless  when  it  was 
protruding  from  the  os.  He  asked  if  the  use  of 
the  blunt  or  sharp  curette  with  dilatation  of  the  os 
and  dragging  down  the  uterus  was  reasonable  treat- 
ment, or  whether  retention  of  the  placenta  was  so 
dangerous  or  ct)mnion  as  to  justify  these  methods  ? 
His  experience  did  not  justifv  such  measures. 
With  the  curette  one  was  working  in  the  dark, 
and  could  not  fail  to  wound  the  liealthy  mem- 
brane and  so  assist  septicemia,  and  when  the 
amount  of  injury  which  an  inexperienced  jjerson 
can  uiflict  with  a  uterine  sound  was  remembered, 
we  should  hesitate  to  recommend  the  curette. 
When  hemorrhage  was  present  he  generally  used 
an  antisejjtic  vaginal  tampon  with  a  firm  bandage, 
and  found  it  sufficient.  He  has  not  had  good 
results  from  ergot.  If  sym[)toms  of  septic  poison- 
ing are  jiresent,  he  uses  frequent  antiseptic  injec- 
tions. He  considers  that  patience  in  these  cases 
will  do  less  haira  than  lueddleso  ne  interference. 
Dr.  I.ombe  .-^ithill,  speaking  of  these  cases 
in  which  abortion  could  not  be  averted,  said,  that 
if  hemorrhage   was   aUirmingj   plugging  w^s    the  , 


most  certain  means  of  combating  it.  It  was 
essential  that  these  plugs  should  be  removed  m 
six  hours  at  the  farthest,  when  the  uterus  should 
be  washed  out  with  an  antiseptic  soltition.  It 
was  seldom  necessary  to  I'lug.  He  advocated 
the  treatment  by  hot  water  injections,  which  was 
perfectly  safe  and  nearly  always  efficient.  He 
disapproved  of  the  forcible  removal  of  the  pla- 
centa in  the  early  months  of  pregnancy,  until  it 
was  jiroved  that  it  would  not  be  cast  off.  Dr.  J. 
A.  Byrne  has  found  that  the  hemorrhage  accom- 
panying or  preceding  abortion  was,  as  a  rule,  not 
dangerous.  He  believed  in  the  use  of  hot  water, 
and  also  in  rapid  dilatation  if  necessary,  and  the 
removal  of  the  ovum.  In  the  early  months  of 
gestation  there  was  not  much  trouble  in  removing 
the  ])lacenta.  but  after  the  fourth  month  it  was 
most  intimately  attached  to  the  uterus.  Dr.  A. 
Lawrence  always  plugged  the  cervix  uteri  with 
r.irbulized  lint  when  hemorrhage  was  excessive, 
it  the  contents  could  not  be  cleared  out  he  passed 
an  iodoform  bougie  into  the  uterus  and  plugged 
with  iodoform  wool.  If  in  twenty-four  hours  he 
could  not  clean  the  uterus  he  repeated  the  pro- 
cess. Mr.  Lawson  Tait  was  of  opinion  that 
anyone  who,  knowingly,  left  a  piece  of  placenta 
altera  miscarriage  might  well  lay  himself  open  to 
a  charge  of  gross  carelessness.  There  was  no 
need  of  any  dilatation  or  of  the  use  of  any  shar[i 
curette.  His  "  alligator ''  ovum  forceps  would 
remove  anything  which  had  been  left  without  any 
risk.  Dr.  Mur|ihy  regarded  the  vaginal  tampon 
in  the  year  1887  as  an  anachronism.  The  place 
to  ])lug  was  the  cervix,  not  the  vagina,  and  the 
material  caoutchouc  bags  (Barnes'  or  Tarnier's), 
not  antiseptic  cotton.  He  thought  Dr.  Atthill's 
advocacy  of  the  expectant  treatment  was  founded 
on  his  exi)erience  at  the  Rotunda  Hospital, 
where  assistance  was  always  at  hand.  In  private 
practice  this  Avas  not  safe,  and  he  invariably 
removed  the  placenta  under  chloroform  with  the 
fingers. — British  Medical  Journal,  March  31, 
1888. 


WHEN  TO    OPEN    A    FELON,  AND  HOW 
TO    ABORT  IT. 
(W.  D.  Hutchings,  M.D.) 

In  order  to  avoid  the  mortifying  results — ne- 
crosis, loss  or  deformity  of  finger^following  deep 
seated  paronychia,  the  surgeon  must  abandon  a 
temporizing  policy,  and,  at  the  proper  time,  make 
boldly  a  free  incision  to  the  pus  formation.  No 
half-way  measures  will  answer  in  this  case  ;  the  in- 
cision must  be  carried  down  to  the  point  indicated, 
and  be  made  sufficiently  free  to  avoid  occlusion 
and  retention  of  pus,  by  the  subsequent  swelling 
of  the  parts. 

The  time,  to  incise  is  an  all  important  point  in 
obtaining  a  successful  issue,  and  is  left  indefinite 
by  our  best  authorities.  This  trouble  is  not  even 
noticed  in  the  handbooks  of  surgery  by  Sfiiith  Of 

Stimson,    Surely  neither  of  these  writers  ever  siif-- 


I 


THE    CANADA    ArEniCAI,    UKrOUD. 


isr 


fcred  with  tliis  exceedingly  painful  affection,  else 
jiiigcs  would  have  been  devoted  to  its  consider- 
ation. Is  the  loss  of  a  finger,  the  dreadftil  suffer- 
ing, the  deformity  of  a  hand,  of  such  little  moment 
that  the  re|nitalion  of  the  surgeon  can  not  suffer 
thereby? 

The  venerated  I  )i.  (!ross,  in  an  admirable  arlii  le 
in  his  "  System  of  Surgery,  "  recommends  an 
early  operation,  but  does  not  desigjiaie  the  day  or 
mention  the  inilinl  si/mplom  ol'tiie  disease — a  symp- 
tom which  is  the  indicator  of  the  day  when  the 
lancet  should  be  used.  The  sensation  of  a  splinter, 
briar,  or  foreign  body  being  in  the  part  where  the 
disease  is  locating,  is  the  iniliul  si/inptum,  and  the 
sul)iect  has  almost  invariably  endeavored  to  pitk 
it  before  apphing  for  advice. 

'I'he  tiiiir  for  the  free  use  of  the  lancet  is  the 
fifth  or  sixth  dav  fallowing  the  initial  symptom.  I 
never,  if  opportinuty  affords,  defer  its  use  beyond 
the  seventh  day.  Almost  all  cases  who  have 
aijplied  to  me  after  the  eighth  day  had  passed 
have  made  a  tedious  recovery — many  with  the 
loss  of  a  ]ihalanx  or  an  entire  finger,  the  bone  hav- 
ing been  destroyed  before  the  remedy  was  brought 
to  bear. 

Tbe  above  remarks,  of  com'se,  apply  to  whitlow 
when  deep-seated.  The  superficial  variety  is  an 
easily  managed  and  comparatively  a  trivial  affair. 
As  we  do  not  ineet  with  whitlow  in  subjects  free 
from  systemic  derangement,  I  always  resort  to 
appropriate  treatment.  I  address  the  liver,  ad- 
minister quinine  or  other  remedies,  until  the  evil 
is  overcome. 

I  will  now  consider  the  plan  to  abort,  ^^"hen 
consulted  during  the  initial  symptom,  I  seldom 
fail  to  abort  by  iiiditijiiii/  absorption  from  contin 
ued  pressure  of  the  jiart.  1  force  absorption  by 
wrapping  or  binding  the  finger  with  a  cord  or 
very  narrow  tape — but  prefer  a  cord  of  one-eighth 
of  an  inch  diameter — commencing  at  the  extreme 
distal  end  of  the  finger,  and  carrying  it  up  to  the 
proximal  joint  above  the  local  error,  and  let  it  re- 
main until  pain  and  throbbing  become  unendur- 
able, then  quickly  release  the  finger,  and  after 
resting  it  a  few  minutes,  again  rebind  still  more 
firmly  in  the  same  manner,  thus  binding  and  re- 
binding  for  half  to  three-quarters  of  an  hour,  until 
the  finger  is  reduced  to  two-thirds  its  normal  size. 

By  this  procedure  I  have  never  failed,  when  the 
subject  presented  in  time,  to  abort  paronychia,  or 
to  convert  it  into  a  superficial  abcess.  li  the  pa- 
tient neglects  the  initial  stage,  and  a  particle  of 
pus  is  formed,  the  lancet  is  the  only  resort. 

Thirty-nine  years  ago,  the  writer,  then  a  dis- 
tinguished medical  student,  came  near  being  ex- 
tinguished by  a  felonious  felon  ;  and  then  and  there 
determined  never  again  to  suffer  torments  worse 
than  those  of  Txion's  wheel,  and  by  this  method  he 
has  preserved  not  only  himself  and  others,  but 
members  of  his  own  family,  tmie  and  again,  from 
those  infernal  tortiires.^i«(?.  Med.  Jour. 


TASTELESS  QUININE. 

In  these  degenerate  days  of  mal  iria  and  "  bil- 
liousnes  ,"  quinine  jiiays  a  most  important  part 
in  every  physician's  treatment.  Quinine  has  for 
years  had  a  bitter  taste,  in  fact  ''quinine  by 
another  name  would  be  as  bitter."'  Chemists  and 
pharmacists  of  all  degrees  of  .scientific  acquire- 
ments have  tried  their  hands  to  make  quinine 
tasteless,  but  alter  all  there  was  left  behind  a  bitter 
twang  that  was  a  reminder  that  quinine  is,  was, 
and  always  will  be  bitter.  At  last,  when  we  are 
least  expecting  it,  cheinistry  furnishes  us  a  com- 
pound <that  will  readily  and  easily  disguise  the 
intensely  bitter  and  disagreeable  t.aste  of  quinine. 
This  chemical  compound  is  none  other  than 
siii-.rhitn'iif,  a  wliite  powder  that  has  an  intensely 
sweet  taste.  Prof  11.  C.  Wood  says  that  saccha- 
rine is  250  times  sweeter  than  sugar,  one  grain  in 
a  pint  <if  water  gives  a  distinctly  sweet  taste. 
Sai;<haime  is  only  slightly  soluble  in  water,  but  will 
mote  readily  dissolve  in  alcohol.  Saccharine,  like 
benzoic  and  salicylic  acids,  possesses  antiseptic 
properties,  and  retards  and  prevents  fermentation. 
Physiologically,  it  is  jierfectly  harmless,  generally 
[lassing  quickly  out  of  the  body  unchanged  through 
the  urine. 

The  following  prescriptions  have  been  used  by 
myself  in  twenty-eight  cases,  with  the  result  of  pro- 
ducing the  ciiaracteristic  effects  of  quinine  : 
R     .Saccharine   5  ss. 

Quinine  sulph.   3  ss. 
Acidi  sulphurici  dil.  gtt  xxx 
Vini  portensi     ?  i. 
M.  Sig  :     Teaspoonful  every  two  or  three  hours. 
This  mixture  was   very  slightly   better  and  only 
momentary  at  that : 
R     Saccharine  gr.  xvi. 

Quinine  sulph.  gr.  viii. 
M.     Ft.     Chart.    No.    viii.     Sig :     One   every 
two  hours  for  a  child  two  years  old. 
This  was  perfectly  tasteless. 
R     Saccharine. 

Quiniae  sulph.  aa  3  i. 
M.     et  Ft.  Chart.   No.  x.     Sig:  One  every   2 
hours. 

This  was  only  very  slightly  bitter: 
R     Saccharine  3  i. 

Quiniae  sulph.  3  ii. 
M.     et  Ft.     Chart    No.   x.     Sig:     One  every 
two  hours. 

This  was  slightly  bitter,  but  the  taste  passed 
away  in  less  than  a  minute's  time. 

Aly  experience  from  the  use  of  saccharine,  as  in 
the  above  formulae  in  the  twenty-eight  cases,  jus- 
tify the  following  deductions : 

Saccharine,  two  or  three  parts  to  one  of  quinine, 
gives  a  palatable  and  tasteless  mixture.  Fqual 
parts  of  quinine  and  saccharine  give  only  a  very 
slight  bitter  taste,  and  one  that  is  only  momentary. 
Saccharine  one  part,  and  quinine  two  or  three 
parts,  gives  a  slightly  bitter  taste  that  is  not  last- 
ing,— Medical  Waif,  Lafayette,  Ind, 


1S8 


THE   CANADA   MEDICAL   RECORD. 


A    NEW    TREATMENT    OF    SLEEPLESS- 
NESS. 

Eccles  regards  the  hot  bath  and  massage  as 
important  factors  in  the  treatment  of  insomnia. 
The  bath  is  to  be  taken  immediately  before 
retiring,  and  with  the  following  precautions  :  The 
bath-room  must  be  heated  to  about  70  °  F.,  then 
the  patient  must  be  stripped  in  the  bath-room, 
the  head  and  face  first  being  rapidly  douched 
with  water  at  ioo°F.  By  this  means  the  body 
is  cooled,  while  a  rush  of  blood  is  sent  to  the 
head.  Then  the  whole  body,  excluding  the  head 
and  face,  is  immersed  in  the  bath  at  98  °  F.,  rapid- 
ly raised  to  105°  or  110=^  F.  In  about  eight 
to  fifteen  minutes  the  patient  feels  a  sensation  of 
pleasant  languor,  when  he  must  be  wrapped  in 
warm  blankets,  and  proceed  to  the  beuroom  with 
as  little  personal  effort  as  jjossible.  By  the  time 
the  bedroom  is  reached  the  moisture  on  the  sur- 
face of  the  body  will  have  been  absorbed  ;  the 
patient  must  then  put  on  his  night-clothes  and 
get  into  bed,  lying  with  the  head  raised,  hot 
bottles  to  the  feet,  and  well  covered  with  bed- 
clothes. No  conversation  or  moving  about  the 
room  should  be  allowed,  and  all  light  must  be 
excluded.  In  a  few  minutes  the  patient  will  be 
found  in  a  quiet,  refreshing  sleep.  The  theory 
of  this  method  is  based  on  sudden  exposure  of 
the  body  contracting  the  arterioles  of  the  skin, 
causing  thereby  a  corresponding  dilatation  of  the 
vessels  of  internal  organs,  which  in  the  case  of 
the  brain  is  further  induced  liy  the  application  of 
hot  sponging.  The  immersion  of  the  whole  body 
next  causes  a  dilatation  of  the  vessels  of  the  sur- 
fiice,  except  the  head  and  face,  with  contraction 
of  the  vessels  of  the  brain  and  gradual  slowing 
of  the  heart's  action,  thus  placing  the  brain  in  the 
most  favorable  condition  for  complete  functional 
rest.  There  are  certain  conditions,  however,  in 
which  this  method  is  contraindicated.  Persons 
suffering  from  extreme  anaemia,  or  emaciation,  or 
from  aortic  valvular  disease,  or  in  whom  signs  of 
atheroma  are  recognized,  should  not  be  subjected 
to  such  rapid  variations  of  local  arterial  tension 
as  this  process  entails.  The  author  treated  two 
cases  of  aortic  regurgitation,  in  which  the  patients 
suffered  from  insomnia,  by  rest,  feeding,  and 
massage.  The  patient  should  keep  the  recum- 
bent position  all  day,  and  in  the  evening,  about 
10  or  II  o'clock,  a  thorough  kneading  of  the 
trunk  and  extremities  should  be  performed. 
Massage  of  the  trunk  and  extremities  is  attended 
by  stimulation  of  the  sensory  nerves,  with  inhibi- 
tion of  vaso-motor  action  in  the  part  undergoing 
vigorous  kneading,  the  vessels  dilate,  and  the 
force  and  rate  of  the  circulation  is  increased, 
thus  causing  a  vascular  dilatation  over  a  large 
area,  accompanied  by  a  corresponding  contrac- 
tion of  other  parts,  especially  of  the  brain.  In 
order  to  maintain  the  effect  of  the  massage  on 
,  the  vessels  of  the  abdomen,  a  hot  abdominal 
compress  is  used  in  some  eases  where  sleep  does 


not  follow  soon  after  the  massage.  In  persons 
suffering  from  the  ill  effects  of  prolonged  over- 
work, mental  distress,  morphine  habit,  chloral- 
drinking,  and  such  like  conditions,  tne  evening 
kneading  often  causes  excitement  instead  of 
repose,  and  if  done  at  all  it  must  be  done  at  an 
early  hour.  These  cases  are  extremely  difficult 
to  treat,  and  it  is  often  necessary  to  administer 
the  wet  pack. — The  Practitioner,  March,  1888. 


PEPPERMINT    WATER  IN    PRURITUS 
PUDENDL 

F>ery  practitioner  will  have  had  under  his  care 
cases  of  this  troublesome  affection,  which  have 
been  proof  against  all  treatment,  especially  in  the 
neurosal  forms,  where  the  cause  of  the  pruritus 
which  is,  of  course,  only  a  symptom,  is  more 
difficult  to  remove.  No  excuse,  therefore,  is  need- 
ed to  mention  a  local  remedy,  which  will,  if  the 
skin  be  unbroken,  either  cure  the  patient,  or  afford 
relief  whilst  the  source  of  the  irr  tation  is  being 
treated.  i  , 

The  agent  here  alluded  to  is  peppermint  water, 
used  as  a  lotion.  The  B.P.  preparation  of  aq 
menth.  pip.  answers  well,  but  is  bulky  for  carrying 
about,  and  is  incapable  of  concentration  unless 
rendered  alkaline.  This  is  best  done  by  borax, 
as  being  in  itself  soothing  and  antiseptic.  Patients 
can  easily  make  their  own  lotion,  as  required  for 
use,  by  putting  a  teaspoonful  of  borax  into  a  pint 
bottle  of  hot  water,  and  adding  to  it  five  drops  of 
ol.  menth.  pip.,  and  shaking  well,  the  parts  affect 
ed  to  be  freely  bathed  with  a  soft  sponge. 

If  no  cracks  or  sores  are  present,  this  lotion 
will  remove  the  itching,  but  if  there  be  eczema, 
etc.,  or  rawness  from  scratching,  it  is  inapplicable, 
olive  oil,  with  five  grains  of  iodoform  to  the  ounce, 
being  then  more  useful.  The  greatest  and  most 
permanent  relief  is  afforded  in  the  neurosal  form, 
especially  in  the  reflex  purritus  which  often  accom- 
panies pregnancy,  and  which  then  may  take  the 
place  of  reflex  sickness  or  vomiting.  It  is  also 
very  useful  in  the  pruritus  which  occurs  in  the 
climacteric,  or  in  elderly  women,  in  whom  it  may 
be  only  part  of  a  general  pruritus,  and  also  in 
those  cases  of  women  of  all  ages,  where  the  urine 
simultaneously  becomes  of  very  low  specific  grav- 
ity, without  any  evidence  of  having  a  gouty  or 
granular  kidney  as  a  remote  cause. 

In  pruritus  due  to  pediculi,  ascarides,  an  irrit 
able  urethral  caruncle,  an  endocervical  polypus, 
early  cancer  of  the  cervix,  distension  of  Bartholini's 
ducts  or  glands,  the  leucorrhcea  of  vaginitis,  endo- 
cervicitis,and  metritis,  or  the  irritating  discharges 
of  advanced  carcinoma  uteri,  or  to  a  gouty  or  dia- 
betic diathesis,  the  drug  excels  all  others,  cocaine 
inclusive,  in  affording  relief,  whilst  endeavors  are 
being  made  to  remove   the  cause. 

In  two  obstinate  cases  of  uncontrollable  pru- 
ritis  of  pregnancy,  where  this  remedy  only  gave 
temporary  relief,  the  patients  were  cured  by  apply- 
ing iodine  liniment  to  the  angry  looking  cervix 


I 


•ftit  dAttADA  MBlOiCAL  RECORD. 


m 


uteri,  which  metliod  li:isl)ocn  iHC.l  successfully  by 
Dr.  John  I'hillips  and  others  for  the  similarly 
severe  vomiting  of  pregnancy. 

Peppeiniint  has  long  been  used  by  tiic  Chinese 
as  a  local  remedy  for  neuralgia,  and  has  lately 
been  sold  here,  combined  with  camphor,  as  a 
menthol.  It  appears  lo  act  as  a  local  ana:sthetic. 
its  effect  lasting  often  many  hours,  and  in  some 
cases  of  reflex  origin  a  single  application  of  the 
lotion  has  cured  the  patient  The  remedy  was, 
I  believe,  named  in  a  casual  communication  to 
the  Journal  about  twenty  years  ago,  but  I  have 
failed  to  find  the  reference,  and  though  it  has  been 
prescribed  spasmodically  by  my  father,  and  per- 
haps by  others,  its  extreme  utility  seems  known  to 
very  few. — Dr.  Amand  Routh  in  Hritish  Medloil 
Juiirnnl. 


TRE..\TMENT  OF  WARTS. 

Rcesen  has  found  the  following  procedure  very 
serviceable  in  removing  warts,  callosities,  etc.  : 

The  thickened  epidermis  is  slightly  moistened 
with  an  antiseptic  solution  (boracic  or  salicylic 
acid)  and  then  covered  with  a  fairly  thick  layer  of 
pure  crystallized  salicylic  acid.  Over  this  is  placed 
moist  borated  lint  in  four  layers,  a  piece  of  gutta- 
percha fabric,  and  a  bandage.  In  the  case  of 
small  warts  and  callosities,  the  dressing  is  allowed 
to  remain  for  five  days.  On  removal  it  will  be 
found  that  the  thickened  tissue  is  somewhat 
shrunken  and  has  separated  from  the  subjacent 
parts,  which  are  covered  with  perfectly  normal 
skin,  presenting  no  traces  of  injury  or  bleeding. 
The  author  has  never  seen  any  caustic  effect  from 
this  application  on  the  surrounding,  and  subjacent 
tissues.  If  the  callosity  is  of  any  considerable 
thickness,  as  is  often  seen  on  the  sole  of  the  foot, 
the  dressing  should  be  left  in  place  for  ten  days, 
or  renewed  after  five  days.  The  great  advantage 
of  this  application  is  that  the  effects  of  the  salicylic 
acid  are  localized  to  the  thickened  area. — 
MuiicliKuer  Malic.  Wochenschei: 


ADVANCES 


IN    THE    TREATMENT 
SYPHILIS. 


OF 


Neisser  gives  the  following  injunctions  ; 

1.  Every  local  infection  suspected  of  being 
syijhilis  must  be  destroyed  by  energetic  local 
treatment  as  early  as  possible,  or  removed  by  deep 
incision.  If  there  is  no  syphilitic  infection  present, 
the  slight  operation  is  at  least  harmless,  and  if 
syphilis  be  present,  it  may  undoubtedly  be  remov- 
ed once  and  for  all  by  excision. 

2.  Well  marked  primary  lesions  should  be 
deeply  excised  when  their  situation  permits  of  it, 
as,  m  the  author's  opinion,  complete  cure  of  the 
syphilis  may  thus  be  brought  about. 

3.  Constitutional  treatment  must  be  one  of  mer- 
cury ;  must  never  be  begun  before  ihe  diagnosis  is 
firmly  established  ;  must  never  be  considered  as 
completed  before  the  fourth  year  of  the  disease. 


4.  The  most  agreeable  and  convenient  mode  of 
administration  is  the  internal  method. 

5.  The  surest,  most  raiiid  and  efficacious  method 
is  that  of  hypodermic  injection  of  the  drug. 
Infiammalory  tendencies  are  reduced  to  a  minimum 
by  suspending  the  calomel  in  oil. —  lU't-ek/y  Med. 
Review. 


TINCTURE  OF  IRON;   ITS  AD.MIM.S  rR.\- 
TION. 

According  to  Silence  (Nimu  Remidex),  recent 
experiments  made  with  the  ferric  chloride  diluted 
with  water,  show  that  the  deleterious  action  of  this 
preiiaration  upon  the  teeth  arises  in  consequence 
of  such  dilution.  The  phenomenon  is  thus  ex- 
plained, the  addition  of^  water  to  the  alcoholic 
.solution  precipitates  the  peroxide  in  Hakes,  and 
as  these  can  offer  no  protective  covering  to  the 
teeth,  the  acid  set  free  by  decomposition  acts 
directly  upon  the  salts  of  lime  composing  them. 
When  the  solution  is  given  pure,  there  can  be  no 
chemical  action  ;  the  peroxide  then  formed  is 
anhydrous  and  adheres  to  the  teeth  which  it  thus 
protects  against  the  action  of  the  acid.  The  ex- 
periments appear  to  demonstrate,  so  says  the 
writer,  that  only  three  liquids  can  be  properly  used 
in  diluting  the  ferric  choloride  :  alcohol,  vichy 
water,  and  simple  syriq). 


FOR  CHILLBEAINS. 
Valentine  Mott's  remedy  is  as  follows  : 

Beef's  gall 4  ounces. 

01.  terebinth, 4      " 

Spts.  vmi.  rect.,  90  per  cent  ..    i  J     " 
Tinct.  opii, 1       " 

Another  formula  fijr  the  same  affection  is  : 

Beefbrine, j  pint. 

PotassK  nitratis, 2  drachms. 

Aquffi  ammoniffi, 3  ounces. 

— Mtdlad  Classics,  Oct.,  1S87. 


JABORANDI  INOB.STRETRIC  PR.\CTICE. 

liy  Jerome  Hardcastle,  M.D.,  Cecilton,  Md. 

Med.  and  S'irg.  Rep.  April  7  : — Having  for 
many  years  noted  the  fact  that  parturition  does  not 
progress  favorably  till  diaphoresis  occurs,  I  have 
for  some  months  past  induced  this  condition,  in 
the  early  stage  of  labor  by  giving  fl.  ext.  jaborandi 
(green — the  brown  has  proved  worthless  in  my 
hands  ).  My  plan  is,  when  called  to  a  case,  to 
order  a  warm  brick  to  be  apislied  to  the  feet — 
which  are  always  cold,  and  then  to  cive  one-third 
of  a  teaspoonful  of  ti.  ext.  jaborandi  in  half  a 
wineglassful  of  water,  and  repeat  the  dose 
every  half  hour   until    perspiration    occurs.  It    is 


190 


ftta  eiM-ADA   MfiDtfiAt  ftfiCOfii). 


very  suldoin  that  more  than  two  doses  are  requir- 
ed. The  first  effect  of  this  medicine  on  the  patient 
is  sootiiing,  she  becomes  more  quiet,  and  bears  her 
pains  with  resignation.  Upon  being  questioned 
the  patient  often  states  that  her  pains  do  not 
hurt  her  as  they  did.  On  examination,  after 
dia]ihoresis  occurs,  the  os  will  be  found  dilating 
rapidly  ;  the  soft  parts  to  be  in  a  favorable  condi- 
tion; and  in  a  short  time  the  labor  will  he  satis- 
factorily terminated.  Should  the  patient  appear 
weak  from  the  sweating,  I  wipe  her  face  and 
neck  with  a  dry  towel,  and  give  her  a  teaspoonful 
of  whiskey  or  half  as  much  of  aromatic  spirits  of 
ammonia. 

Since  using  the  above  remedy,  I  have  had  no 
occasion  to  use  ether,  chloroform,  or  the  forceps. 
I  have  not  seen  any  mention  of  the  use  of 
jaborandi  in  obstetric  jiractice  ;  but,  having  had 
such  favorable  results  from  its  employment  I 
recommend  it  to  the  consideration  of  the  pro- 
fession.— Epitome  of  Pnict.  A/cd.  <nid  Surgrri/. 


TREATMENT  OF  POSTPARTUM 
HEMORRHAGE. 

Dr.  R.  N.  Foster  writes  in  the  .VedicaJ  Era  as 
follows :  Treatment  for  jiost-partum  hemorrhage, 
in  order  of  use. 

First.  One  hand  outside  ; 

Second.  One  hand  outside  and  one  inside  ; 

Third.  Ergot,  one  to  two  teaspoonfuls,  in 
water ; 

Fourth.  Injections  of  hot  water  ; 

Fifth.  Injections  of  cold  water,  or  the  introduc- 
tion of  ice  into  the  womb  ; 

Sixth.  Injections  of  vinegar,  hot  or  cold  ; 

Seventh.  Injection  of  |iersulphate  of  iron,  or 
muriated  tincture  of  iron,  two  drachms  to  a  pint 
of  water. 

Treatment  for  puerjteral  convulsions  : 

Finst.  Give  the  woman  chloroform,  and  keep 
her  under  its  infiuenee  : 

Second.  r3tliver  her  as  soon  as  possible  ; 

Third.  If  it  takes  too  nnich  chloroform  to  quiet 
her,  administer  a  hypodermic  injection  of  uku- 
phine,  ys  to  fs  grains  ; 

Fourth.  After  administration  of  morphine,  use 
chloroform  with  caution  ; 

Fifth.  Have  a  com])etent  person  remain  by  the 
patient,  at  least  twent)  lour  hours  after  deliverv, 
ready  to  give  choreiform  should  there  be  the  least 
sign  of  returning  spasm. — Epitome  of  F met.  Mid. 
and  Surgery. 


POISONING   BY  A  TEN-GRAIN   DOSE  OF 

ANIIPVRINE. 

By  S.  Peters,  M.D.  Colioes,  N.  Y. 

Med.  Rgisler,  Mar.  24  : — For  a  severe  head- 
ache, of  a  nervous  character,  in  a  lady — Mrs. 
H. — of  about  twenty-five  years  of  age,  and  other- 
wise healthy,  I  prescribed  two  powders  (ten  grains 


each)  of  antipyrine,  one  to  be  taken  an  hour  after 
the  first,  if  needed.  She  took  one  about  9.30 
P.  M.,  and  in  two  or  three  minutes  she.  began  to 
experience  a  "  snapping  "  in  her  head,  along  with 
an  itching  and  burning  in  the  mouth  and  throat, 
]iarticiilarly  in  the  roof  of  the  mouth.  This  feeling 
also  extended  to  the  eyes,  nose,  and  ears,  and 
became  so  violent  that  she  involuntarily  thrust  her 
fingers  into  her  mouth  and  ears  to  seek  relief. 
The  "snapping"  in  the  head  increased  in  intensity 
until  she  b;canie  almost  frantic,  and  ran  up  and 
down  the  room,  screaming,  partially  losing  control 
of  herself,  and  apprehending  acute  insanity.  Sneez- 
ing soon  commenced,  and  became  extremely 
violent,  the  act  being  repeated  at  least  fifty  times, 
while  the  nose  and  eyes  were  running  a  very 
copious,  watery  fluid.  The  turgescence  of  the 
mucous  membrane  was  so  extreme  that  she  could 
not  breathe  through  the  nostrils  for  several  hours — 
indeed,  not  until  the  next  day.  Following  all 
this,  there  was  a  stupid,  tormenting  feeling,  with 
swelling  of  the  nose  and  eyes,  till,  exhausted,  she 
finally  fell  asleep.  This  sleep  was  disturbed  and 
tiresome,  but  the  headache  proper  was  relieved. 
The  most  violent  part  of  the  process  continued 
for  only  about  ten  minutes,  but  recovery  was  not 
perfect  till  the  next  day. 

THii  Canada  Medical  Record 

A  Monthly  Journal  of  Medicine  and  Surgery- 


EDITORS  : 
FRANCIS    <.V.  CAMPBEI,!,,   MA.,  M.D.,  L.K.C.P    LOUD 

Editor  ami  rioprietoi-. 

R.  A.  KENNEDY,  M.A.,  M.D.,  Managing  E,\Uor. 

ASSISTANT  EDITOR: 

A,  LAPTHOaN  SMITH,  B.A.,  M  D.,  M  RC  S.  Eng.,   F.OS. 
LONDON. 

siTuscnirTiiiN  two  uollaks  per  anndm. 

All  communiciitions  and  Eiehnnqps  must  b!  aidressed  to 
tlie  Editor s,Dr(twcT'i^G,  Post   Office,  Montreal. 


MONTKK.Ab,  MAY,   1SS8  . 

BURIAL  REFORM. 

The  disposal  of  the  bodies  of  the  dead  is  evidently 
a  subject  which  is  attracting  considerable  atten- 
tion from  scientific  men.  The  improvements  in  the 
present  methods  may  be  divided  into  negative  and 
[lositive.  The  former  including  those  which  mere- 
ly look  to  getting  rid  of  them  with  the  least  injury 
to  the  living,  such  as  using  coffins  of  the  most  per- 
ishable and  lightest  material,  all  lasting  substances 


ftlR  CAlIAbA   MEDICAL  ftF.CofeD. 


101 


being  rejected ;  burial  immediately  after  death ; 
interment  in  i)lain  earth  with  total  disuse  of 
vaults  and  bricked  graves,  and  rapid  decoiniiosi- 
tion  l>y  means  of  heat,  known  as  cremation.  The 
positin-  improvements  consisting  of  turning  the 
ile.ul  l)ody  to  useful  pmiroses.  One  recent  writer 
advocates  the  abstraction  of  fatty  matters  to  be 
turned  into  soap,  candles  and  glycerine,  and  the 
drying  and  pulveriKing  of  the  muscles  and  bone,  so 
as  to  form  a  valuable  manure  resembling  guano, 
rich  in  ammonia  and  phosphates.  Another  writer 
suggests  that  we  should  hand  over  all  that  is  mor- 
tal of  our  de|)artcd  relatives  to  the  gas  coni[)any, 
which  would  give  us  in  return  a  bon  for  so  much 
illuminating  gas,  wliic  h  the)'  would  distil  from  it, 
keeping  as  their  share  of  the  profit  the  coke, 
anuiionia  and  tar,  with  its  endless  possibilities  of 
beautiful  color.  He  terminates  his  article  with  the 
grim  reiriark  that  it  would  then  be  possible  for  a 
beauty  to  appear  at  a  ball,  decked  in  hues  from, 
and  literally  shining  in  the  light  of,  her  ancestors. 


WESTERN  HOSPITAL. 

There  is  at  present  a  large  attendance  at  the 
out-door  department  on  Mondays  and  Thursdays, 
when  the  gentlemen  who  are  interested  in  study- 
ing the  diseases  of  women  have  ample  opportuni- 
ties for  practical  work.  Two  members  of  the 
class  are  detailed  each  day  to  make  examinations 
and  record  their  observations,  under  the  direction 
of  the  lecturer  on  Gynecology,  Dr.  Lapthorn 
Smith.  As  the  material  is  practically  unlimited, 
their  opportunities  are  only  bounded  by  the  time 
they  care  to  devote  to  it. 

In  the  in-door  department  the  staff  attend  every 
day  at  12  o'clock. 

Dr.  McConnell  gives  a  practical  clinic  on  dis- 
eases of  the  heart  and  lungs,  every  Monday  at  11 
o'clock. 


IMPROVEMENTS  IN  PHARMACY. 
At  the  invitation  of  Mr.  Lawrence,  of  the  Davis 
and  Lawrence  Manufacturing  Company,  a  repre- 
sentative of  the  Record  was  lately  shown  over  their 
extensive  factory.  This  establishment  is  the  out- 
come of  the  National  Policy,  as  owing  to  the  Pro- 
tective Tariff  manufacturers  for  the  Canadian  mar- 
ket are  obliged  to  manufacture  their  goods  in 
Canada.  It  may  not  be  generally  known  to  the 
physicians  of  Canada  that  Messrs.  Wyeth  &  Bro. 
of  Philadelphia  now  manufacture  all  of  their  pre- 


parations in  Montreal,  and  sell  them  in  this  market 
at  the  same  prices  as  they  get  for  them  at  home 
in  the  United  States  where  competition  is  muclf 
greater.  We  understand  that  this  firm  were  the 
pioneers,  so  to  speak,  in  introducing  to  the  medi- 
cal world  ihe  new  and  elegant  jjreparatipns  which 
have  *nlmost  done  away  with  the  old  style  of  dis- 
pensing. Their  compressed  triturates,  for  instance, 
are  exceedingly  convenient  for  country  practi- 
tioners and  others  who  desire  for  various  reasons 
to  dispense  their  own  medicines.  Instead  of 
having  to  laboriously  weigh  them  out  and  do  them 
up  in  powders,  he  has  <  nly  to  count  out  the 
desired  number,  all  ready,  accurately  weighed  and 
compressed  into  the  form  of  a  neat  little  tablet. 
As  an  instance  ui  the  saving  of  time  which  this 
effects,  we  might  mention  that  having  a  prescrip- 
tion for  a  powder  which  we  very  often  use,  which 
requires  the  greatest  care  and  exactness  in  jiutting 
up,  we  handed  a  small  package  of  the  ingredients 
to  this  establishment,  and  in  a  few  minutes-  we 
received  it  back  in  the  form  of  the  proper  number 
of  tablets,  each  of  the  proper  weight.  The  machi. 
nery  by  means  of  which  this  result  is  obtained  is 
exceedingly  ingenious,  but  would  have  to  be  seen 
to  be  properly  appreciated.  Each  machine  is 
presided  over  by  a  neat  but  demure  little  maiden, 
as  bright  and  clean  as  the  polished  steel  before 
her.  There  was  one  feature  of  this  factory  over 
which  our  reporter  was  especially  eulogistic,  and 
for  which  the  firm  cannot  be  too  highly  commen- 
ded, the  large  amount  of  space  allowed  for  each 
operator  and  the  ample  facilities  for  getting  light 
and  sunshine.  This  fiim  seems  to  understand  that 
good  work  cannot  lie  got  out  of  people  who  are 
breathing  bad  air.  The  whole  appearance  of  the 
place  and  the  method  of  doing  business  reminded 
us  forcibly  of  Squibb's  celebrated  establishment  in 
Brooklyn. 

Our  space  does  not  permit  us  to  specify  all 
their  preparations,  but  the  most  imjiortant  are  the 
hypodermic  tab  ets  which  no  physician  should  be 
without,  as  they  are  always  fresh  and  ready  for  use. 
Also  the  tablets  of  rhubarb  and  soda,  bismuth  and 
pepsine,  and  the  old  reliable  five  and  ten  grain 
Dover  powders.  In  conclusion,  we  are  informed  by 
Mr.  Lawrence  that  they  will  be  glad  to  show  any 
of  the  profession  over  their  factory,  as  they  feel 
sure  that  any  such  will  leave  feeling  satisfied  that 
everything  is  carried  on  with  the  sole  object  in 
view  of  obtaining  accuracy,  uniformity  and  per- 
fection in  manufacture. 


192 


TfiE   CANADA   MEDICAL  RECORD. 


THE  CODE   OF  ETHICS  OF  THE  AMERI- 
CAN MEDICAL  ASSOCIATION. 

OF    THE    DUTIES    OF    PHYSICIANS    TO    EACH    OTHER, 
AND  TO  THE  PROFESSICN    AT  LARGE. 

Art.  I. — Duties  for  the  support  of  professional 
character. 

1  Every  individual,  on  entering  the  profession, 
as  he  becomes  thereby  entitled  to  all  its  privileges 
and  immunities,  incurs  an  obligation  to  exert  his 
best  abilities  to  maintain  its  dignity  and  honor,  to 
exalt  its  standing,  and  to  extend  the  bounds  of  its 
usefulness.  He  should,  therefore,  observe  strictly 
such  laws  as  are  instituted  for  the  government 
of  its  members;  should  avoid  all  contumelious  and 
sarcastic  remarks  relative  to  the  faculty  as  a  body  ; 
and  while,  by  unwearied  diligence,  he  resorts  to 
every  honorable  means  of  enriching  the  science, 
he  should  entertain  a  due  respect  for  his  seniors, 
who  have,  by  their  labors,  brought  it  to  the  eleva- 
ted condition  in  which  he  finds  it. 

2.  It  is  not  in  accord  with  the  interests  of  the 
public  or  the  honor  of  the  profession  that  any 
physician  or  medical  teacher  should  examine  or 
sign  diplomas  or  certificates  of  proficiency  for,  or 
otherwise  be  specially  concerned  with,  the  gradua- 
tion of  persons  who,  they  have  good  reason  to 
believe,  intend  to  support  and  practice  any  exclu- 
sive and  irregular  system  of  medicine. 

3.  There  is  no  profession  from  the  members, 
of  which  greater  purity  of  character  and  a  higher 
standard  of  moral  excellence  are  required,  than 
the  medical ;  and  to  attain  such  eminence  is  a 
duty  every  physician  owes  alike  to  his  profession 
and  to  his  patients.  It  is  due  to  the  latter,  as 
without  it  he  cannot  command  their  respect  and 
confidence;  and  to  both,  because  no  scientific 
attainments  can  compensate  for  the  want  of  correct 
moral  principles.  It  is  also  incumbent  upon  the 
faculty  to  be  temperate  in  all  things,  for  the  prac- 
tice of  physic  requires  the  unremitting  exercise  o' 
a  clear  and  vigourous  understanding ;  and,  on 
emergencies,  for  which  no  professional  man  should 
be  unprepared,  a  steady  hand,  an  acute  eye,  and 
an  unclouded  head  may  be  essential  to  the  well- 
being,  and  even  to  the  life,  of  a  fellow  creature. 

4.  It  is  derogatory  to  the  dignity  of  the  pro- 
fession to  resort  to  public  advertisements,  or 
private  cards,  or  handbills,  inviting  the  attention 
of  individuals  affected  with  particular  dieases — 
publicly  offering  advice  rmd  medicine  to  the  poor 
gratis,  or  promising  ra  ical  cures  ;  or  publish 
cases  and  operations  in  the  daily  prints,  or  suffer 


such  publications  to  be  made ;  to  invite  laymen  to 
be  present  at  operations,  to  boast  of  cures  and  re- 
medies, to  adduce  certificates  of  skill  and  success, 
or  to  perform  any  other  similar  acts.  These  are 
the  ordinary  practices  of  empirics,  and  are  highly 
reprehensible  in  a  regular  physician. 

5.  Equally  derogatory  to  professional  charac- 
ter is  it  for  a  physician  to  hold  a  patent  for  any 
surgical  instrument  or  medicine  ;  or  to  dispense  a 
secret  nostrum,  whether  it  be  the  composition  or 
exclusive  property  of  himself  or  of  others.  For, 
if  such  nostrum  be  of  real  efficacy,  any  conceal- 
ment regarding  it  is  inconsistent  with  benificence 
and  professional  liberality  ;  and  if  mystery  alone 
give  it  value  and  importance,  such  craft  implies 
either  disgraceful  ignorance  or  fraudulent  avarice. 
It  is  also  reprehensible  for  physicians  to  give  cer- 
tificates attesting  the  efficacy  of  patent  or  secret 
medicines,  or  in  any  way  to  promote  the  use  of 
them. 

PERSONAL. 

Dr.  Gardner,  Professor  of  Gynecology  in  McGill 
College,  owing  to  continued  ill  health,  has  decided 
to  leave  about  the  ist  July  for  a  few  montiis'  holi- 
day in  Europe.  Our  confrere  is  a  prime  favorite 
with  the  profession,  and  we  cannot  afford  to  loose 
him,  so  that  we  join  in  the  general  wish  of  his 
numerous  friends  that  he  may  return  with  his 
health  and  strength  firmly  re-established. 

Dr.  Stewart  of  McGill  has  left  town  to  si)end  a 
few  months  in  Europe. 

Dr.  F.  W.  Campbell,  Dean  of  Bishops' College 
has  been  called  away  to  Metapedia,  to  attend  a 
wealthy  New  Yorker.  It  is  probable  that  lie 
will  combine  business  with  pleasure  and  make 
his  visit  a  "  flying  "  one  in  a  double  sense,  and  we 
hope  with  his  usual  success. 

Dr.  Major  will  be  .abs  nt  from  the  city  for 
several  months. 

AVe  are  glad  to  learn  that  a  short  course  of  lec- 
tures on  Physiology  and  Hygiene  will  be  delivered 
by  Dr.  Reed  to  the  pupils  of  the  McGill  Normal 
School.  We  consider  this  a  move  in  the  right 
direction,  and  an  example  to  be  followed  by  every 
school. 

Mr.  Jack,  who  was  appointed  to  the  position  of 
Resident  Clinical  Assistant  to  the  Western  Hospi- 
tal, a  few  nionths  ago,  has  been  obliged  to  resign, 
owing  to  ill  health,  which  was  unequal  to  the 
strain  of  such  a  responsible  position.  Mr.  Nichol 
has  temporarily  replaced  him.  In  this  connection 
we  venture  to  suggest  that  the  duties  of  the  posi- 
tion are  sufficiently  onerous  to  require  the  undivi- 
ded attention  of  a  fully  qualified  graduate. 


THE  CANADA  MEDICAL  RECORD. 


Vol.    XVI. 


MONIREAL,    JUNE,    1888. 


No.  9. 


ORIGINAL  COMMUNICATIONS. 

Asllnna  .... -  l-'3 

SOOIITY   PROCEEDINGS. 

McilicMi-CliinuKiculSncic^tydf  Aroiitri'al  I'.H 

PROGRESS  OF  SCIENCE. 

Jpecnciuiiilui  Spray  in   Chronic  Bron- 

lOiiliH aili 

TrcalnuMit  of    Clironic    Broiieliitis    in       1 

Cliil.lron    I'On 

(  )ilciri<li' i>f  Sodium  ill  tlio  Sickness  of       ) 

I  'DTiiaiicy  207 

llecliaiiical    Trcatmpnt    of    Whooping 

Coiigli 207 


To  liisyiiisfi  tliG  <.>ilor  (if  loiloform  207 

Sncccsufiil  KxciBioii  of  a  Tumor  of  tho 

Spinal  (.'oril 207| 

rennannnnatP  of  Potaeh  in  Diiilitheria  208, 
'J'lio  KWicicy  of  LarRP  Doses  of  Arsenic 

ill  ('lio]-i.a 208 

TicalMicnl  of  lioctal  Pain  witli  Conium  20!)| 

New  Mcilioilof  Applyirij! 'I'a.xis  210, 

Aiilipyriii  ill  ilie  Treatment  of  Seminal        I 

Kmi^sions      210^ 

An  Iiihalalion  for  Phtliisis 210 

IHarson'sTi'Sl  for  SuOTr  in  the  Urine..  210 

A  KuMii;^atioii  for  ..\sthma 210 

I'lcasolvin  I'litliisis 210 

To  lieinove  Freckles 211 

Salicylic  Acid  iu  Skin  Diseases 211 


Preliminary  Treatment  of  Psoriasis. 
Lactic  Acid  ill  Dianhiea  


..  211 
..  211 


EDITORIAL 

Provincial  Medical  liiiar.l 212 

Wetting  with  KrcBli  ami  Salt  Water..   .  21.3 

Troatmont  of  Sick  Headache  214 

Tlu^  Montreal  Medical  -Journal 214 

Beautiful  Chemical  Preparation 214 

Diet  in  Alhuininuria 214 

British  Columhia  Medical  Council 214 

The  Code  of  Ethics  of  the  American 

Medical  Association  21.5 

Canadian  Medical  Association 21.5 

The  New  Medical  Bill  for  Quebec 215 

Saccharine  Tablets   215 


I 


^i'l6inal  QommunicafiQUri. 


ASTHMA. 

A   Cli.nical  Lecture,  delivered  at  the  Montreal 

General  Hospital, 

By  F.   Wayland   Campiiell,   M.D.,    LK.C.P.  London, 

Dean  of  and  Professor  of  the  Theory  and  Practice  of 

Medicine  in  the  Faculty  of  Medicine  of  the 

University  of  Bishop's  College. 

Gentlemen, — The  patient  now  before  you  is 
suffering  from  spasmodic  asthma.  When  the 
allack  is  not  present,  auscultation  does  not  reveal 
anytliing  abnormal.  During  an  attack  you  will 
hear  on  using  the  stethescope,  whistling  and  wheez- 
ing sounds.  Bronchitis  and  emphysema  are  often 
found  co-existing  with  this  disease,  and  when 
present  you  will  have  these  characteristic  signs. 
To  any  student  who  desires  to  study  fully  this  dis- 
ease, I  would  recommend  Hyde  Salter's  work  on 
Asthma.  He  says  that  every  case  of  Asthma  has 
a  climate  which  will  cure  it.  The  trouble  is  we 
cannot  tell  just  what  climate  will  suit  each  case, — 
but  it  is  somewhat  singular  that  the  majority  of 
cases  seem  to  do  best  in  the  dirty,  smoky  air  of  large 
cities.  Hereditary  spasmodic  asthma  is  difficult 
if  not  impossible,  of  cure,  though  very  much  can  be 
done  to  relieve  and  diminish  the  frequency  of 
attack.  This  disease  has  strange  vagaries.  Per- 
sons may  often  be  all  but  permanently  relieved  by 
changing  the  house  in  which  they  live,  but  any 
return  to  the  original  place  of  attack  is  certain  to 
bring  about  a  recurrence.  The  chief  characteristic 
is  the  suddenness  of  the  onset.  Occasionally,  how- 
ever, there  is  some  warning,  such,  for  instance,  as 


an  unusually  large  discharge  of  pale,  limpid  urine. 
Then  the  patient  has  an  extreme  sense  of  suffoca- 
tion, with  tightness  and  oppression  across  the 
chest.  He  is  forced  to  loose  every  particle  of 
clothing,  and  at  times  so  great  is  the  dyspnoea 
that  he  rushes  to  the  window,  and  places  his  head 
in  a  draught  of  fresh  air.  If  this  is  not  done,  he 
sits  upright,  resting  his  arms  or  elbows  on  some 
support.  Every  muscle  of  respiration  is  called  into 
action.  We  soon  have  signs  of  overloading  of  the 
venous  system — the  face  cyanosed,  lips  blue,  extre- 
meties  cold,  and  pulse  small  and  quick.  The  great 
majority  of  cases  occur  during  the  night,  very  often 
at  the  same  hour  every  night.  A  hearty  meal 
before  retiring  is  often  known  to  induce  an  attack, 
whicii  may  end  suddenly  after  lasting  a  few  hours, 
or  it  may  last  a  day  or  more,  though  the  last  is 
seldom.  Occasionally  a  cough  sets  in  towards  the 
close  of  an  attack,  but  the  expectoration  is  slight, 
as  a  rule.  The  prognosis  is  favorable,  death  being 
a  rare  occurrence  during  a  fit,  as  it  is  termed,  of 
the  disease. 

The  treatment  of  asthma  is  divided  into  treat- 
ing the  paroxysm,  and  treatment  to  prevent  a 
recurrence.  In  treating  asthma  it  is  best  always 
to  use  single  remedies.  It  would  take  more 
time  than  we  have  at  our  disposal  to  mention 
even  all  the  drugs  which  have  been  found  bene- 
ficial. To  relieve  an  asthmatic  paroxysm, 
tobacco  is  one  of  the  best.  It  is  of  course  very 
likely  that  a  patient  using  tobacco  for  this  pur- 
pose may  acquire  a  fondness  for  the  weed,  but 
if  it  is  going  to  be  useful  in  future  attacks,  he  must 
not  use  it  as  a  social  comfort,  or  it  will  loose  its 
effect.     At  times  a  few  whiffs  of  a  cigar  will  stop 


194 


THE  CANADA  MEDICAL  RE60BD. 


the  paroxysm,  but  as  a  rule  the  smoking  must  be 
continued  till  constitutional  effects  are  manifes- 
ted by  a  depressed  circulation,  cold  perspiration 
and  nausea.  If  the  heart  is  weak  this  remedy 
must  not  be  employed  ;  smoking  Datura  Tatula  is 
often  very  useful.  Stramonium, — smoking  the 
leaves  is  also  a  common  remedy.  They  may 
be  smoked  alone  in  a  pipe  or  in  cigarettes, 
or  the  leaves  may  be  mixed  with  tobacco,  and 
made  into  cigars.  In  the  same  way  the  leaves 
of  Hyosciamus  and  Belladonna  have  been  found 
valuable.  The  most  common  remedy  is  salt- 
petre paper.  A  saturated  solution  of  nitrate  of 
potassium  is  prepared,  and  in  this  is  soaked 
blotting  paper,  which  is  then  dried  and  cut  into 
strips  ;  when  lighted,  those  strips  burn  slowly, 
and  the  patient  inhales  the  smoke.  Some  ad- 
vise a  very  small  proportion  of  arsenic  to  be 
added  to  the  saltpetre  solution.  Cocoa  leaves 
are  also  advised  to  be  smoked,  mixed  with  or- 
dinary tobacco.  The  latest  remedy  is  pyridene. 
This  is  used  in  quantities  of  a  drachm,  and 
vaporized  on  a  hot  plate  in  a  closed  room.  It 
is  said  to  be  very  useful.  Emetics  are  sometimes 
found  useful,  and  perhaps  the  best  is  Tartar 
Emetic.  Nitrate  of  Any!  is  often  very  serviceable 
in  relieving  a  paroxysm.  Nitro-glycerine  gtt.  i 
of  a  1  per  ct  Sol.  is  recommended  also.  Sudden 
fright  has  been  known  to  instantly  cure  a  par- 
o.xysm.  Chloral  Hydrate,  where  the  heart  is  not 
diseased  or  weak,  in  doses  of  15  to  20  grs.  is  very 
good  ;  }{,  gr.  of  morphia  combined  with  '^j  of  a 
gr.  of  sulphate  of  atropia  will  as  a  rule  cut  short 
an  attack.  If  frequently  used  there  is  the  danger 
of  the  Morphia  habit,  which  is  much  worse  than 
an  attack  of  Asthma,  bad  as  it  may  be  ;  stimulants 
are  bad,  and  never  should  be  used.  To  prevent 
the  return  of  the  disease,  there  are  several  useful 
remedies,  and  first  on  the  list  stands  arsenic, 
which  must  be  continued  for  several  months. 
Ammonium  Bromide  is  well  spoken  of.  The 
Bromides  are  eliminated  by  the  bronchial  mucous 
membrane,  and  are  believed  to  exert  a  local 
anjesthetic  effect.  Potas.  Bromid.  is  also  used. 
Cimicifuga,  a  plant  indigenous  to  this  country, 
is  a  remedy  not  so  much  used,  as  I  think  it  de- 
serves to  be.  Quinine  may  be  used  both  during 
a  paroxysm  and  afterwards.  If  an  attack  is  ex- 
pected, say  about  one  in  the  morning,  a  full  dose 
of  Quinine  at  9  o'clock  the  preceding  evening  will 
sometimes  prevent  its  coming  on,  or  it  may  only 
modify  the  severity  of  the  attack.      It  sometimes 


fails  to  have  any  effect.  Another  remedy  intro- 
duced during  the  last  few  years  is  Grindelia 
Robusta.  It  is  highly  spoken  of,  and  may  be 
given  in  doses  of  ^  a  drachm  of  the  Fid.  Ext. 
several  times  a  day.  In  some  patients  who 
are  sufferers  from  Hay,  Asthma  or  Hay 
fever,  there  has  been  recently  found  hypertro- 
phy of  certain  portions  of  the  schneiderian 
membrane.  These  hypertrophied  points,  are 
believed  to  be  potent  parts  of  irritation, 
and  their  destruction,  by  means  of  the  gal- 
vano-cautery,  have  been  followed  by  excellent 
results.  This  is  a  very  recent  advance  on  the 
pathology  of  this  disease.  Still  more  recently  it 
has  been  suggested  that  possibly,  in  ordinary 
asthma,  these  points  of  hypertrophy  may  also 
exist  in  the  trachial  and  bronchial  mucous 
membrane.  These  points  cannot  of  course  be 
reached  by  the  cautery,  but  it  is  suggested 
that  this  condition  can  be  remedied  by  the 
persistent  inhalation  for  months  of  the  vapor 
of  Iodine  and  Carbolic  Acid.  It  is  theoreti- 
cally a  good  practice.  I  have  seen  hypertro- 
phied tonsils  greatly  improved  by  this  inhalation. 
Attention  to  diet  is  important.  Indigestible 
articles  must  be  avoided,  and  asthmatics 
must  absolutely  avoid  eating  before  going  to  bed. 

Sotidij  J^mteedlmS. 

MEDICO-CHIRURGICAL      SOCIETY    OF 
MONTREAL. 

Stated  Meeting,  March  2nd,  1888. 

Jas.  Perrigo,  M.D.,  President,  in  the  Chair. 

Muscular  Atrophy. — Dr.  Stewart  exhibited  two 
cases  of  muscular  wasting. 

Extirpation  of  the  Uterus. — Dr.  Wm.  Gardner 
exhibited  two  uteri  removed  by  the  vaginal 
method.  In  the  first  case,  the  patient,  aged 
over  50,  was  sent  to  him  by  Dr.  A.  A.  Browne 
of  this  city.  There  was  a  history  of  menopause 
for  several  years,  then  hemorrhage  and  other 
discharges  for  eight  or  ten  months,  and  severe 
pelvic  pain  for  three  or  four  months.  Decided 
failure  of  strength  and  general  health.  On 
examination,  a  friable,  ulcerated,  easily  bleeding 
condition  of  the  cervix.  No  enlargement  of  the 
uterus  or  palpable  involvement  of  vagina  and  ■ 
broad  ligaments.      The    diagnosis   was   cancer, 


THE  CANADA  MEDICAL  RECOHD. 


195 


and  extirpation  of  the  uterus  advised.  The 
patient  consented,  and  the  operation  was  done 
on  the  i8th  of  February.  On  opening  the 
uterus,  the  diseased  action  was  found  to  have 
extended  some  distance  within  the  cavity  of  the 
body,  thus  accounting  for  the  severe  pain.  The 
patient  made  an  easy  recovery,  and  left  Dr. 
Gardner's  private  hospital,  feeling  better  than 
for  months  previously. 

The  second  specimen  was  from  a  patient  of 
Dr.  C.  O.  Browne  of  Knowlton.  She  was  aged 
29,  married  twelve  years ;  five  pregnancies,  all 
to  full  term,  the  last  labor  two  years  and  four 
months  previously.  She  had  suffered  from 
uterine  symptoms  and  intense  nervousness  for 
six  years.  All  the  symptoms  had  been  much 
worse  for  twelve  months,  during  which  time 
pelvic  pain,  hemorrhage  and  dirty-colored 
vaginal  discharges  were  constant  and  pro- 
nounced. On  examination,  the  uterus  was 
retroverted  and  prolapsed,  the  cervix  lacerated, 
of  stony  hardness,  and  the  posterior  lip  occupied 
by  an  ulcer  which  Dr.  Browne  asserts  to  have 
existed  for  four  months.  The  diagnosis  was 
probable  malignant  disease,  and  extirpation 
recommended.  Three  weeks  later  she  entered 
Dr.  Gardner's  private  hospital,  and  the  operation 
was  done  on  ist  March.  The  method  adopted 
in  this  case  was  that  practised  by  Martin  of 
Berlin,  the  posterior  cul-de-sac  being  opened  as 
the  first  step.  The  patient  made  a  tedious 
recovery.  The  pulse  ranged  for  several  days 
from  150  to  180,  being,  in  fact,  at  times  scarcely 
to  be  counted.  Other  symptoms  were  without 
any  alarming  feature.  The  pulse  before  oper- 
ation was  between  120  and  130.  I'he  specimen 
was  pronounced  by  Dr.  Johnston  to  be  not 
malignant,  but  in  view  of  the  clinical  character 
of  the  case,  and  the  fact  that  the  microscope 
was  not  always  a  certain  means  of  diagnosis  of 
cancer.  Dr.  Gardner  felt  justified  in  extirpating 
the  uterus  and  ovaries  in  this  case.  The 
operation  had  been  done  in  Germany  several 
times,  for  conditions  well  known  not  to  be 
malignant,  but  not  amenable  to  other  methods 
of  treatment.  When  the  mortality  has  been 
reduced,  as  in  Leopold's  hands,  to  six  per  cent., 
as  a  result  of  improved  technique  and  otherwise, 
then  he  (Dr.  Gardner)  considered  it  perfectly 
justifiable  for  certain  cases  other  than  malignant, 
and  in  future  he  intended  to  advise  it  for  a 
limited  number  of  such.     This  was  the  fifth  case 


in  which  he  had  extirpated  the  uterus  without  a 
death  and  without  alarming  symptoms. 

Dr.  Roddick  asked  if  Dr.  Gardner  would 
recommend  extirpation  of  the  uterus  for  chronic 
endometritis. 

Dr.  Gardner  replied  tliat  the  question  was  an 
important  one  that  often  presented  itself  to  the 
gynecologist.  The  operation  is  now  done  with 
comparative  safety,  and  in  selected  cases  would 
certainly  operate  in  this  way. 

Dr.  J.  C.  Cameron  referred  to  the  necessity  of 
microscopic  examination  of  the  tissues  removed 
by  scraping,  before  a  diagnosis  of  malignant 
disease  is  made.  The  microscope  is  not  used  as 
much  in  America  as  it  should  be  in  such  cases. 
The  German  gynaecologists  are  setting  us  an 
example  in  this  respect. 

Sutured  Patella. — Dr.  Bell  showed  a  patella 
which  had  been  sutured  five  months  previously. 
The  patient,  a  young  Norwegian  sailor,  fell  from 
the  rigging  of  his  ship  and  fractured  his  patella, 
nine  weeks  prior  to  the  arrival  of  his  ship  in 
port.  He  had  had  no  treatment  of  any  kind. 
He  was  admitted  to  hospital  on  the  arrival  of 
his  ship  in  port,  when  the  patella  was  found  to 
be  fractured  transversely  through  its  centre. 
There  was  no  sign  of  any  union,  and  on  flexing 
the  leg  the  parts  separated  widely,  so  that  the 
articular  surface  of  the  end  of  the  femur  could 
be  distinctly  felt  through  the  skin.  The  patella 
was  treated  by  paring  off  the  rounded  cartila- 
ginous faces  of  the  fracture,  and  suturing  with 
three  strong  sterilized  silk  sutures.  The  first 
dressing  was  not  removed  for  six  weeks,  when 
the  wounds  were  all  perfectly  and  soundly  healed, 
and  the  patella  apparently  firmly  united.  A 
splint  was  applied  for  three  weeks  longer  and 
then  removed,  and  the  patient  allowed  up,  and 
advised  to  practice  passive  movement  of  the 
joint.  After  three  weeks  of  this  passive  motion 
the  union  of  the  patella  fragments  seemed  to  be 
not  so  firm,  and  the  patient  was  put  to  bed  and 
a  [jlaster-of-Paris  splint  applied.  In  six  weeks 
more  this  was  removed,  and  the  house  surgeon 
applied  a  light  posterior  splint  of  Gooch's  ribbed 
splinting,  and  with  this  he  walked  about  in 
perfect  health  and  comfort  until  the  22nd  of 
January,  four  months  after  operation,  when  he 
complained  of  a  little  fever  and  some  pain  in  the 
leg  and  knee.  On  examination,  the  knee  was 
found  tender  and  slightly  swollen,  and  a  sore 
which  had  been  produced  on  the  skin  by  the 


196 


THE   CANADA   MEDICAL   RECORD. 


corner  of  the  splint  and  dressed  with  a  little  dry 
gauze  was  found  to  contain  fully  an  ounce  of 
pent  up  pus,  which  was  removed  and  the  wound 
treated.  He  also  had  a  suppurating  ingrown 
great  toe  nail  on  the  foot  of  the  same  side. 
Pyaemia  developed,  and  the  patient  died  in  four 
weeks,  just  live  months  and  a  half  after  oper- 
ation. The  pyaemia  was  undoubtedly  due  either 
to  the  sore  on  the  skin  or  the  ingrown  toe-nail, 
and  could  not  have  been  in  any  way  directly  due 
to  the  operation,  as  the  knee  had  been  perfectly 
healed  and  free  from  pain  or  other  symptom  for 
over  three  months  before  the  pyaemic  symptoms 
appeared.  At  the  autopsy,  ulcerative  endocar 
ditis  was  found,  as  well  as  several  purulent  focj 
in  internal  organs.  The  patella  was  found  to  be 
perfectly  united,  the  union  being  quite  firm  and 
evidently  bony.  The  silk  sutures  were  found 
just  as  they  had  been  left  at  the  operation,  the 
silk  being  apparently  unchanged. 

Discussion. — Dr.  Armstrong  said  he  thought 
the  specimen  showed  bony  union,  and  asked 
Dr.  Bell  why  he  thought  the  union  was  not 
good  when  the  dressing  was  taken  off 

Dr.  Bell  replied  that  there  was  movement  at 
that  time  between  the  parts,  though  subsequently 
complete  union  occurred. 

Dr.  Roddick,  congratulated  Dr.  Bell  on  the 
excellent  result  of  this  operation,  and  was  in- 
clined to  accept  his  explanation  of  the  cause  of 
the  pyemia,  as,  if  the  knee  had  been  the  starting 
point,  there  would  not  have  been  such  union, 
and  the  joint  would  have  been  seriously  affected. 
He  referred  to  a  case  of  a  young  girl  recently 
confined,  who  came  to  hospital  with  a  painful 
knee.  The  bursa  patellae  was  found  enlarged, 
and  on  the  inner  side  of  the  leg,  two  inches  above 
the  inner  malleolus,  was  a  small  ulcer  the  size  of 
a  shilling,  unhealthy  and  sloughing  ;  proceeding 
up  from  this  was  swelling  and  suppurative  cellu- 
litis to  the  bursa  patella,  which  also  was  in 
a  state  of  suppuration.  The  bursa  was  opened, 
cleaned  and  drained,  and  the  cellulitis  and  ulcer 
treated,  with  the  result  that  the  girl  Avas  well  in 
two  weeks. 

Dr.  Shepherd  saw  the  case  with  Dr.  Bell  in 
hospital.  He  found  undoubted  mobility  after 
the  dressing  was  removed,  and  did  not  think 
now  that  the  union  was  a  complete  bony  one, 
but  the  parts  were  no  longer  movable.  He 
thought  there  was  a  line  of  fibrous  union  bet- 


ween the  fragments.  The  pyaemia  was  not  due 
to  the  operation,  but  to  sores  on  the  leg  and 
foot. 

Stated  Meeting,  March   2^th,   1888. 
Jas.  Perrigo,  M.D.,  President,  in  the  Ch.'MR. 

Snhdiaphragmatic  Abscess.  —  Dr.  Shepherd 
exhibited  the  patient,  whose  case  he  had  related 
at  a  previous  meeting  of  the  Society,  and  who 
had  suffered  from  subdiaphragmatic  abscess. 
When  the  case  was  rejiorted  to  the  Society,  a 
sinus  remained  below  the  costal  cartilages  on 
the  right  side.  This  had  now  completely  closed, 
and  the  patient  felt  as  well  as  ever  he  did. 
Liver  dulness  was  normal,  and  breath  sounds  in 
right  lung  clear  in  every  part. 

The  Bacillus  Scarlatiiin:. — Dr.  McConnell 
read  the  following  paper  on  this  subject  : — 

The  nature  of  the  contagium  of  scarlatina  is  a 
question  which  has  during  the  past  year  occupied 
a  prominent  place  in  English  medical  societies 
and  periodicals.  In  December,  1885,  an  out- 
break of  scarlatina  occurred  in  London,  and  it 
was  supposed  that  the  infection  was  conveyed 
by  milk  from  a  dairy  in  Hendon.  The  subject 
was  investigated  by  Dr.  Klein.  Several  of  the 
cows  were  found  to  be  suffering  from  an  infec- 
tious disease  characterized  by  vesicles  and 
ulcers  on  the  udders.  From  this  Dr.  Klein 
isolated  a  streptococcus.  He  also  discovered  a 
similar  organism  in  the  blood  of  scarlatina 
patients  after  the  fourth  day.  Inoculation  expe- 
riments were  performed,  and  Dr.  Klein  con- 
cluded that  the  Hendon  cow  disease  was 
identical  with  scarlatina.  In  a  critical  review  of 
this  subject  by  Dr.  Geo.  Thin,  at  the  Dublin 
meeting  of  the  British  Medical  Association, 
doubts  were  cast  upon  these  conclusions ;  and 
later.  Prof.  Crookshank  was  deputed  by  the 
Agricultural  Department  of  the  Home  Office  to 
make  further  investigations.  Abstracts  of  the 
voluminous  reports  of  the  investigation  were,  in 
December  last  and  January  of  this  year,  placed 
before  the  Pathological  Society  of  London.  The 
conclusions  arrived  at  were  that  the  streptococcus 
sciirlatiiue  of  Dr.  Klein  was  identical  with  strep- 
tococcus pyogenes,  a.  micro-organism  found  in 
acute  abscess,  etc.,  and  frequently  found  asso- 
( iated  with  a  number  of  other  affections,  and 
that  the  Hendon  disease  was  cow-pox. 

Researches  regarding  the  nature  of  the  con- 
tagium of  scarlatina  were  piade  in  the  early  part 


^■\ 


tttE  CANADA   MEDtCAL  RECOfeD. 


19? 


I 


of  iScS?,  at  the  Bacteriological  Laboratory  of 
Kdinluiigh  University.  l>y  Dr.  Alex.  Edington. 
I'jglU  tlilViTrnt  orgiinisins  were  isolated.  A 
streptococcus,  provisionally  specied  as  riihigi- 
nosiis,  was  found  in  20  ])er  cent,  of  tlie  original 
tubes  intnulaled  with  scales  from  scarlatina 
jiatients  during  the  stage  of  desquamation,  or 
from  the  blood,  and  is  apparently  identical  with 
I'r.  Klein's  streptococcus  scarlatinje.  A  bacillus 
was  found  to  be  present  in  the  scales  in  every 
instance  when  examined  after  the  third  week, 
and  in  every  case  the  same  bacillus  was  found  in 
the  blood  during  the  first  three  days  of  the 
fever.  Rabbits  and  calves  were  successfully 
inoculated,  producing  a  disturliance  and  appear- 
ance resembling  scarlatina  in  man.  The  con- 
clusions formed  were  that  this  liacillus  (called 
li.  itcarhi/iiiii )  was  the  specific  cause  of  scarla- 
tina, and  that  the  other  organisms  were  "  merely 
concomitants,  and  pass  into  the  blood  only  after 
the  vitality  of  the  system  and  tissues  has  been 
loAvered  by  the  entrance  of  this  specific  or 
ganism." 

In  September  last  I  inoculated  test  tubes  of 
potash  peptone  gelatine  from  several  cases  of 
scarlatinse,  using  sterilized  capillary  tubes,  to 
M  liicli  about  an  inch  of  the  original  glass  tubing 
remained,  this  part  being  plugged  with  cotton 
Wool  ;  the  finger  from  which  the  blood  was  taken 
being  previously  covered  with  lint  saturated  with 
a  20  per  cent,  solution  of  carbolic  acid.  In  the 
first  case  the  blood  was  examined  about  the 
beginning  of  the  fourth  day  of  the  disease.  The 
tubes,  on  being  incubated,  were  all  found  to  be 
sterile.  The  blood  of  another  child  in  this 
family  was  examined  on  the  second  day  of  the 
disease,  when  almost  a  pure  culture  of  Eding- 
ton's  bacillus  was  obtained. 

On  Oct.  13th,  1887,  similar  cultivations  were 
made  from  a  child,  five  years  of  age,  suffering 
from  scarlatina,  on  second  day  of  fever  ;  and 
also  from  her  sister  a  few  days  later.  The  same 
bacillus  was  procured.  The  lower  limb  of  the 
first  child  was  in  accordance  with  Edington's 
method  of  securing  the  desquamation,  wrapped 
in  sterilized  cotton  wool,  after  being  cleansed 
and  disinfected.  The  scales  procured  on  the 
twenty-second  day  gave  an  abundant  culture  of 
the  same  bacillus,  associated  with  micrococci. 
The  character  of  this  organism,  as  you  can 
ascertain  from  an  examination  of  these  stained 
specimens    and  cultures,    are    distinctive.     Dr. 


Edington's  description  appeared  in  the  Brltinh 
Mcdiail  Jiiiinial  of  .August  6th,  1887.  The  bacil- 
lus, which  is  motile,  is  from  2  m.  to  5  m.  in 
length  and  4  m.  to  5  m.  in  breadth  ;  it  is  mark- 
edly aerol)ic,  grown  on  jelly  in  the  incubator 
at  from  18°  C.  to  23''  C,  it  will  form  a  pellicle 
at  the  surface  in  from  24  to  36  hours.  The  time 
in  which  the  pellicle  will  form,  and  the  rapidity 
with  which  it  will  liquify  the  gelatine,  is  less, 
where  the  material  used  is  the  last  of  a  number 
of  successive  inoculations  from  tube  to  tube 
which  increases  its  activity.  The  pellicle  forms 
more  readily  on  bouillon,  is  semi-transparent, 
looking  like  parchment,  very  firm,  and  formed 
by  the  interlacing  of  the  bacilli  into  a  felt-like 
membrane,  it  now  becomes  wrinkled,  and  the 
margin  vnay  be  pushed  up  the  side  of  the  tube 
ovoid  ;  spores  then  form,  and  in  three  or  four 
weeks  the  pellicle  will  disappear.  It  grows 
ra|iidly  on  milk  and  on  potato,  forming  a  citron- 
white  pellicle,  which  becomes  darker  in  color  ; 
grows  less  readily  on  agar-agar,  and  jjoorly  on 
blood-serum.  On  plates  the  growth  is  charac- 
teristic. The  colonies  grow  for  a  day  or  two 
before  the  gelatine  begins  to  liquify ;  this 
occurring  first  in  the  centre,  and  proceeding  out- 
wards, the  bacilli  then  become  motile,  and 
later  assumes  the  form  of  Leptothrix  filaments. 
The  colony  then  has  the  appearance  of  three 
zones — Leptothrix  in  the  centre,  actively  mul- 
tiplying bacilli  at  the  margin,  and  motile  bacilli 
at  the  edge  of  the  liquified  portion. 

The  point  of  chief  interest  is  the  fact  that  the 
bacillus  is  found  in  the  blood  only  up  to  the 
third  day  of  the  fever,  and  not  in  the  desquama- 
tion until  the  twenty-second  day.  The  rapid 
growth  of  the  bacilli  is  in  harmony  with  the 
short  period  of  incubation  of  scarlatina,  and  the 
finding  of  the  bacilli  in  the  scales  is  in  accord 
with  their  well  known  infectiousness  ;  and  the 
prolonged  duration  of  their  infective  powers  is 
explained  by  the  tendency  to  spore  formation, 
even  in  the  blood,  which  characterizes  the 
bacilli.  The  practical  utility  of  this  addition  to 
our  knowledge  concerning  scarlatina  was  demon- 
strated by  Dr.  Jamieson, — at  whose  suggestion 
the  experiments  were  carried  out, — even  before 
the  discovery  of  the  real  nature  of  the  contagium, 
from  the  fact  that  by  applying  antiseptic  remedies 
to  the  throat  in  the  earliest  stage,  bathing  the 
surface,  and  applying  carbolized  ointments  as 
soon  as  desquamation  began,  he  was  enabled, 


l98 


THE  CANADA   MEDICAL  RECORD. 


on  the  arm  of  a  friend,  without  whose  assistance 
without  any  special  isolation  of  the  patients,  to 
prevent  the  spread  of  the  disease  to  any  other 
hieniber  of  the  family  in  which  it  occurred,  even 
in  instances  where  a  number  of  young  children 
\vere  allowed  to  associate  as  usual  with  the 
affected  member.  During  the  last  three  years 
this  happy  result  had  invariably  been  attained. 
Although  not  yet  fully  trusting  to  these  baths 
and  anointing  alone — that  is,  without  isolation — 
one  case  where  this  was  impossible  illustrates 
the  utility  of  these  measures.  In  this  family 
there  were  three  children  ;  the  oldest  had  sfcar- 
latina  on  Dec.  15th  last ;  the  anointing  was  fully 
carried  dut,  and  although  the  children  mingled 
together  constantly,  the  others  escaped  the 
disease. 

Further  investigations  will  be  required  before 
this  organism  can  be  fully  established  as  being  the 
true  specific  cause  of  scarlatina,  as  evidenced  by 
the  first  report  of  the  committee  of  the  Edin- 
burgh Medico-Chirurgical  Society  appointed  to 
investigate  the  subject,  in  which  they  stated  their 
inability  to  infect  calves  by  either  blood  or 
scales  of  scarlatina  patients.  Their  suscepti- 
bility to  scarlatina  is  a  point  claimed  by  both 
Drs.  Klein  and  Edington  in  their  experiments; 
but  that  we  have  in  the  antiseptic  treatment  of 
the  skin  and  throat  a  means  of  preventing  the 
spread  of  the  disease  seems  well  established, 
and  should  the  claims  of  Dr.  Illingvvorth  for 
biniodide  of  mercury  as  an  abortive  in  this 
disease  be  sustained,  great  advance  has  been 
made  in  the  management  of  this  prevalent  affec- 
tion, and  the  night  of  empiricism,  which  has 
hitherto  prevailed  in  regard  to  the  treatment  of 
this  class  of  disease,  we  may  anticipate  will  soon 
give  place  to  the  light  of  scientific  methods. 

A  Case  0/  LiijhtHing  Shock. — Dr.  Mills  read 
a  paper  on  this  subject,  and  Dr.  Buller  gave 
the  intra-ocular  changes  produced. 


Stated  Meeting,  Ajrril  6th,  1888. 
James  Perrigo,M.D.,  President,  in  the  Ch.\ir. 

Alopecia  Areata.— Dr.  Armstrong  exhibited 
the  case,  and  gave  the  following  history  :  The 
patient  is  a  young  woman  of  25  ;  married  last 
November.  About  a  month  after  marriage 
noticed  a  large  bald  patch  a  little  behind  and  to 
the  right  of  the  situation  of  the  post-fontanelle. 


From  that  time  to  the  present  new  patches  have 
continued  to  appear  at  short  intervals  on  dif- 
ferent parts  of  the  hfead,  until  now  there  are 
twelve  or  fourteen  patches,  varying  in  size  from 
a  20  cent  piece  to  that  of  a  half  dollar,  and 
situated  back  and  front  and  at  both  sides.  It  is 
for  this  reason  principally  that  I  show  the  case. 
There  is  still  a  difference  of  opinion  as  to  the 
etiology  of  this  form  of  alopecia.  ThusDuhring 
and  Stelwagon,  in  Pepper's  System  of  Medicine, 
Vol.  IV,  state  that  the  disease  is  "  not  parasitic, 
nor  is  it  contagious."  Balmanno  Squire,  in  the 
third  volume  of  Reynolds'  System  of  Medicinei 
defines  the  disease  as  contagious,  and  produced 
by  a  vegetable  parasite,  the  irticrospoi'on nndonini, 
and  he  inserts  an  illustration  of  the  spores  of 
the  fungus.  The  appearance  of  these  patches, 
situated  on  all  sides  of  the  scalp,  suggests  very 
strongly  to  me  the  idea  that  the  disease  is 
parasitic.  If  due  to  nerve  disturbance,  one  must 
admit  that  some  cause  is  acting  which  involves 
the  terminal  twigs  of  many  different  nerves  and 
of  several  branches  of  the  same  nerve.  I  am 
not  familiar  with  any  variety  of  nerve  distur- 
bance at  all  analogous  to  the  condition  which 
obtains  in  this  case  of  alopecia.  The  large 
patch,  with  several  smaller  ones  appearing 
secondarily  and  subsequently,  suggests  the  idea 
of  contagion,  the  same  as  occurs  in  ringworm  of 
the  scalp.  I  know  of  an  instance  where  father 
and  son  suffer  from  alopecia  areata,  the  one 
having  it  some  time  before  the  other. 

Discussion. — Dr.  Bell  said  the  ordinary  clini- 
cal history  of  the  disease  was  against  the  theory 
of  a  parasitic  origin.  The  pathology  is  very 
doubtful.  He  never  made  a  practice  of  sepa- 
rating patients  from  the  rest  of  the  family,  and 
in  most  cases  there  is  recovery  in  a  few  months, 
but  the  hair  is  apt  to  come  in  differently  pigmen- 
ted, if  not  white.  Treatment  was  usually  expec- 
tant, used  a  shampoo  to  keep  the  skin  healthy, 
and  gave  tonics. 

Dr.  Trenholme  had  seen  coal  oil,  well  rubbed 
in,  restore  the  color  of  hair  when  the  color  was 
spoiled. 

Fibroid  0/ the  Uterus.— Dr.  Lapthorn  Smith 
exhibited  a  patient  to  illustrate  the  effects  of 
electrical  treatment,  and  read  the  following  his- 
tory : — 

The  patient  came  to  me  on  the  19th  March, 
very  wretched  in  appearance,  and  leaning  heavily 


THE   CANADA  MEDICAL   RECOHl). 


199 


she  was  hardly  able  to  walk.     She  measured  32 
inches  around   the  waist,  although  her    normal 
waist  measurement  she  said  was  21  inches  three 
years  ago.     1  was  unable  to  pass  the  sound  any 
further  than  3}^  centimetres,  but  with  it  at  this 
distance   I  gave  her   50   milliampcres    with  the 
negative  pole  during  seven  minutes.     She  came 
again  on  the  20th  March,  telling  me  that  she  had 
had  less  pain  since  and  could  walk  better,  and 
that  her  friends  told  her  she  was  looking  better. 
I  gave  her  150  negative  for  five  minutes,  which 
she  bore  well.     On  the  23rd  she  was  menstruat- 
ing, so  I  did  not  give  her  any  electricity,  but  her 
belly  was  not  at  all  tender  to  pressure,  and  the 
menstrual  flow  was  more  profuse  than  usual.  On 
the  27th  she  came  again,  having  ceased  menstrua- 
ting ;  instead   of  lasting  fifteen  days,  as  it  did 
before  treatment,  it  only  lasted  five  days,  but  she 
lost  more  in  the  five  days  this  time  than  she  did 
in    fifteen  before — not    more,    however,  than  a 
woman  should  lose  at  a  period.     She  measured 
4  inches  less  around  the  waist.     I  gave  her  150 
positive  for  five  minutes,  the  sound  entering  five 
centimetres.     On  the   29th  March  she  measures 
only  27  inches  around  the  waist,  and  she  feels  so 
much  better  that  she  thinks  she  will  soon  be  able 
to  return  to  work.     I  gave  her   140  positive  for 
five  minutes. 

March  3l!<. — She  says  she  has  a  hollow  at  the 
pit  of  her  stomach  now,  instead  of  a  lump.  I 
gave  her  125  negative  during  five  minutes,  which 
she  bore  well,  the  sound  entering  five  centime- 
tres. 

April  'ird. — Waist  measurement  steadily  de- 
creasing, and  she  is  hardly  at  all  sensitive  over 
the  abdomen.  Gave  her  100  negative  for  five 
minutes,  ^th — Gave  her  100  negative  during  six 
minutes,  which  she  bore  easily. 

This  is  as  far  as  I  have  got  with  the  case,  and 
of  course  I  am  only  in  the  middle  of  the  treat- 
ment ;  but  the  result  has  been  so  striking,  and 
her  previous  condition  having  been  so  well 
authenticated,  and  she  seemed  so  willing  to  come 
here  to  show  herself,  where  it  is  not  always  easy 
to  bring  them,  I  thought  it  would  be  interesting 
to  the  members  to  see  one  of  the  many  cases  of 
the  kind  I  have  at  present  under  treatment. 

Perforating  Ulcer  of  the  Stomach. — Dr.  Arm- 
strong also  showed  a  specimen  of  round  ulcer 
of  the  stomach,  remarkable  for  its  large  size,  as 
well  as  the  obscure  previous  history.    The  patient. 


was    a    well-nourished,  but  anaemic,  unmarried 
woman,  aged  28,  a  nurse  in  the  Western  Hospi- 
tal.    For  a  year  past  she  had  complained  of  be- 
ing out  of  sorts,  at  one  time  having  well-marked 
left  intercostal  neuralgia  affecting    the    seventh 
and  eighth  nerves  of  that  side.     She  had  also 
complained  of  burning  pain  at  lower  end  of  back> 
which  was  found   to  be    due  to  a    retroverted 
uterus,  and  which  was  relieved  by  the  use  of  a 
suitable  pessary.     Her  appetite  had  been  poor, 
but  she  always  denied  suffering  pain  after  eating, 
and  had  never  vomited  her  food  except  once. 
For  about  a  month    or    six  weeks    before  the 
symptoms    of   perforation    developed,   she  had 
nearly  every  day  complained  of  severe  abdominal 
pain,  referred  principally   to  the   region   of  the 
umbilicus,  and   sometimes  of   pain  in  left  iliac 
fossa.     This  was  unaccompanied  by  correspond- 
ing pain  on  pressure.     Her  bowels  moved  every 
day,  and  the  stools    were  of   good    color  and 
formed,  but  iiot  hard  or  dry.     On  Friday  after- 
noon she  suddenly   took    a    severe   chill,  with 
severe  pain   referred  at  first  to  left  iliac  fossa. 
In  a  few  hours  symptoms  of  general  peritonitis 
developed  with   vomiting  of   everything    taken 
into    the    stomach.     Death    ensued    forty-eight 
hours  after  the  symptoms  of  perforation.     At  the 
autopsy  there  were  the  usual  evidences  of  general 
suppurative  peritonitis.     The  left  fallopian  tube 
was  dilated  to   one  inch   in  diameter,  and  con- 
tained pus.     So  far  as  could  be  made  out,  no 
rupture  of  tube  had  taken  place.     On  the  pos- 
terior wall  of  the  lesser  curvature  of  the  stomach, 
a  large  round  perforation   was  found,  having  a 
diameter  of  i}{  inches.  The  edges  were  rounded 
and  smooth.     This  is  certainly  a  very  unusually 
iarge  opening. 

Dr.  Perrigo  said  that  the  patient  was  under 
his  care  in  the  Western  Hospital  for  some  time ; 
she  then  had  paroxysmal  intercostal  neuralgia, 
coming  on  every  afternoon.  Small  repeated  doses 
of  quinine  had  no  effect,  but  large  doses  gave 
relief.  There  was  no  history  of  vomiting  or  indi' 
gestiou. 

Dr.  Bell  referred  to  a  case  recently  shown  by 
Dr.  George  Ross.  The  stomach  of  a  girl  aged  1 9 
had  several  ulcers  ;  two  were  completely  healed 
and  some  partially,  one  had  perforated  and  caused 
death.  During  life  there  were  no  symptoms  re- 
ferable to  gastric  trouble.  No  history  of  vomiting 
or  indigestion. 


200 


THE  CANADA  MEDICAL   RECORl). 


Renal  Tuberculosis. — Dr.  Lafleur  exhibited 
the  kidneys  and  bladder  from  a  case  of  renal 
tuberculosis.  The  right  kidney  was  much  enlarg- 
ed, nodular,  and  could  be  distinctly  mapped  out 
externally.  Its  capsule  was  thickened  and  adher- 
ent to  the  liver,  ascending  colon  and  duodenum. 
On  section,  was  found  to  consist  of  a  collection  of 
small  cavities  filled  with  creamy  (nis  and  caseous 
detiiius,  all  communicating  with  i)elvis  of  kidney. 
Ureter  was  dilated  and  infiltrated  with  tubercular 
nodules.  In  left  kidney  there  was  a  small  caseat- 
ing  nodule  at  the  apex  of  one  of  the  pyramids,  and 
the  rest  of  the  organ  showed  marked  amyloid  re- 
action. Ureter  normal.  Bladder  was  filled  with 
pus,  and  its  mucous  membrane  was  ulcerated  in 
several  places  and  deeply  pigrnenlcd.  Vesiculaj 
seminales  were  normal.  Kpididymis  of  right  tes- 
ticle was  tubercular.  'J  he  lungs  and  liver  contain- 
ed miliary  tubercles.  The  oldest  tubercular  de- 
posit was  found  in  some  of  the  bronchial  glands, 
which  contained  a  gritty,  mortar-like  material. 

Furelgn  Body  in  tlie  A^ose. — The  patient  was 
shown  by  Dr.  Lapthorn  Smith,  who  stated  that 
he  had  exhibited  a  somewhat  similar  case  seven 
or  eight  years  ago,  that  of  a  child  about  two  years 
old,  which  had  been  suffering  for  several  months 
previous  to  his  seeing  it  from  a  fcetid  discharge 
from  the  nostril,  which  had  been  treated  for  ca- 
tarrh. In  that  case  the  cause  of  the  discliarge 
was  found  to  be  a  piece  of  wood  niuch  larger  than 
could  be  forced  into  the  child's  nose,  but  which  the 
child  introduced  in  a  dry  and  much  smaller  state. 
The  present  case  was  that  of  a  girl  14  years  old, 
who  had  been  troubled  with  ozLena  ever  since  she 
was  3  years  of  age,  and  the  odor  from  which  had 
become  latterly  so  very  unpleasant,  that  her 
parents  were  forced  to  keep  her  in  a  separate 
room  from  those  occupied  by  the  rest  of  the 
family.  She  had  been  treated  for  catarrh  at  seve- 
ral public  institutions,  but,  probably  owing  to  the 
fearful  smell,  none  of  the  attendants  had  ever 
examined  her  nose  carefully.  Dr.  Smith  had 
himself  hurriedly  prescribed  for  her  general  health 
at  the  Montreal  Dispensary  some  years  ago,  with- 
out e.xamining  her,  as  she  was  supposed  to  be 
suffering  from  the  sequel*  of  smallpox.  But  a 
few  days  ago  she  was  brought  to  his  office,  when, 
on  examining  her  nose  with  a  speculum  and  probe, 
a  hard,  grey  and  glistening  object  was  seen  and  felt. 
It  was  readily  removed  with  a  suitable  pair  of  for- 
ceps, when  it  turned  out  to  be  a  shoe  button,  which 
she  must  have  introduced  ten  or  twelve  years  ago. 


and  which  he  showed  to  the  Society.  The  button 
was  incrusted  with  phosphates.  There  was  a  little 
bleeding  from  the  surface  of  the  cavity  which  it 
had  hollowed  out  for  itself  in  the  nostril.  Dr. 
Smith  said  that  his  object  in  showing  this  case 
was  to  emphasize  the  importance  of  making  a 
local  examination  in  every  case  of  this  kind,  as,  if 
this  had  been  done  in  the  first  instance,  years  of 
discomfort  would  have  been  saved  the  patient. 
Although  only  a  short  time  has  elapsed  since  the 
button  was  removed,  the  ozcena  has  completely 
disappeared,  and  the  ulcerated  surface  was 
almost  entirely  healed. 

S'l'cii  Cduseciitivi:  SucccsxJ'al  Op  iriotiimics. — 
Dr.  TuENHOLMb;  exhibited  cystic  ovaries  and 
enlarged  tubes,  removed  last  week  from  Miss  G.Cl., 
a  young  woman  aged  22,  which  makes  the  seventh 
iiljeiation  performed  since  he  was  last  at  a  meeting 
of  the  Society.  The  patient  was  of  slight  buikl, 
and  suffered  from  a  persistent  mtnorrhagia  since 
the  menses  began.  There  were  at  such  times 
severe  pelvic  pains,  and  she  was  unable  to  per- 
form her  daily  work,  by  which  she  had  to  obtain 
her  living.  On  examination,  finding  both  ovaries 
and  lubes  enlarged  while  the  uterus  was  normal, 
any  pos.sible  treatment  except  the  removal  of  the 
appendages  was  excluded.  The  specimens  now 
shown  are  much  shrunken.  The  ovaries  were  as 
large  as  small  hen's  egg,  and  so  densely  adherent 
that  they  ruptured  during  their  removal.  The  tubes 
were  as  large  as  a  small  finger,  filled  with  blood, 
and  so  densely  adherent  that  their  removal'  was 
difficult.  The  opening  into  the  abdominal  cavity 
was  about  21.4  inches  long,  and  closed  with  three 
silk  worm-gut  sutures  ;  horse  hair  was  used  for 
superficial  sutures.  A  few  layers  of  antise])tic 
gauze  held  in  place  by  two  straps  of  adhesive 
plaster  completed  the  abdominal  toilet, 

Cdse  2. — Miss  S.,  aged  28 ;  always  suffered 
during  menstrual  period.  Of  late  has  had  to  use 
morphia  to  relieve  the  increasing  distress.  All 
her  family  having  become  insane,  and  fearing  for 
her  own  sanity,  she  consulted  me.  On  examina- 
tion, found  enlargement  of  both  ovaries  and  a 
small  fibroid,  size  of  a  plum,  in  the  posterior 
wall,  at  the  fundus  of  the  uterus.  Removed 
appendages  in  my  usual  way.  Result,  perfect 
recovery. 

Case  3.— IVfrs.  W.,  aged  30,  always  suffered 
since  menses  began,  but  of  late  the  sufferings  are 
intolerable  without  ojiiates.  Has  been  under 
various  treatment,  but  without  relief.    Found  both 


THE   CANADA   MEDICAL   RECORD. 


201 


ovaries  cystic  and  riglit  tube  enlarged  about  one 
inch  in  diameter  by  2)4  long.  Recovery  from 
operation  anil  lier  former  sufferings  good,  bu' 
uKers  of  rectum  have  retarded  jterfect  restoration 
to  health. 

Case  4 — Mrs.  R.,  aged  32,  as  a  girl,  was  a 
terrible  sufferer  during  the  iIdw  of  the  menses  ; 
has  borne  three  children.  After  the  first,  a 
thrombus  formed  in  right  side  of  pelvis,  which 
was  opened  after  several  months  suffering;  sub- 
setiueiUly  bore  two  children,  although  the  sac 
refilled  and  escaped  several  times.  During  past 
.suuimer  she  caught  cold,  which  caused  intense 
suffering.  On  examination,  found  a  tumor  size  of 
fuital  head  on  right  side  of  uterus  and  above  the 
former  cyst,  though  close  to  it.  While  operating, 
the  vvall.s|of  the  cyst  were  so  friable,  that  it  was  with 
difliciiliy  that  the  thick  tarry  contents  were  pre- 
vented from  entering  the  cavity  of  the  abdomen. 
The  operation  was  followed  by  a  tedious  convales- 
cence, owing  to  the  refilling  ot  the  old  abscess, 
which  had  to  be  tapjjcd  several  time.  Eventually 
she  made  an  e.vcellent  recovery,  although  the  walls 
of  the  abscess  are  still  tender,  and  form  a  small 
tumor. 

f'i(.se  5. — Mrs.  D.,  22  years,  mother  of  two 
children.  History  very  like  that  of  case  4.  Suf- 
ferings are  so  severe  duiiiig  menstruation  that 
she  prefers  de.ilh  to  life.  On  examination,  found 
both  ovaries  enlarged,  also  left  tube.  Result  of 
operation,  perfect  recovery  and  the  acquirement  of 
sexual  pleasure,  a  thing  never  before  enjoyed. 

Cast;  6. — Mrs.  S. ;  ovarian  cyst,  18  lbs.;  recovery 
perfect. 

Giisc  7. — Mrs.  C;  enlargement  of  both  ovaries, 
left  one  behind  the  uterus.  Diagnosis  of  suppu- 
rating cysts  of  ovaries.  Operation  was  difficult 
on  account  of  adhesions,  which  were  very  dense 
and  universal.  Both  ovaries  were  about  the  size 
of  hen's  eggs  and  tilled  with  putrid  pus,  which 
escai)ed  into  the  jicritoneal  cavity.  The  rotten 
state  of  the  cyst  walls  caused  rupture  with  the 
sliglitest  touch.  A  curious  horn-shajjed  cyst 
sprang  from  the  fimbria  of  tlie  left  ovary,  back  of 
the  fundus  uteri,  and  curling  upward  and  forward 
over  the  uterus  was  attached  by  the  point  to  the 
walls  of  the  abdomen.  It  was  about  i  JX  inches 
at  base  and  6  inches  long,  filled  with  clear  fluid. 

Eli'ctricily    in    Gyncecologij, — Dr.     Lapthokn 

Smith  read  the  following  paper  on  this  subject : — 

As  all  diseases  of  womer>  may  be  attributed  to 

disorders  of  the  nerves  of  gensatiop,  pf  motion,  or 


of  nutrition,  three  forms  of  electricity  may  be  em- 
ployed as  remedial  agents;  and  although  the 
subject  of  electricity  in  gynajcology  is  too  big  a 
one  to  bring  within  the  sco|)e  of  a  smill  paper, 
still  I  think  I  might  briefiy  outline  the  various 
kinds  of  electricity  used  in  gynaecology  and  the 
various  diseases  in  which  they  are  rationally  indi- 
cated. 

Disorders  of  sensation  are  the  most  numerous 
and,  jjcrhaps,  the  most  important,  because  it  is 
pain  which  most  often  brings  a  woman  to  consult 
us.  In  what  exactly  pain  consists  nobody  knows, 
but  this  we  do  know,  that  when  it  depends  on 
disordered  innervation  alone,  we  possess  a  certain 
remedy  for  it  in  the  faradic  current  of  tension,  or 
from  the  lonj;,  fine  wire.  I  have  many  times 
proved  its  efficacy  in  cases  of  ovarian  neuralgia, 
and  in  seme  of  them  I  believe  that  the  necessity 
of  oophorectomy  has  been  done  away  with.  On 
this  point,  Apostoli  s.iys  :  "The  current  of 
tension  alone  is  very  well  borne  by  nearly  all 
uteri,  and  in  particular  by  those  of  hysterical 
patients;  alone  the  current  of  tension,  with  a  very 
great  tolerability,  and  a  much  greater  power  of 
radiation  than  that  of  quantity,  enjoys  the  remark- 
able quality  of  rapidly  calming  peri-uterine-  pain, 
and  that,  too,  all  the  better,  and  in  a  manner  all 
the  more  permanent,  when  it  is  employed  in  cases 
of  neuralgia  of  an  hysterical  nature." 

"  In  all  neuralgias  of  the  pelvis,"  he  says, 
'•whatever  may  be  their  origin,  nature  or  severity, 
the  element  of  pain  can  and  always  should  be 
treated,  most  often  successfully,  by  the  faradic 
current,  and  always  by  the  current  of  tension  alone. 
It  is  harmless  and  efficacious  only  on  condition 
that  we  conform  ourselves  to  the  following  rules: — 

1.  Never  to  make  the  patient  suffer,  and  never 
to  apply  a  stronger  intensity  than  she  can  bear. 

2.  Make  the  operations  last  long,  and  continue 
them  until  the  appearance  of  a  manifest  seda- 
tion. 

3.  Make  by  means  of  the  bipolar  excitor  an 
intrauterine  application  whenever  possible,  or  a 
vaginal  one  in  other  cases." 

By  these  simple  means,  therefore,  we  can  suc- 
cessfully treat  a  numerous  class  of  cases,  in  many 
of  whom  the  ovaries  would  have  hitherto  been 
removed,  and  that,  too,  without  curing  the  pain, 
which  was  the  very  oliject  of  removing  the  healthy 
ovaries. 

In  the  faradic  current  of  quanity— 'that  is,  from 
the  short,  thick  v/ire— >ye  po§?p§§  a  rational  treat- 


202 


THE   CANADA   MEDICAL   RECORD. 


ment  for  all  diseases  of  the  uterus,  owing  their 
origin,  directly  or  indirectly,  to  relaxation  or  loss 
of  tone  of  muscular  fibre.  This  category  includes 
all  forms  of  flexions  and  versions,  and  prolapsus, 
as  well  as  subinvolution  and  the  pathological  con- 
ditions resulting  from  it ;  for  all  displacements  of 
the  uterus  (as  may  be  seen  by  referring  to  this 
rough  chart)  are  due  to  the  organ  being  too  heavy 
for  its  supports,  or  the  supports  being  too  weak  to 
hold  up  the  normal  weight,  or  to  a  combination  of 
the  two  causes  in  some  cases.  As  far  as  flexions 
are  concerned,  it  requires  no  argument  to  show 
that  the  uterus  is  a  hollow  muscular  column,  liL-ld 
upright  on  itself  by  its  own  tonicity,  and  that 
whenever  the  walls  of  that  column  become  weak 
or  relaxed,  or  whenever  the  superincumbent 
weight  becomes  increased,  the  column  will  bend, 
either  forwards  or  backwards,  .according  to  certain 
principles.  Also,  it  will  be  admitted  by  every 
one  that  relaxation  of  the  muscular  walls  of  the 
bloodvessels  in  the  uterus  will  allow  an  increased 
quantity  of  blood  to  remain  in  it,  and  thereby 
increase  its  weight. 

But  it  is  when  we  come  to  talk  about  the  muscle 
in  the  uterine  supports  that  people  look  at  us 
blankly  as  though  they  had  never  heard  of  such  a 
thing.  This  unfortunate  ignorance  of  such  im- 
portant structures  is  probably  due  to  the  habit  we 
have  fallen  into  of  calling  these  supports  ligaments, 
which  conveys  the  idea  to  our  mind  of  fibrous 
tissue.  Others,  again,  have  been  brought  up  with 
the  idea  that  the  uterus  was  held  in  its  place  in 
the  pelvis  by  means  of  the  fold,  of  peritoneum, 
which  in  reality  only  cover  the  ligaments,  and 
which  are  quite  incapable  of  performing  the  fiuic- 
tions  which  we  know  the  ligaments  of  the  uterus 
do  perform-  To  those  who  do  not  see  any  mus- 
cular tissue  on  the  uterine  supports,  it  is  folly  to 
say  that  those  supports  can  be  strengthened  by 
means  of  the  faradic  current,  which  has  no  benefi- 
cial action  whatever  on  peritoneum  or  ligamentous 
tissue.  I  have  not  time  now  to  argue  this  matter 
out,  and  I  must  assume  for  the  moment  that  there 
is  muscular  tissue  in  these  so-called  uterine  liga- 
ments. Now,  I  have  only  to  remind  you  that 
every  time  a  muscle  contracts,  it  developes,  in 
consequence  of  its  improved  nutrition;  the  pro- 
ducts of  tissue  waste  being  removed  by  the  veins 
and  lymphatics,  and  room  being  left  for  a  fresh 
supply  of  arterial  blood.  With  the  interrujited 
current  we  can  produce  artificially  many  thousands 
of  contractions  at  each  seance,  and  in  the  course 


of  a  few  weeks,  treatment  we  may  even  bring  about 
hypertrophy  of  the  muscular  tissue,  in  the  peri- 
neum, vagina,  and  ligaments.  You  know  that 
the  strength  of  the  backsmith's  right  arm  is  jjr.j- 
\erbial  simply  because  he  makes  its  muscles 
contract  the  most ;  and  medical  men  engaged  in 
administering  faradism  through  their  own  bodies,  ^ 
ai  route  to  their  patients,  attest  the  fact  that  their 
arms  become  enormously  increased  in  size  thereby. 

It  is  also  generally  admitted  that  faradism  is  an 
excellent  remedy  for  chronic  constipation,  because 
it  causes  the  muscular  fibres  in  the  intestine  to 
contract  and  thereby  develop.  In  fact,  the  far.idic 
eiurent  of  quantity  dues  directly  and  at  the  veiy 
.-.[lot  just  what  ergot,  (Quinine  and  strychnine  do 
mdirectly,  after  being  absorbed  by  the  stomach 
.uid  carried  by  the  circulation  to  the  affected 
parts. 

\V'hile  writing  this  I  have  just  received  a  letter 
from  a  leading  practitioner  of  Toronto,  asking  me 
if  1  could  tell  him  what  was  m;ant  by  the  quality 
current,  a  term  employed  in  the  writings  of  Engel- 
man  of  St.  Louis.  'J'he  answer  is  that  it  is  used 
o  designate  the  current  of  tension,  as  opposed  to 
[he  current  of  quantity  ;  but  I  think  it  would  be 
better  to  give  the  two  latter  more  explicit  terms, 
as  both  the  current  of  tension  and  the  current  of 
quantity  are  currents  of  different  qualities.  This 
reminds  me  of  another  question  which  I  am  asked 
every  day,  viz.  :  Why  won't  the  ordinary  Mcin- 
tosh faradic  battery  do  for  gynaecological  work? 
.Simply  because  it  only  contains  one  kind  of 
induction  coil  ;  and  if  that  coil  is  long  and  fine,  it 
is  not  suitable  for  diseases  characterized  by 
relaxation  of  muscle.  If,  on  the  other  hand,  it  is 
coarse,  it  is  not  only  of  no  use,  but  positively 
hurtful  in  diseases  characterized  by  pain.  It  is 
only  on  condition  that  the  proper  kind  of  current 
be  given  in  the  proper  cases  that  we  can  hope  to 
have  satisfactory  results. 

You  will  naturally  ask  me  what  have  been 
the  results  of  the  two  faradic  currents  in  my  hands  ? 
In  suitable  cases  eminently  satisfactory  ;  in  unsuit- 
able ones,  disappointing.  For  instance,  in  cases 
of  procidentia,  due  to  increased  weight  of  the 
uterus,  the  increased  weight  being  due  to  areolaj- 
hy])erplasia,  the  use  of  the  faradic  current  alone 
«ill  be  disappointing,  because  it  has  not  the  power 
to  cause  absorption  of  fibrous  tissue.  It  will,  it 
is  true,  increase  the  strength  of  the  supporting 
uuiscles,  but  in  such  cases  something  more  is 
recpiired,  and  that  is  to  reduce  the  weight  of  the 


fate  CAKAftA  MEDtCAL  RECOttO. 


203 


hyportropliicd  organ.  Fortunately  we  possess  in 
the  Lontinuoiis  current,  especially  llie  negative, 
the  means  of  causing  the  reabsi)r[)ti()n  into  the  rircu- 
lalinn  of  the  plxstic  exudation.  It  is  a  question 
for  investigation  whether  the  pelvic  muscles  ever 
become  so  completely  airophieil  as  to  utterly  fail 
to  respond  to  the  faraJic  stimulus.  In  that  case, 
of  course,  it  would  he  useless  to  employ  it. 

A  brief  ouilinc  of  the  following  case  might  be  of 
interest: — Mrs.  R.,  aged  about  70,  came  to  my 
office  in  a  pitiable  condition.  Her  uterus  was 
hanging  outside  of  her  body,  and  the  cervix  was 
lacerated  and  covered  with  star-shaped  fissures  and 
ulcerations.  The  organ  was  enlarged  is  every 
diameter,  the  sound  entering  nearly  five  inches, 
and  it  had  a  hard  feeling  to  the  touch.  Her 
thighs  were  excoriated,  and  her  clothing  was  stain- 
led  with  blood  coming  from  the  raw  surface  of 
the  uterus,  which  stuck  to  them  whenever  she  sat 
down.  At  times  she  was  quite  unable  to  go  about. 
From  the  1st  to  the  i8th  of  September  I  gave  her 
six  applications  of  the  coarse  faradic  wire  in  the 
vagina,  with  the  only  result  that  she  felt  and  was 
observed  to  be  much  stronger,  and  she  was  able 
to  go  about  more.  From  the  i8lh  .September  to 
the  i6th  October  I  gave  her  an  intra-uterine 
application  of  the  coarse  wire  faradism,  with  the 
result  that  the  sound  enters  at  most  4''2  inches. 
As  the  uterus  still  came  out  of  the  body,  though 
not  so  much  as  before,  I  decided  to  try  the  conti- 
nuous current,  in  order  to  improve  the  nutrition  of 
the  organ  to  such  an  extent  as  to  make  it  return 
to  a  size  and  weight  more  nearly  approaching  the 
normal.  In  this  hope  I  was  not  disappointed,  for 
after  giving  her  bi-weekly  applications  of  the  nega- 
tive current  of  100  millianiperes  for  five  minutes 
each  time,  from  the  i6th  October  till  the  27th 
November,  I  was  enabled  to  make  the  following 
entries  in  my  note-book: — 

Nov.  6th. — Uterus  rarely  comes  out  now,  and 
when  it  does,  it  goes  back  of  its  own  accord  when 
she  sits  down.  9^/1 — Excoriation  on  thighs  all  gone. 
i3?/t — Uterus  only  been  down  once  since.  16^/1 
— Fissures  on  os  completely  healed.  20^/1 — Uterus 
remarkably  soft  to  the  touch.  23;-^ — .Sound 
enters  only  three  and  a  halt  inches. 

JJec.  \st. —  Discharged,  for  the  present,  as  the 
uterus  has  not  been  down  since  last  time  of  com- 
ing. 

I  did  not  see  her  again  till  April,  1SS8,  when  I 
was  called  to  attend  her  for  paralysis.  I  took 
advantage  of  my  visits  to  ascertain    the   condition 


of  the  womb.  I  found  it  still  soft,  small,  and 
well  up  in  the  pelvic,  and  she  stated  that  it  had 
never  given  her  any  trouble  since. 

This  is  only  one  of  many  similar  cases.  My 
general  experience  has  been  that  we  can 
surely  relieve  those  case  of  partial  prolapsus,  in 
which  the  patient  complains  of  a  dragging  feeling 
in  the  back,  and  which  I  believe  to  be  due  to  relax- 
ation of  the  muscular  tissues  of  the  pelvis.  Fara- 
dism alone  is  insufficient  in  those  cases  in  which 
there  is,  in  addition  to  relaxation  of  the  supports, 
an  increased  weight  of  the  organ  to  be  supported, 
in  which  case  the  trophic  action  of  the  continu- 
ous current,  preferably  negative,  will  be  necessary. 

The  continuous  current  will  form  the  subject  of 
another  paper,  but  in  the  .nieantinie  I  may  say  that 
the  field  for  its  use  is  daily  enlarging,  and,  among 
many  others,  its  employment  in  strictures  is  emin- 
ently satisfiictory. 


Stated  Meeting,  April  20<7^,1888. 
Dr.  Trenholme  in  the  Chair. 

Drs.  J.  A.  Hutchinson,  Brodeur  and   D,  McG. 
Decow  were  elected  members  of  the  Society. 

Mnliilocuhxr  Cyst. — Dr.  Trenholme  exhibited 
a  large  multilocular  ovarian  cyst,  which  he  had 
removed  from  a  woman  aged  40.  The  operation 
was  not  one  of  unusual  difficulty,  and  the  patient 
was  doing  well.  It  h;id  first  been  noticed  eight- 
een months  ago,  and  had  grown  very  rapidly. 

Pi/elo- Nephritis;  Infiltration  of  Urinf.  icith 
Sloughing  of  Lfrethm.—Hr.  Lafleur  exhibited 
specimens  for  Dr.  Shepherd  from  a  case  of  surgical 
kidney,  caused  by  enlarged  prostate.  Patient, 
aged  67,  complained  of  retention  of  urine,  which 
was  relieved  by  catheterization,  and  followed  by 
infiltration  of  urine  in  peiineum  and  scrotum,  with 
formation  of  abscess  between  neck  of  bladder  and 
rectum.  Scrotum  was  cedematous  and  gangre- 
nous. Through  incision  in  perineum  finger 
could  be  passed  into  a  cavity  about  the  size  of  a 
large  walnut,  between  neck  of  the  bladder  and 
rectum,  which  contained  some  necrosed  tissue. 
Catheter  passed  through  urethra  could  be  felt  at 
posterior  part  of  this  cavity  for  about  an  inch,  the 
urethra  having  completely  sloughed  away  in  this 
situation.  The  pelvis  and  ureter  of  the  right  kid- 
ney were  dilated,  and  contained  ammoniacal 
urine,  but  the  organ  appeared  otherwise  normal. 
The  left  kidney  was  enlarged,  and  its  capsule  was 
,  loosened  in  places.     The  pelvis   and  ureter  were 


204 


THE   CANADA   MEDICAL  ftECOfeD. 


moderately  dilated, thickened  and  deeply  pigmented 
indicating  chronic  inllaniniation,  and  contained 
very  foul,  thick,  greenish-grey  nnico-pus.  The 
apices  of  the  pyramids  projecting  into  calices  of 
pelvis  were  necrosed,  while  the  rest  of  the  paren- 
chyma was  intensely  inflamed,  the  ]5yramids  being 
dark  red  with  small  yellowish  areas,  indicating 
formation  of  abscesses ;  in  the  cortex  the  same 
change  was  taking  place,  but  not  to  such  a  marked 
degree.  The  walls  of  the  liladder  were  much 
thickened,  the  mucous  membrane  deeply  pigmen- 
ted and  roughened,  while  the  cavity,  which  was 
contracted,  contained  a  mixture  of  ammoniacal 
urine  and  dark  green  mnco-pus.  The  prostate  was 
enlarged,  and  friable  on  section.  The  inmicdiate 
cause  of  death  was  croupous  j)neunionia  affecting 
lower  and  middle  lobes  of  right  lung. 

Coucrctio  Pericardii. —  l)r.  Lafleuk  also  exhib- 
ited for  Dr.  Wilkins  a  heart,  showing  complete 
adhesion  of  parietal  and  visceral  layers  of  the 
pericardium,  from  a  patient  who  had  suffered 
from  severe  pttacks  of  acute  rheumatism. 

ASiippura/ive  Appendicitis  with  Pi/irmic  Ahsrexses 
of  the  Liver. — Dr.  Lafi.f.ur  exhibited  si)eoimens 
from  the  case,  and  reported  that  at  the  autopsy 
sinuses  were  found  over  the  lower  jjart  of  the 
abdomen,  which  converged  more  or  less  towards 
right  iliac  fossa.  Pelvic  cavity  contained  hve 
ounces  of  thin,  putrid  fluid,  with  a  few  flakes  of 
lymph,  but  the  peritoneum  was  everywhere 
smooth  and  glistening.  Appendix  deeply  |)ig- 
mented  and  glued  to  tissues  in  iliac  fossa  by  firm, 
inflammatory,  fibrous  tissue.  At  its  midlle  was 
a  perforation  a  quarter  of  an  inch  in  diameter. 
From  this  point  sinuses  diverged  in  three  differ- 
ent directions.  One  sinus,  which  appeared  to 
be  the  oldest,  on  account  of  the  thickness  of  its 
walls  and  their  intense  slaty  pigmentation,  lay 
beneath  the  sheath  of  the  psoas  muscle,  passing 
upwards  and  backwards  as  far  as  the  ligamentum 
arcuatnm  internum,  where  it  formed  a  cul-de-sac. 
A  second  sinus  was  traced  inwards  and  down- 
wards over  the  brim  of  the  pelvis,  into  the  loose 
cellular  tissue  around  the  bladder  and  rectum, 
opening  externally  in  the  jjerineum  half  way 
between  the  scrotum  and  the  anus.  The  third 
sinus  passed  in  a  curved  direction  outwards  to 
the  abdominal  wall,  where  it  divided  into  several 
branches,  running  in  the  main  parallel  to  Pou- 
part's  ligament,  upwards  towards  the  iliac  crest 
and  downwards  into  the  scrotum.  There  was 
no  abscess  cavity  in  connection  with  appendix  or 


csecum.  The  liver  was  enlarged,  and  on  the 
under  surface  of  the  right  lobe  was  a  fluctuating 
swelling  the  size  of  a  large  orange,  which  con- 
tained thick  foetid  pus,  and  was  traversed  by 
bands  of  necrosed  tissue.  Another  abscess  cavity 
existed  under  the  coronary  ligament,  and  a  third 
one,  an  inch  and  a  half  in  diameter,  was  found 
on  the  ujijjcr  surface  of  the  right  lobe,  which  was 
adherent  to  abdominal  wall  in  that  situation. 
The  liver  tissue  around  these  cavities  was  studded 
with  minute  foci  of  supjuiration,  showing  origin 
of  the  large  abscess  cavities  from  fusion  of  mul- 
tiple lobular  abscesses.  There  were  no  thrombi 
in  the  portal  vein  or  in  the  vena  cava  and  its 
main  branches.  The  infection  was  probably 
conveyed  to  the  liver  from  a  small  branch  of  the 
portal  vein  involved  in  inflammatory  change 
about  apjiendix  or  cfficum.  The  kidneys  were 
ana;mic,  and  showed  slight  fatty  changes  in 
tubules.  Pericardium  contained  five  oimces  of 
slightly  turbid,  yellow  serum,  with  a  small  amount 
of  adherent  lymph.  There  were  no  endocardial 
changes.  The  spleen  was  enlarged  and  soft. 
Brain  and  lungs  were  normal.  The  immediate 
cause  of  death  was  perforation  of  the  ajipendix. 

Dr.  Beli.  gave  the  following  history  of  the 
case  :  The  patient,  a  very  stout  man,  was  admit- 
ted into  the  General  Hosi)ital  in  July,  1887, 
suffering  from  symptoms  of  perityphlitis.  He 
was  dischargetl  ajjparently  cured  in  a  few  weeks, 
but  returned  in  December  with  various  sinuses 
over  the  lower  part  of  the  abdomen  and  scrotum  ; 
all  these  sinuses  led  into  the  right  iliac  fossa, 
which  contained  much  dense  inflammatory  tissue. 
These  sinuses  discharged  a  large  amount  of 
fuitid  pus.  Dr.  Bell,  under  whose  charge  the 
patient  was,  opened  up  and  scraped  the  sinuses 
and  evacuated  many  pockets  of  pus,  but  could 
not  find  the  course  of  the  pus  in  the  iliac  fossa. 
The  wounds  were  packed  with  iodoform  gauze, 
and  a  dressing  of  washed  gauze  applied.  The 
temperature,  which  had  ranged  from  100  °  to 
103°  F.,  became  normal,  and  the  patient  gradu- 
ally gained  strength.  Three  weeks  after  he 
suddenly  became  maniacal.  After  this  no  dress- 
ings could  be  kept  on,  and  the  patient's  condition 
gradually  grew  worse  ;  the  temperature  became 
high  and  irregular,  and  two  weeks  later  he  died 
suddenly,  apparently  from  collapse.  He  never 
recovered  his  sanity.  There  was  no  family 
history  of  insanity. 

Dr.  Shepherd  thought   that  the  direct  cause 


Tttft  (JANAM  MEDICAL  feECOftO. 


^05 


of  death  was  abscess  of  the  liver  and  pyocmia. 
'J'lic  mode  of  origin  of  the  sinuses  from  jjcrfora- 
lion  of  the  apjiendix  was  the  most  interesting 
feature  of  the  case.  Even  if  a  diagnosis  could 
have  been  made  early,  the  autopsy  showed  that 
treatment  by  abdominal  section  would  not  have 
lieen  more  effective.  At  the  operation,  owing  to 
llu-  r.ii  in  the  jliilominal  walls,  the  sinuses  could 
not  be  traced.  He  regarded  the  iodoform  poi- 
soning as  one  of  the  incidents  of  the  case,  but 
not  as  the  cause  of  death. 

In  answer  to  Dr.  Roddick,  Dr.  Bell  said  that 
the  temperature  was  decidedly  septic  at  first,  but 
after  evacuation  of  the  sinuses  it  fell  to  normal, 
and  remained  so  for  weeks.  At  the  time  of  the 
operation,  he  was  convinced  that  all  the  pus  had 
not  been  evacuated. 

fifomc  Rare  Farms  of  Extnirnmition  nf  Urine.. — 
Dr.  Bell  read  a  paper  on  this  subject,  which 
ap|)eared  in  the  May  number  of  the  Camido 
Medical  iiud  Siiryiedl  Jouriuil. 

Biscnssion. — Dr.  Fenwick.  was  with  Dr.  Bell  :it 
the  operation  for  ovariotomy  mentioned  in  the 
paper,  and  was  greatly  surprised  to  find  (he 
bladder  so  high  up.  Sometimes  this  accidental 
wounding  of  the  bladder  was  unavoidable.  He 
had  himself  once  wounded  a  prolapsed  bladder 
in  a  operation  for  hernia,  but  the  patient  ultim- 
ately made  a  good  recovery.  He  had  seen 
several  cases  of  mania  produced  from  the  use  of 
iodoform  ;  the  most  recent  case  was  that  of  a 
stout  old  gentleman,  on  whom  he  had  operated 
for  lateral  lithotomy.  Iodoform  dressings  were 
used,  and  the  patient  several  days  after  became 
affected  with  mania,  which  lasted  two  weeks  ;  he, 
however,  recovered  perfectly. 

Dr.  Shepherd  said  that  the  case  of  urinary 
infiltration,  following  wound  of  the  bladder  during 
the  performance  of  an  ovariotomy,  was  a  very 
interesting  one,  owing  to  the  probability  of  death 
having  resulted  from  iodoform  poisoning.  He 
had  several  cases  of  mania  following  operations, 
in  all  of  which  iodoform  had  been  used,  though 
only  in  small  quantities,  and  he  was  in  doubt 
whether  to  attribute  the  mania  to  iodoform,  the 
anaesthetic,  or  to  traumatism.  In  all  cases  there 
was  an  hereditary  taint.  Only  one  died, —  a 
case  of  sequestrotomy  of  the  femur  in  a  man 
aged  25.  Acute  mania  came  on  in  five  days  after 
the  operation  ;  only  about  one  drachm  of  iodo- 
form had  been  used.  In  another  case,  a  peri- 
caecal  abscess  in  a   man  aged   40,  acute   mania 


came  on  the  second  day  and  lasted  one  month. 
The  patient  ultimately  recovered.  A  small 
amount  of  iodoform  was  used,  and  only  at  the 
oi>eration.  Several  of  the  patient's  immediate 
relatives  had  died  insane,  and  the  i)atient  him- 
self was  subject  to  fits  of  ungovernable  temper. 
The  third  was  a  case  of  amputation  of  the 
breast  in  a  woman  aged  60.  .\  milii  form  of 
insanity  followed  from  the  ana:sthelic,  and  the 
Woman  never  comiiletely  recovered  up  to  the 
lime  of  her  death,  a  couple  of  years  after,  from 
cerebral  hemorrhage. 

Dr.  Roddick,  was  very  much  interested  in  the 
cases  of  iodoform  poisoning.     He  believed  it  is 
frequently  due   to    idiosyncrasy.     He   had   seen 
one    case  follow    excision    of  the  breast   where 
iodoform  had  been   used.     There  was  a  history 
of  insanity  in  the  family.     The  mania  lasted  ten 
days.     He  thought  iodoform    should    be    used 
with  more  care.     Large  quantities  are  unneces- 
sary ;  he  had  found  it  to  produce  severe  eczema- 
tons  irritation  of  the  skin.     He   now  uses    car- 
bonate of  bismuth  in  preference  to  iodoform,  as 
ii    is  less  irritating.     He    also    sometimes    uses 
boric  acid  and  naphthalin.     Lately  he  had   been 
using  hydronaphthol  with  benefit.    It  is  odorless 
and  non-irritating.     Referring    to    the    case    of 
infiltration  of  urine,  he   thought  the  explanation 
of  the  case  by  sujjposing  iierforation  of  the  pros- 
tate and    posterior  layer  of  the  triangular    liga- 
ment was  not  necessary,  as  it  is  well  known  that 
when  the    membranous  portion  of  the  urethra 
is  perforated  the  urine  escapes  behind  the    an- 
terior layer  of  the  triangular  ligament — the  ten- 
dency   of   the    fluid   is    to  infiltrate    backwards 
towards  the  rectum  and  not  to  come  forward.    If 
the    posterior  ligament  be  perforated,  then   the 
urine  extends  behind  the  pelvic  fascia  into  the 
pelvis,  and  is  generally  fatal. 

Dr.  Stewart  had  seen  Dr.  Bell's  first  case, 
and  regarded  it  as  a  case  of  iodoform  poison- 
ing. It  is  well  known  that  in  cases  of  mania 
from  any  cause,  the  mania  remains  long  after 
the  removal  of  the  cause.  Cases  in  which  there 
is  much  adipose  tissue  are  more  liable  to  poison- 
ing, because  the  fat  decomposes  the  iodoform  in 
contact  with  it. 

Dr.  Armstrong  asked  if  it  was  necessary  to 
use  iodoform  at  all.  Recent  experiments  have 
demonstrated  that  it  is  devoid  of  germicidal 
jjroperties.  He  thought  its  use  was  unnecessary 
in  the  treatment  of  sinuses. 


m 


*tiE  CANADA  Medical  RseoRO. 


Dr.  Trenholme,  referring  to  the  case  men- 
tioned by  Dr.  Bell  when  the  bladder  was 
wounded,  said  he  thought  the  bladder  should 
never  be  emptied  before  an  operation,  as  it  is 
much  more  easily  avoided  when  containing  fluid. 
If  it  be  accidentally  wounded,  then  sutures  of 
shoemaker's  thread  or  silk  should  be  used,  not 
catgut,  which  is  very  unreliable. 


3^m6l€iS  of  Science. 


IPECACUANHA     SPRAY     IN    CHRONIC 
BRONCHITIS. 

WlLLLI.\M  MURREL,  M.    D. 

The  ipecacuanha  spray  was  originally  introduc- 
ed as  a  remedy  for  chronic  bronchitis  and  other 
diseases  of  the  throat  and  respiratory  organs,  in 
consequence  of  the  reputed  success  attending 
the  use  of  a  nostrum,  both  in  London  and  Paris, 
by  an  irregular  |)ractitioner.  It  was  difficult  to 
obtain  any  clue  to  the  composition  of  the  secret 
remedy,  as  apparently  the  propietor  varied  the 
constituents  from  time  to  time,  in  order  to  puzzle 
the  analysts  and  escape  detection.  A  number 
of  preliminary  trials  were  made,  which  speedily 
demonstrated  that  even  if  the  specific  were  not 
ipecacuanha  wine,  that  very  useful  drug  entered 
largely  into  its  composition,  and  that  locally 
a|)plied  in  the  form  of  a  spray  it  was  capable  of 
affording  relief  to  congested  and  irritated  bron- 
chial mucous  membranes.  Sometirnes  the  ipeca^ 
cuanha  wine,  pure,  or  diluted  with  an  equal 
quantity  of  water,  used  with  a  small  steam 
vaporizer,  but  more  commonly  the  ordinary 
hand-ball  spray  apparatus,  such  as  is  employed 
for  the  production  of  local  ansesthesia,  was  pre- 
ferred. A  sf)lution  in  sprit  made  of  the  samii 
strength  as  the  wine  was  found  equally  effica- 
cious. After  a  few  visits  the  [jatient  was  usually 
taught  how  to  use  the  apparatus  himself.  The 
following  may  be  regarded  as  t)'pical  of  a  ninn- 
ber  of  cases  which  have  been  under  treatment  at 
the  Westminster  Hospital  during  the  last  six 
months.  David  J.,  set.  53,  a  cigar  maker  by 
trade,  has  had  a  cough  in  the  winter  for  12  years 
or  more.  There  is  not  much  dust  in  his  work, 
and  he  is  not  exposed  to  wet  or  cold,  but  he 
has  travelled  a  good  deal,  and  has  known 
what  it  is  to  rough  it.  The  cough  is  trouble- 
some, but  it  is  not  paroxysmal.  There  are  no 
bad  attacks  of  cough,  but  there  is  a  good  deal 
of  hacking,  and  this  keeps  him  awake  at  night. 
There  is  very  little  expectoration,  certainly  not 
eough  to  give  him  any  trouble.  He  has  had  no 
haemoptysis,  and  has  not  lost  flesh.  On  examining 
the  chest,  the  percussion  note  is  found  to  be 
normal.  Small  rales  are  detected  at  the  left  apex  in 
front,  and  at  the  right    base  posteriorly.     The    1 


patient  was  given  15  cc.  of  ipecacuanha  wine, 
with  an  equal  quantity  of  water,  by  a  steam 
spray  apparatus,  and  this  was  repeated  on  three 
successive  days,  the  dose  being  gradually  increas- 
ed to  30  cc.  On  the  fourth  day  the  hand-ball 
spray  was  used,  and  at  the  expiration  of  the 
week  the  patient  reported  that  his  cough  had 
entirely  left  him,  and  that  he  was  practically  well. 
On  examining  the  chest  it  was  found  that 
the  rhonchus  had  disappeared.  [Five  other 
cases  are  given  in  detail,  and  the  writer  conclu- 
des]; Most  successful  results  are  obtained  from 
the  employment  of  the  ipecacuanha  spray  in 
cases  of  chronic  bronchitis  and  bronchial  catarrh. 
In  fibroid  phthisis  there  is  often  a  marked  im- 
provement, even  when  no  constitutional  treatment 
is  adopted.  A  single  inhalation  will  sometimes 
restore  the  voice  in  case  of  hoarseness  due  to 
congestion  of  the  vocal  cords.  The  spray  must 
be  warm,  and  the  patient  should  not  go  out  for 
some  minutes  after  inhaling.  Care  should  be 
taken  to  see  that  the  spray  really  enters  the 
chest,  and  is  not  stopped  by  the  arching  of  the 
tongue  against  the  wall  of  the  mouth.  The  best 
results  are  obtained  by  using  the  spray  for 
about  ten  minutes  three  or  four  times  a  day.  In 
the  majority  of  cases  of  winter  cough  relief  will 
be  obtained  in  ten  days. — Med.  Press,  Lond., 
April  25. 


TREATMENT  OF  CHRONIC  BRONCHITIS 
IN  CHILDREN. 

By  Thomas  J.  Mays,  M.D.,  Professor  of  Diseases  of  the 
Cliest  in  the  Philadelpliia  Polyclinic. 

Meil.  News : — Quite  an  extended  experience  in 
the  treatment  of  these  cases  teaches  us  that 
persistent  counter-irritation  is  of  tl.e  first  conside- 
ration. If  there  is  much  impediment  to  the 
ingress  and  egress  of  air,  or,  in  other  words,  if 
there  is  much  dyspnoea,  the  child  is  at  once 
placed  in  bed,  the  chest  is  enveloped  with  a  hot 
flax-seed  meal  poultice  (covered  well  with  oiled 
muslin),  which  must  be  changed  every  three 
hours.  In  most  cases,  however,  it  is  not  necessary 
to  order  the  child  to  bed,  and  counter-irritation  is 
produced  by  a  mild  croton  oil  liniment.  Crotonoil 
and  sweet  oil,  well  mixed  in  proportion  of  one  to 
two  parts  of  the  former  to  six  of  the  latter,  is  will 
rubbed  into  the  skin  of  the  child's  chest — in  front, 
under  the  arms,  and  between  the  shoulder  blades 
not  with  a  flannel  or  cloth,  but  with  the  mother's 
oi-  nurse's  fingers,  twice  a  day,  and  then  the  chest 
is  Well  covered  with  a  layer  of  cotton  wool.  It  is 
important  that  as  much  as  ten  or  fifteen  minutes 
be  spent  in  rubbing  the  liniment  well  into  the 
skin,  after  which  the  hands  must  be  thoroughly 
washed.  In  the  course  of  four  or  five  hours  a 
red  blush  of  the  skin  will  appear,  ending  in  fine, 
yellow-pointed  pustules.  Simultaneous  with  this 
erujition  the  cough  becomes  easier,  the  expectora- 
tion more  free',  thedyspncea  less — in  fact,  the  most 
remarkable  change  will  be  brought  about  in  the 
little  patient. 


THE   CANADA    MKDICAL    UKCORD. 


207 


Our  attention  was  first  called  to  the  usefulness 
oftiiis  applicaiiiin  liyDr.  Park,  in  a  short  coniri- 
Inuion  to  the  Lomion  I'mc'lliniicr  for  March, 
1882  (|).  170),  and  although  he  principally  rec.oni- 
nicnds  it  in  acuie  bronchiiis,  we  can  say  that  wc 
iiave  found  il  as  useful  in  llie  form  of  hroncliilis 
here  described  as  he  did  in  the  ac.ite  form  of  the 
disease.  Indeed,  we  may  atld  that  we  have  also 
given  it  a  fair  trial  in  acute  catarrhal  affections  of 
the  chest  in  ihildren,  and  never  had  any  reason  to 
feel  disappointed  with  its  action. 

The  interval  treatment  must  be  directed  lovvard 
a  stimulation  of  the  bionchial  mucous  membrane, 
and  toward  a  recovery  of  the  appetite.  The  former 
will  be  attained  ill  a  great  measure  by  the  following 
combination  : 

)J.     .Vimnuiiia   muiiat 3j 

Ex.   euplioibi.i  [)il.  lid 

'J'lnc.   digitalis,  aa f-  iij 

Atropia;  sul|jh gr.  i^V 

Chlorofornii gtt.  .\ij 

Syr.  tolu,  

Syr.  picis  liquid.,  aa  q.s.f  "j 

Aquse,         ad q.s.  friv         M. 

SiG. — One  teaspoonful  every  three  hours. 

For  the  puri)ose  of  aiding  digestion,  and  as 
a  general  tonic,  the  followinu  will  be  found  use- 
fut: 

B.     Acid,  phosphorici  dil.. 
Acid,  nitro-muriatic.  dil., 
Acid.  sul|)huric.  aromat., 
Tinct.  ferri  chloridi,     aa     f3ss     M. 
SiG. — Thirty   drops    in    sweetened  water   after 
each  meal,  three  times  a  day. 

The  aiet  should  be  exceedingly  liberal,  although 
no  food  must  be  allowed  which  is  likely  to  disagree. 
Our  main  reliance  must  be  placed  on  rich  milk, 
soup,  oatmeal,  beef,  mutton  and  other  kinds  of 
nutritious  food.  At  no  time  during  the  treatment 
is  it  necessary  to  confine  the  child  within  doors 
during  pleasant  weather.  Indeed,  out-door  exer- 
cises should  be  encouraged  as  much  as  possible. 
— Epitome  of  Pnictic'tl-  Mtdicine  and  Snigeri/. 

CHLORIDE    OF    SODIUM  IN   THE  SICK- 
NESS OF   J'REGNANCY. 

Dr.  Greene  states  that  he  has  recently  had  two 
very  severe  cases  of  sickness  during  pregnancy, 
The  first  patient  had  been  under  several  physi- 
cians, who  had  tried  all  kinds  of  remedies,  but 
nothing  stopped  the  sickness.  When  seen  by  the 
author  she  was  in  the  seventh  month  of  pregnancy, 
and  very  much  reduced.  Before  resorting  to 
the  induction  of  premature  labor,  it  was  decided 
to  try  the  effect  of  small  doses  of  chloride  of 
sodium  (common  salt)  in  chloroform-water.  It 
was  given  in  5-grain  doses  in  one  ounce  of 
chloroform-water.  After  the  first  dose  the  sick- 
ness was  lessened,  and  by  the  time  six  doses  had 
been  taken  it  had  entirelv   ceased,     It  was  found 


necessary  to  continue  the  medicine  three  times 
a  day  up  to  the  time  of  delivery.  The  i)atient  had 
a  good  labor,  and  made  a  good  recovery.  In 
another  case  a  similar  treatment  was  followed  by 
the  same  result.  The  action  of  this  drug  seems  to 
be  accountetl  for  by  its  strong  antacid;  yet  soda, 
potash,  and  ammonia  gave  no  beneficial  results. 
The  author  suggests  to  call  the  remedy  in  prescrib- 
ing by  its  chemical  name,  as  some  jiatients  might 
despise  it  when  called  common  salt. — M<:di<:al 
Press. 


MECHANIC.M.  TRK A  IMKNTOF  W  HOOP- 
ING-COUGH. 

Goldsmith  gives  a  practical  method  by  which 
he  has  had  unexpected  success.  He  treats  this 
disease  mechanically.  Believing  that  the  nose  and 
the  naso-ijharynx  constitute  the  seat  of  the  conta- 
gion, he  injects  a  solution  of  salicylic  acid  (i  to 
1000),  or  corrosive  sublimate  (:  to  10,000),  into 
the  nose,  making  the  injection  every  two  hours, 
and  effected  in  this  way  a  complete  disinfection  of 
the  nose  and  naso-jjliarynx.  He  only  uses  the 
injection  in  the  daytmie  (six  times),  the  next  day 
only  four  times,  and  in  most  cases  the  whooping- 
cough  disappears  by  this  treatment.  Should  another 
attack  appear  in  a  few  days,  it  would  only  be 
necessary  to  make  a  few  more  injections.  Gold- 
smith declares  that  whooping  cough  in  the  first 
stage  will  certainly  disappear  in  the  short  time  state 
under  the  above  mentioned  treatment. — Ntw-York 
AJcdiail   Tillies^  April,  1888. 


TO      DISGUISE    THE    ODOR    OF     IODO- 
FORM. 

Dr.  Andrew  Fraydon  communicates  the  fol- 
lowing item  to  the  Mcdlad  Xvws  of  recent 
date  :  — 

After  a  large  experience   in  the  use  of  iodoform 
in  Jefferson    College  Hospital  and   elsewhere,    I 
have  found  the  following  formula  to  be  very  satis- 
factory and  to  mask  the  odor  thoroughly  : — 
5   Balsam,  canadensis. 

Iodoform,  aa  3  j 

Vaseline,  3  vj. 

M. — Solve. 


SUCCESSFUL  EXt^ISION  OF  A  TUMOR  OF 
THE  SPINAL  CORD. 
Surgery  is  a  science,  or  perhaps  we  should 
say  a  fine  art,  which  will  tolerate  no  limits  to 
its  domain.  It  has  of  late  taken  up  the  invasion 
of  the  brain  in  earnest;  it  has  just  made  its  first 
successful  dash  at  a  tumor  in  the  spinal  cord. 
Last  Tuesday  evening,  before  the  meeting  of  the 
Medical  and  Chirurgical  .Society,  a  ]irivate  patient 
of  Dr.  Gowers  and  Mr.  Victor  Horsley  very  gene- 
rously allowed  the  Fellows  and  visitors  of  that 
Society  the  opportunity  of  seeing  all  that  had  been 


208 


THE   CANADA   MEDICAL   RECORD. 


done  for  the  improvement  of  liis  condition.  He 
had  spent  about  three  years  in  severe  pain,  which 
was  most  intense  just  below  and  inside  the  angle 
of  the  left  scapula,  and  was  accompanied  by 
absolute  loss  of  motion  and  sensation  of  the  body 
and  limbs  below  that  level.  The  upper  border 
of  the  anaesthesia  was  distinctly  in  the  region  of 
the  fifth  intercostal  nerve  on  the  left  side,  on  the 
right  it  was  less  acctirately  defined,  but  did  not 
extend  liigher.  All  the  symptoms  agreed  with 
those  of  tumors  of  the  spinal  cord,  and  the  intense 
pain  afforded  ample  justification  for  making  an 
attempt  to  excise  the  tumor.  Mr.  Victor  Horsley 
accordingly  removed  the  spines  and  parts  of  the 
lamina  of  the  fifth  and  fourth  dorsal  vertebrae  ; 
but  not  until  the  third  vertebra  had  been  similarly 
treated  did  the  tumor  come  into  sight.  It  was  a  small 
oval  myxoma  compressing  and  making  a  deep 
impression  on  the  leftside  of  the  spinal  cord  below 
the  third  vertebra.  It  was  easily  shelled  out,  and 
under  careful  antiseptic  treatment  the  temperature 
did  not  rise  more  than  i  °  F.  The  wound 
healed  rapidly,  except  at  the  uppermost  point, 
where  a  drain  had  been  left  in  by  which  a  little 
c^rebro  spinal  fluid  flowed  away  very  slowly.  For 
t  iree  or  four  weeks  the  former  acute  pain  did  not 
lessen,  and  even  at  times  seemed  more  agonizing  ; 
but  after  that  it  gradually  and  intermittently 
decreased,  and  now,  after  seven  months,  is  enti- 
rely gone ;  the  sensation  and  motion  of  the  body 
aud  legs  are  almost  completely  restored.  This  is, 
we  believe,  the  first  times  that  such  an  operation 
had  been  attempted,  and  we  must  most  heartily 
congratulate  b(3tli  the  patient  and  his  advisers  on 
the  triumphant  character  of  its  success.  How- 
ever lar  and  hou-ever  quickly  surgery  may  advance, 
it  will  long  be  amem>rab!e  day  when  it  gained  its 
first  victory  on  so  new  a  field  and  over  so  formid- 
able an  enemy. — British  MidiadJounial,  Jan.  28, 


PERM.\NG.\NATE  OF    POTASH  IN  DIPH- 
■J'HERIA. 

In  a  communication  in  the  BrooMijn  Medical 
Journal,  May,  1888,  Dr.  L.  D.  Mason  says 
that  a  solution  of  permanganate  of  potash,  used 
in  the  form  of  a  spray  though  the  atomiser,  has 
gives  him  more  satisfaction  and  better  results 
than  any  other  drug  so  used.  A  stock  solution  is 
prepared  of  potassium  permanganate,  3  ij  to 
distilled  water  f  ?  iij,  or  grs.  v  to  f  3  j  ;  one  fluid 
drachm  of  the  solution  is  added  to  about  f  3  jss  or 
f  ^  ij  of  water,  the  average  capacity  oft  le  atomizer 
bottle.  It  is  then  ready  for  use  as  a  spray,  in  the 
manner  already  indicated.  The  first  notable 
effect  is  the  almost  immediate  arrest  of  the  fetor 
exhaled  by  the  patient  ;  and  when  once  this  is 
corrected  and  the  disinfection  properly  kept  up, 
it  will  not  recur  during  the  treatment.  Br  this 
means,  he  says,  we  rapidly  simplify  and  reduce  to 
an  innocuous  product  the  dijjhtheritic  exudate  ; 
the  self-poisoning    that  has  been    in  progress    is 


arrested  or  modified.  The  danger  of  the  [latient 
to  himself,  if  we  can  so  express  it,  and  to  others 
also,  is  averted,  a  downward  tendency  is  arrested, 
and  the  chances  of  recovery  greatly  enhanced. 

An  occasional  mouth-wash  or  gargle  can,  he 
says,  be  used  between  the  spraying,  if  not  contra- 
indicated.  If  used,  it  should  be  prepared  with 
hot  water,  a  weaker  solution  of  potassium  per- 
manganate will  answer.  Fluid  nourishment,  taken 
hot  if  possible,  will  have  a  good  local  effect.  All 
cloths,  etc.,  on  which  secretions  are  caught,  should 
be  frequently  burned,  their  places  being  supplied 
by  fresh  clean  pieces.  Old  and  small  pieces  of 
linen  are  preferable  to  larger  cloths  or  handker- 
chiefs. The  hands  and  face  of  the  patient  should 
be  kept  clean,  using  bay  rum  or  alcohol  and 
water.  In  a  word,  he  advises  that  a  ])erfect  anti- 
septic condition  of  the  patient  and  his  surround- 
ings should  be  secured  and  maintained.  His 
experience  with  potassium  permanganate  was,  he 
says,  first  a  surgical  one,  as  a  deodorizer  and  mild 
stimulant  in  the  cleansing  of  foul  ulcers  and 
sloughing  tissues ;  secondly,  in  puerperal  septi- 
c>i;mia,  as  an  intra-uterine  douche  ;  in  scarlatina 
anginosa,  with  putrid  sore  throat,  and  the  so-call- 
ed "snotty  nose"  complication  and  secondary 
glandular  infiltration;  and,  finally,  in  diphtheria; 
and  in  none  of  these  conditions  has  it  disappointed 
him  as  to  its  antibroraic,and  antiseptic  properties. 
Used  in  the  form  of  a  spray  he  regards  it  as  per- 
fectly safe  :  "  We  can  use  it  freely.  We  will  not 
poison  our  patient.  We  cannot  so  confidently 
speak  of  the  possible  effects  of  other  drugs  used 
for  purposes  of  disinfection;  indeed  poisonous, if 
not  fatal,  effects  have  been  traced  to  some  that 
have  been  so  used."  He  advises  that  the  use  of 
the  spray  should  be  continued  until  the  la^t  vestige 
of  the  diphtheritic  exudate  has  disappeared.  The 
frequency  of  its  use  will  depend  on  the  amount  of 
exudation  present,  and  the  stage  of  the  disease. 
.\s  a  rule,  the  absolute  control  of  the  fetor  is  the 
best  guide. 


THE    EFFICACY    OF  LARGE    DOSES    OF 
ARSENIC  IN    CHOREA. 

The  curative  property  of  arsenic  in  certain 
forms  of  chorea  is  well  attested  by  numerous 
unimpeachable  observations.  It  is  equally  cer- 
tain, liowever,  that  arsenic  does  not  always  cure. 
Dr.  James  Sawyer  in  an  article,  published  in  The 
Birminijham  Medical  Review,  maintains  that  when 
arsenic  tails  to  manifest  its  ordinary  therapeutic 
efficacy,  it  is  because  the  drug  is  not  administered 
in  the  right  way.  Properly  exhibited,  he  regards 
its  action  as  little  less  than  specific.  According 
to  him,  in  order  to  get  the  best  effects  of  arsenic 
in  chorea,  the  remedy  must  be  employed  in  large 
and  increasing  doses.  The  medicine  may  be 
safely  "  pushed,  "  until  irritative  vomitingis  excited 
As  with  other  drugs,  some  manifestation  of  physio- 
logical action  coincides  with  the  direct  therapeu- 
tical) pfTect  of  the  remedy.     It   may  be  remarked 


THE  CANADA  MEDICAT.RECORt). 


209 


in  this  connection,  however,  that  irritative  vomit- 
ine;  belongs  ratlier  so  the  pathological  than  to  the 
physiological  effects  of  arsenic,  a  fact  which  Dr. 
Sawyer's  enthusiasm  for  this  remeily  may  have 
caused  hnii  to  overlook. 

The  author  describes  a  typical  illustrative  case 
as  follows  :"  A  little  girl,  ten  years  old,  weakly 
and  neucotic,  has  subacute,  general  chorea.  1  i;ive 
her  five  minims  of  l'"owler's  solution  of  arsenious 
acid,  in  an  ounce  of  water,  thrice  daily.  In  three 
days,  the  dose  increased  to  ten  minims;  in 
lliree  days  more,  to  fifteen,  in  Uiree  days 
more,  to  twenty,  and  .so  on,  until  she  is  taking 
thirty-live  minims  of  the  solution,  or  a  little 
more  than  a  fourth  of  a  grain  of  arsenious  acid, 
thrice  daily.  l<rom  the  commencement  of  the 
treatment,  the  choreic  movements  gradually  sub- 
siile  in  severity,  in  frequency  and  in  e.Ktent  of  dis- 
tiibution,  and  when  the  large  dose  of  more  than 
half  a  drachm  of  Fowler's  solution  is  attained,  the 
movements  entirely  cease,  and  a  little  vomiting 
and  stomach-ache  warn  us  that  we  have  reached 
the  earlier  phjsiological  manifestations  of  our 
remedy.  We  tlien  withdraw  the  ilrug  altogether 
for  two  d.iys.  Afterward,  for  a  few  days,  we  give 
a  rediux'd  dose,  ten  or  hfleen  minims  of  the  solu- 
tion ;  tlien  the  remedy  is  linally  discontinued. 
The  child  remains  well.  After  a  fortnight's 
further  observation,  she  is  dismissed  from  our  care, 
cured." 

Perhaps  the  author  claims  too  much  for  his 
favorite  remedy.  But  it  may  be  well,  in  smtable 
cases,  where  moderate  doses  ofarsenic  have  failed, 
to  test  the  thera|)eutic  efficacy  of  the  drug  in  the 
larger  doses  employed  by  Sawyer. — Medical  /i,:cord, 
April  i.[,  i88S. 


TRE.VTMENT    OF  RECTAL    PAIN    WITH 
CONIUM. 

Dr.  \V.  Whiila,  Ph)sician  to  the  Royal  Hos- 
pital, and  Consulting  Physician  to  the  Ulster 
Hospital,  Belfast,  in  a  communication  to  the 
Fnictitioner,  April,  i8S8,  says  :  The  object  of  this 
brief  paper  is  to  bring  under  notice  the  value  of 
hemlock  as  a  local  anaesthetic  in  painful  affections 
of  the  rectum  and  anus.  In  pruritus  ani,  especially 
when  associated  with  or  caused  by  hemorrhoids, 
or  fissures  about  the  anus  or  in  the  lower  part  of 
the  rectum,  the  physician  or  surgeon  often  finds 
much  difficulty  in  giving  relief.  The  pain  and 
annoyance  caused  by  a  minute  fissure  is  very 
often  uninfluenced  by  cocaine,  even  when  used  as 
a  strong  solution,  and  if  relief  should  follow  it  is 
seldom  complete,  and  is  always  of  such  very  short 
duration  that  the  patient  will  generally  discontinue 
its  use,  preterring  the  misery  of  his  ailment  to  the 
exacerbation  of  suffering  caused  by  the  applica- 
tion of  the  remedy.  Morphine,  carbolic  acid, 
creasote,  belladonna,  and  the  usual  array  of  local 
sedatives,  have  been  found  in  the  hands  of  most 
observers  to  give  very  uncertain  results  in  painful 
conditions  of  this  region  of  the  body.     It  will  be 


perhaps  the  experience  of  most  that  they  have 
more  frequently  aggravated  than  relieved.  Their 
application  I  have  noticed,  when  used  to  allay  the 
pain  of  an  inflamed  pile,  has  sometimes  added  a 
more  distressing  symptom,  namely,  itching. 

It  is  a  long  time  since  conium  has  been  recom- 
mended and  used  as  a  local  anx'sthetic  ;  I  had 
tried  it  when  other  reme  lies  had  failed,  and  with 
only  such  success  as  did  not  tempt  me  to  perse- 
vere, in  some  cases  the  patients  asserting  that  their 
sympt(jms  were  aggravated.  About  a  year  ago  I 
noticed  somewhere  in  our  current  medical  litera- 
ture very  satisfactory  reports  of  this  drug  from  an 
American  .source,  but  I  regret  that- 1  connot  recall 
the  name  of  the  physician  or  the  journal.  Hav- 
ing studied  the  action  of  conium  some  years  ago 
on  the  endings  of  the  sensory  nerves,  by  applying 
a  strong  ointment  made  with  the  extract  to  ulcer- 
ated surfaces,  and  painful  e.xcoriations  and  superfi- 
cial neuralgias,  1  was  led  to  believe  that  it  had 
little  or  no  influence  upon  the  sensory  terminals. 
Discovering,  however,  that  the  extract  of  the  British 
Fh'crmacojKtia  is  a  most  unreliable,  and  generally 
almose  inert  ]jreparation,  I  determined  to  try  the 
effects  of  the  Si(fC'in.  Acciu'dingly  1  have  had  an 
ointment  prepared  in  the  following  manner : — Two 
ounces  of  the  ph-irmacojiceial  juice  are  placed  in  a 
small  evaporating  dish,  and  permitted  to  evaporate 
slowly  at  a  heat  under  150°  P.,  till  the  bulk  is 
reduced  to  about  one  and  a  half  or  two  drams. 
This  can  be  doiu  by  placing  the  dish  on  the  top 
of  an  ordinary  domestic  hot-water  cistern  for 
twenty  four  or  forty-eiglit  hours.  The  syrupy 
liquid  is  then  carefully  triturated  with  as  much 
lanolin  .as  will  make  the  weight  uj)  to  one  ounce  ; 
the  result  is  a  perfectly  smooth  adhesive  ointment 
of  alight  brown  or  dark  fawn  color,  and  stable. 

Happening  to  have  several  rectal  cases  in  which 
severe  pain  and  torturing  pruritus  were  prominent 
features,  the  ointment  was  ca:efully  applied.  One 
was  a  case  of  multiple  small  fissures  accompanied 
with  intolerable  itching ;  anotlier  was  associated 
with  severe  tenesmus  and  excoriations  from  the 
pus  flowing  from  an  iliac  abscess  bursting  through 
the  levator  ani  muscle  and  penetrating  the  rectal 
walls ;  another  was  complicated  by  a  bleeding 
villous  growth.  These  with  two  cases  of  haemorr- 
hoids, one  of  which  had  an  ulcerated  surface, 
were  so  markedly  and  speedily  relieved  by  the 
conium  ointment  after  nearly  every  known  remedy 
had  failed,  that  1  was  surprised  at  the  result. 

In  a  considerable  number  of  cases  during  the 
last  year  the  same  highly  gratifying  success  was 
achieved  'jy  this  remedy,  whilst  I  cannot  recollect 
a  single  instance  where  the  ointment  caused  incon- 
venience. It  should  be  freely  smeared  inside  the 
sphincter,  and  owing  to  its  adhesive  quality  can 
be  carried  a  considerable  distance  up  the  rectum 
by  the  introduction  of  the  fore-fingerof  the  patient. 
I  have  never  noticed  after  its  use  the  serious 
drawback  which  follows  the  prolonged  application 
of  every  other  greasy  application  to  this  region, 
namely,  a  tender,  sodden,  or  raw  state  of  the  skia 


210 


THE   CANADA    MEDICAL   RECORD. 


about  the  margin  of  the  anus.  The  ointment 
appears  to  me  to  paralyze  the  endings  of  the  moloi- 
nerves  distributed  to  the  fine  muscular  layer 
under  the  surface  of  the  mucous  membrane  ;  the 
reflex  twitchings  of  the  layer  keep  up  the  perpe- 
tual pain  uneasiness  in  diseases  of  the  rectum  and 
anus  associated  with  abrasions,  ulcerations,  or 
fissures.  At  the  same  time  it  undoubtedly  paraly- 
zes the  sensory  filaments.  I  have  obtained  relief 
from  its  use  in  vaginismus  and  some  painful  condi- 
tions of  the  male  urethra,  and  find  it  a  good  lubri- 
cant for  the  sound  or  catheter. 

To  the  ointment  prepared  according  to  the 
above  formula  there  may  be  added  lo  or  12  grains 
of  the  persulphate  of  iron  as  recommended  by  Mr. 
Cripps  in  fissure.  PVom  carefully  watching  the 
results  of  this  combination  of  conium  with 
■iron,  I  am  seen  a  fissure  heal  completely  under 
its  use.  In  acute  inflammation  of  h^morroidalh 
growths  associated  with  swelling  and  painful 
thobbing,  some  relief  may  be  obtained  by  the  free 
application  of  the  conium  ointment  without  iron, 
but  it  is  in  those  exquisitely  painful  fissures  or 
conditions  in  which  there  is  a  loss  of  substance  in 
the  mucous  surface,  that  this  remedy  will  be  found 
to  give  more  relief  than  any  other  drug. 


NEW  METHOD  OF  APPLYING  TAXIS. 
Mr.  G.  Jameson,  Resident  Surgeon  of  the 
Medical  College  Hospital,  Calcutta,  in  a  letter  to 
ihe  British  Med.  Journal,  April  28,  1888,  says: 
A  few  days  ago  a  native  presented  himself  at  the 
dispensary  of  this  hospital  with  a  large  right 
scrotal  hernia,  which  had  been  down  for  some 
months.  The  man  was  placed  on  his  back,  and  the 
tumor  manipulated.  The  coverings  were  fairly 
tense.  Before  attempting  reduction,  I  casually 
asked  the  patient  if  the  tumor  ever  got  smaller. 
He  replied  "  Yes,"  and  ])roceded  to  give  me  a 
demonstration  in  taxis  which  I  had  not  previously 
heard  of.  Lifting  up  the  tumor  with  his  left 
hand,  he  placed  his  right  thigh  on  his  abdomen, 
then  crossed  it  over  to  the  left  side,  catching 
the  tumor  between  the  pubes  and  thigh,  then 
applying  pressure.  The  hernia  disappeared  widi 
a  gurgle  and  a  snap  before  I  had  time  to  call 
the  attention  of  the  students  to  this  novel  pro- 
cedure.    The  reduction  was  complete. 


ANTIPYRIN  IN  THE  TREATMENT  OF  .SE- 
MINAL EMISSIONS. 
The  older  remedies  for  this  affection,  camphor 
and  lupulin,  have  very  properly  been  abandoned. 
Kurschmann  says  that  the  sedative  action  of  lupu- 
lin on  the  genital  organs  is  far  from  demonstrated, 
and  the  employment  of  camphor  is  not  more  relia- 
ble, although  Zeissl,  Purjesz  and  others  consider 
it  the  best  remedy  in  this  affection.  Nux  vomica, 
arsenic  and  atropine  have  also  been  recommended, 
while  Diday  prefers  the  bromides  of  potassium 
and  sodium  to  all  other  remedies.  He  recom- 
mends from  thirty  to  eighty  grains  of  the  bromide 


of  potassium  to  be  taken  on  retiring.  But  these 
large  doses  of  bromide  will  produce  acne,  and  are 
also  liable  to  niduce  mental  enfeeblement.  In  or- 
der to  avoid  the  dangers  of  bromides,  Thor,  of 
Bucharest,  has  been  experimenting  with  antipyrin 
in  the  treatment  of  these  affections.  He  advises 
the  patient  to  take  from  seven  to  fifteen  grains  of 
the  drug  on  retiring.  In  seventeen  cases,  he  has 
completely  cured  the  coraplamt,  wMthout  any  un- 
pleasant consequences.  According  to  Beart,  anti- 
pyrin is  useful  in  neurasthenia  of  the  sexual  organs, 
but  in  these  cases  from  i  to  two  grains  a  day 
should  be  given. — Revista  de  Cincias  Medicas. 


AN  INHALATION  FOR  PHTHISIS. 

In  the  Ecv.  du   Therapeutiqiie  for  December  i, 

1S87,  Filleau  and  Petit  give  the  following  formula 

for  inhalation  in  phthisis  : 

IJ  Carbolic  Acid gr- 30 

Essent.  Terebinth 3,  i2]4 

Essent.  Picis 3      5 

Eucalyptol 3      7}i 

Chloroform  gtt.  5 

M.  S. — To  be  inhaled  four  to  six  times  daily,  for 

five  minutes  at  each  sitting. 


MARSON'S   TEST    FOR    SUGAR   IN    THE 
URINE. 

Dissolve  two  grains  of  ferrous  sulphate  in  about 
150  minims  of  the  urine,  add  five  grains  of  caustic 
potassa,  and  boil.  A  dark  green  precipitate  forms 
if  sugar  is  present,  and  the  supernatant  liquid  is 
reddish  brown  or  black,  according  to  the  amount 
of  sugar.  When  sugar  is  absent,  the  precipitate 
is  greenish  brown  in  color,  and  the  liquid  is  color- 
less.— London  Medical  Recorder,  Feb.  2oih. 


It  may  not  be  generally  known  among  physi- 
cians that  the  bromide  of  lithium  is  almost  a 
specific  for  muscular  rheumatism. — Bartholoic. 


A  FUMIGATION  FOR  ASTHMA. 

Sawyer    (Birmingham    Med.    Rev.",     "  Lyon 
Med.")     recommends    the    following   as    having 
afforded  the   best  results   that    he  has  observed 
among  those  of  a  great  number  of  inhalants  : 
Potassium  nitrate     )    ^^^        ^ 
Powdered  aniseed,  J  '^ 

Powdered  stramonium  leaves,4     " 
A  thimbleful  of  the  mixture,  fashioned  into  a 
little  cone,  is  placed  on  a  plate  and  lighted  at  the 
top. — N.  Y.  jMedical  Journal. 


CREASOTE  IN^  PHTHISIS. 

Dr.  I'eter  Kaatzer,  of  Rehburg,  strongly  recom- 
mends in  the  Berliner  Clinischc  Worhenschccliri/t, 
March  12,  18S8,  the  administration  of  creasote  in 
the  treatment  of  phthisis.  After  trying  various 
formulK  he  settles  upon  the  following  as  the 
best  :  " 


tHE  CANADA    MEDICAL   RECORD. 


211 


R       Creasoli  piirissimi 2  parts 

Alcoliolis 30 

Tr.  gentian  a:, 

I'^xt.  caffcce aa..io  " 

AqiuBclcstillata; 100  " 

M.  Sig. — Sliake    well  and    take  a  tablespoonful 

in  half  a  glass   of  milk    twice   daily.  —  I'Jpilome.  0/ 

Print.  Med.  iiinl  Surgcri/. 

TO  REMOVE  FRECKLES. 
11     Hydr.  prsecip.  albi,  5  parts  ; 
Bisnnuhi  subnitrici,  5  parts  ; 
Ungt.  glycerini,  20  parts. 
M.     Apply  to  freckles  every   second   or   third 
day,  but  not  more  frequently. — Mcnwrabllien. 

SALICYLIC    ACID    IN    SKIN    DISE.ASES. 

Dr.  Besnier,  in  a  clinic  reported  in  the  Jour- 
iKil  de  Mid.  ct  de  Chli:  Pint.,  .\pril,  1888, 
recommends  salicylic  acid  in  the  following  skin 
diseases  : 

In  pityriasis  versicolor,  the  affected  parts 
should  be  bathed  every  evening  with  hot  water 
and  soap.  The  following  ointment  should  then 
be  applied  : 

.\cidi  salicylici gr.  xlv 

Sulph.  prajcip gr.  ccxxv 

Vaselini 3  iij 

The  bathing  and  the  application  of  the  oint- 
ment should  be  renewed  every  evening  ;  recovery 
usually   occurs  in  about  fifteen  days. 

Salicylic  acid  will  also,  he  says,  act  well  in 
senile  pruritus,  that  is  to  say  in  the  vio- 
lent itching  occurring  in  old  people,  unac- 
companied with  senile  retrograde  changes  in  the 
skin.  In  these  cases,  besides  starch  baths,  the 
author  advises  that  every  evening  the  whole 
body  should  be  bathed  with  a  sponge  dipped  in 
very  hot  water  (at  about  104°),  or  with  water 
containing  a  teaspoonful  of  the  following 
liquid  : 

Aromatic  vinegar fl  viij 

Carbolic  acid gr.  Ixxv 

The  body  should  then  be  covered  with  the 
following  powder,  applied  with  slight  friction  with 
the  hand  : 

Starch.  ;  iij 

Salicylate  of  bismuth gr.  cl 

The  salicylate  of  bismuth  may  be  replaced  by 
salicylic  acid.  Finally,  it  may  be  employed  wuth 
advantage  in  acne  with  comedones.  The  follow- 
ing ointment  may  be  used  every  evening  for 
eight  days  : 

B    Salicylic  acid gr.  xxx 

Precipitated  sulphur 

Potash  soap aa  3  jss 

At  the  end  of  eight  days  some  emollient  appli- 
cation is  made,  and  a  great  number  of  comedones 
will  be  found  to  have  been  expelled. — Bevue 
Midlcak,  April,  1888. 


PRELIMINARY    TRE.\TMENT   OF 
PSORIASIS. 

To  remove  the  scales  which  occur  in  psoriasis, 
and  thus  increase  the  efficiency  of  remedial  agents 
to  be  subsequently  ajiplied.  Dr.  .\lf.  Stocfpiart  re- 
commends {Archives  de  Mide.clne^  ct  de  Chirargie 
Pratiques)  the  following : 

R     .\mmon.  Carbonat 2  parts. 

Lanolini  puriss 5  parts. 

Cerat.  Siniplicis 10  parts. 

M. 
This  is  to  be  applied  twice  daily,  and  is  neither 
irritating  nor  painful.     It  leaves  a  clean,  smooth 
surface,  and  its  chief  value  lies  in  the  fact  that  it 
is  cheap. 


L.YCTIC    ACID  IN  DIARRHCE.A. 

M.  Hayem  at  the  Soc.  des  Hop.  stated  that  in 
diarrhoea,  especially  the  green  diarrhoea  of  chil- 
dren, he  had  found  a  teaspoonful  of  a  two  per 
cent.,  solution  of  lactic  acid,  every  hour,  efficient. 
In  adults  when  the  flux  w^as  chonic  and  accompa- 
nied with  dyspepsia,  a  rapid  cure  was  effected  by 
three  tablespoonfuls  of  the  same  solution.  Where 
the  diarrhoea  was  bilious  and  acid,  he  ordered 
large  doses  of  bicarbonate  of  soda. 


The  Canada  Medical  Record 

A  Monthly  Journal  of  Medicine  and  burgerv- 


EDITORS; 

FRANCIS    W,  CAMPBELL,  M.A..  M.D.,  L.K.C.P.  LOUD 

Editor  and  Proprietor. 
B.  A.  KENNEDY,  M.A.,  M.D.,  Managing  Editor. 

ASSISTANT  EDITOR: 

A,  LAPTHORN  SMITH,  B.A.,  M.D.,  M.R.C  S.  Eng.,  F.OS. 
LONDON. 

SUBSCRIPTION    TWO    DOLLARS    PER   ANNDM. 

All  communications  and  Exchanges  must  bt  addressed  to 
the  -Editor s,/Jrnti;er  356,  Post  Office,  Montreal. 


MONTREAL,  JUNE,  1888  . 

We  owe  an  apology  to  our  readers  for  being 
a  number  behind  in  getting  the  Journal  into  their 
hands.  Owing  to  an  unusual  rush  of  work  about 
the  spring  of  the  year,  our  publishers  were  unable 
to  overtake  it,  and  once  behind,  it  is  a  more 
difficult  task  than  one  would  imagine  to  catch  up 
again.  This  we  have  now,  however,  every 
prospect  of  doing,  having  added  some  young 
blood  to  our    editorial   stafi";  the  next  few  num- 


212 


THE   CANADA   MEDICAL    RECORD. 


bers  will  succeed  each  other  every  two  or  three 
weeks. 

We  are  especially  anxious  to  encourage  our 
readers  in  all  parts  of  the  world  to  communicate 
to  us  an)'thing  of  interest  which  may  come 
under  their  medical  observation  ;  we  shall  also 
be  ha])py  to  make  room  in  our  columns  for 
letters  of  inquiry  on  any  topic  in  which  the  Pro- 
fession is  interested,  and  we  will  be  glad  to 
publish  the  answers  which  others  of  our  readers 
may  send  in.  Our  object  is  to  save  from  obli- 
vion the  immense  amount  of  knowledge,  born 
of  experience,  which  must  be  lying  in  the  pos- 
session of  our  thousand  readers,  and  which  might 
otherwise  die  with  them. 

To  begin  with,  we  would  like  those  of  them 
who  have  kept  records  of  their  midwifery  prac- 
tice to  give  us  an  honest  account  of  the  percen- 
tage of  deaths,  and  the  cause  of  death  in  fatal 
cases,  and  whether  the  death  rate  has  been 
less  during  the  last  few  years? 


We  take  great  pleasure  in  calling  the  attention 
of  our  readers  to  the  Meeting  of  the  Canada 
Medical  Association  to  be  held  at  Ottawa  on  the 
1 2th,  13th,  and  14th  September.  Apart  from 
the  fact  that  this  year  the  Meeting  is  to  be  held  in 
a  remarkably  central  and  accessible  location, 
and,  moreover,  that  it  promises  to  be  unusually 
interesting,  there  is  another  reason  why  every 
member  of  the  Profession  should  be  w-illing  to 
made  a  temporary  sacrifice  to  be  present. 
That  is  the  advantage  it  confers  upon  us  to  hear 
in  two  or  three  days  the  result  of  the  life-long 
experience  of  our  elder  brethren.  Our  patients 
may  grumble  somewhat  at  our  absence,  but  in 
their  hearts  they  are  far  seeing  enough  to  know 
that  in  the  end  they  are  the  ones  to  benefit  by 
the  increased  knowledge  we  there  acquire. 

Indeed,  it  is  a  well  known  fact  that  in  the  city 
here,  where  there  are  nearly  two  hundred  competi- 
tors or  more  in  the  professional  struggle,  no  one 
loses  any  of  his  practice  by  devoting  a  certain  part 
of  every  year  to  study,  either  in  the  large  Ameri- 
can cities  or  abroad.  In  most  cases  we  find  shortly 
after  our  return  that  our  practice  has  largely 
increased.  Besides  this,  even  the  most  humble 
among  us  has  observed  something  in  the  course 
of  his  experience,  which  might  be  useful  to  the 
Profession,  and  which  he  is  morally  bound  to 
communicate.  There  can  be  no  better  opportunity 
for     doing      this     than      at     the     reunion     of 


the  whole  Profession  from  every  part  of 
Canada.  It  might  be  objected  that  if  every  ] 
one  attended  these  meetings  and  read  a  paper  at 
them,  there  would  not  be  sufficient  time  for  them 
all.  But  this  difficulty  could  be  easily  overcome 
by  making  the  papers  more  concise  than  they 
sometimes  are.  We,  therefore,  reiterate  our  opi- 
ion  that  the  time  spent  at  the  Medical  Society 
and  at  the  Association  will  not  be  lost,  but  will, 
like  the  golden  wheat  the  farmer  buries  in  the 
ground,  before  long  bring  a  rich  harvest  in 
return  ;  and  we  express  the  hope  that  there  will 
be  a  large  attendance  of  the  rank  and  file  of  the 
Profession,  at  the  Meeting  this  year  in  Ottawa. 
l!y  applying  early  to  Dr.  Bell,  General  Secretar)-, 
Beaver  Hall  hill,  Montreal,  arrangements  can  be 
made  for  greatly  reduced  rates  for  medical  men 
and  their  wives. 


PROVINCIAL  MEDICAL  BOARD. 

The  Semi-Annual  Meeting  of  the  Provincial 
Medical  Board  of  the  Province  of  Quebec  was 
held  in  the  City  of  Montreal,  on  Wednesday,  the 
9th  May,  1888,  Dr.  W.  H.  Kingston,  President,  in 
the  Chair. 

The  report  of  the  examiners  for  admission  to 
the  study  of  Medicine  was  read.  Forty-six  -can- 
didates had  passed.  Thirty-two  were  rejected 
upon  certain  subjects,  and  nine  were  totally  reject- 
ed on  all  subjects. 

It  was  moved  by  Dr.  Lachapelle,  seconded  by 
Dr.  Lemieux.  That  all  candidates  for  license,  who 
have  passed  the  preliminary  examination  in  any 
other  province  than  that  of  Quebec,  shall  be  obli- 
ged to  sign  a  solemn  declaration  that  such  certi- 
ficates were  obtained  in  compliance  with  the 
requirements  of  such  provinces,  and  not  for  the 
purpose  of  evading  the  law  of  the  Province  of 
Quebec, 

An  amendment  was  moved  by  Dr.  T.  Larue, 
seconded  by  Dr.  Pare,  That  the  Provincial  Medi- 
cal Board  cannot,  according  to  its  by-laws,  acce]3t 
the  certificate  from  any  other  province 
of  the  Dominion,  for  the  preliminary  examination 
of  those  who  study  Medicine  in  the  Province  of 
Quebec. 

A  sub-amendment  was  moved  by  Dr.  Kennedy, 
seconded  by  Dr.  Parke,  That  certificates  for 
matriculation  in  Medicine,  registered  by  the 
Ontario  Council,  be  accepted  for  the  present 
as  heretofore,  and  that  a  committee  be  named 
to  examine  into  the  nature  of  the  certificates,  and 


TIFK    CANADA    MKOrCAL    KKCORD 


213 


to  repnri  at  the  next  meeting  of  the  Board. 

liuth  the  anieiidnicnts  and  the  mahi  motion 
were  lost  on  division.  Dr.  hachajielle  then 
resigned  from  the  Committee  on  Qualifications, 
and  was  replaced  by  Dr.  Par6. 

At  the  afternoon  session,  the  reports  from  the 
assessors  of  tjie  Universities  of  Laval,  McGill, 
Victoria  and  Bishop's  Colleges  were  adopted. 

A  duplicate  license  was  granted  to  Dr.  Allcyn, 
ot  New  Orleans,  formerly  of  Quebec,  the  oi  ii;inai 
having  been  accidentally  destroyed  liy   the. 

Dr.  Kennedy,  for  the  Committee  on  (Qualifica- 
tions, reported  that  the  following  gentlemen  were 
entitled  to  the  license  : 

\ictoiia  Un-iversitij. — Henri  Ducharme,  Jos. 
Beanlme,  Victor  Bourgeault,  E.  A.  Laferriere, 
Hyacinthe  Bastien,  L.  A.  Beaudry,  J.  C.  Gadoury, 
J.  .\.  Marcotte,  J.  V..  Brault,  E.  E.  Laurent,  L. 
C.  Bussiere,  Jos.  Barolet.  J.  1\L  Picotte,  J.  A. 
Pomminville,  C.  T.  Morel  de  Ladurantaye,  J.  T. 
Moreau,  J.  \.  Pare,  L.  Leblanc,  Jos.  Theriault, 
Chas.  F.  Clerk. 

Bishop's  Uiiiccrsitij — V.  J.  Groulx. 

Liiual  Unh'trsitij,  Montreul. — E.  A.  Rene  de 
Cotret,  Charles  Marcij,  Arthur  J.  Ricard. 

McGlU  [rniuerslti/.—E.  H.  P.  Blackader,  E.  L. 
Quirk,  F.  G.  Finley,  W.  G.Stewart,  J.  FL  Bell, 
A.  W.  Haldimand,  C.  W.  Ha^ntschell,  W.  W. 
Chalmers,  R.  Marr  Kincaid. 

The  candidates  were  sworn  and  the  licenses 
granted. 

Dr.  Kennedy  then  submitted  the  names  of  a 
number  of  candidates  liaving  the  degree  of  iM.D., 
who  have  passed  their  preliminary  e.xamination 
in  Ontario,  Manitoba,  or  New  Brunswick. 

Moved  by  Dr.  Guay,  seconded  by  Dr.  Rous- 
seau, That  the  qtiestion  of  admission  to  the  study 
of  .VIedicine  be  reconsidered. 

The  motion,  on  division,  received  a  majority  of 
votes,  but  the  President  ruled  that  a  two-thirds 
vote  was  always  required  for  reconsideration. 

Moved  by  Dr.  Grandbois,  seconded  by  Dr. 
Howard,  That  in  future  the  license  shall  be  refused 
to  those  candidates  who,  belonging  to  this  Pro- 
vince, have  endeavored  to  evade  the  law  of  the 
Province  by  passing  their  preliminary  examina- 
tion in  one  of  the  other  provinces,  and  that  the 
candidates  now  before  the  Board,  having  such 
certificates  from  other  provinces,  be  requited  to 
sigti  a  solemti  declaration  that  they  have  obtained 
such  certificates  in  the  regukir  course  and  not 
with  any  intention  of  evading  the  existing  law. 


Moved  in  amendment  by  Dr.  Dagenais,  secon- 
ded by  Dr.  Ladoueeur,  That,  iti  future,  the  Board 
grant  no  license  to  candidates  not  po,ssessing  the 
certificate  of  preliminary  examination  from  this 
Board,  with  the  exception  of  the  cases  provided 
for  by  the  law. 

Atnendmetit  lost  and  main  motion  carried. 

The  foHowing  gradu  ites  signed  the  above  decla- 
ration before  Dr.  Lei)r(;hon,  J.  P.,  were  sworn,  and 
received  the  license : 

Victdi-id.  UiiiDcrsitij — Thos.  Emits,  Felix  Coran, 
Paul  Royal  and  LJ.  .\.  Dorais. 

Bishoji's  l/iiiversifj/ — Frederick  Taylor,  Follin 
H.  Pickel. 

McGiU  iriiicersitij — R.  B.  Struthers,  J.  A. 
Springle,  W.  D.  T.  Ferguisoti,  F.  D.  Robertson, 
John  Geo.  McCarthy,  F.  G.  Desmond,  James 
Hewitt  and  C.  P.Dewar. 

Queen's  College — Jas.  N.  Anglin. 

Dr.  Alfred  Smith,  of  the  Toronto  School  of 
Medicine,  also  received  the  license. 

It  was  resolved  that  the  following  members  be 
a  committee  to  take  the  steps  necessary  for  the 
presentation  of  the  Medical  Bill  before  the  Legis- 
lature ;  Drs.  Lemieux,  Belleau,  Lachapelle  and 
Parke. 

Moved  Ijy  Dr.  Christie,  seconded  by  Dr. 
Durocher,  That  the  Bill  be  withheld  for  six 
months.     Lost. 

Meeting  then  adjourned. 


WETTING     WITH     FRESH     AND     SALT 
WATER. 

The  DuliJln  ileJical  Press  says: — Whether  a  fact 
in  science  or  not,  there  exists  a  very  general  itii- 
pression  amongst  those  who  have  been  much  at 
sea,  that  there  is  little  or  no  danger  to  health 
from  being  wetted  with  sea-water.  It  is  a  proverb 
amongst  sailors  that  there  is  no  danger  from 
getting  wet  from  salt  water.  On  the  other 
hand,  old  tropical  residents,  far  more  even  than 
those  living  in  temperate  latitudes,  have  a  great 
fear  of  getting  wet,  either  from  rain  or  other 
sources.  An  attempted  explanation  of  these 
different  results  was  made  so  far  back  as  in  1839, 
by  Robert  Mudie,  who  remarked  that  "  the 
evaporation  of  sea-water  from  any  surface  has 
not  nearly  so  cooling  an  effect  as  the  evapora- 
tion of  fresh  water  from  the  same,  and  thus  a 
sailor  may  get  wet  and  dry  with  the  spray  of  the 
sea,  and  even  with  the  sea  fairly  breaking  over 
him,  with  far  inore  impunity   than   a  landsman 


214 


THE   CANADA   MEDICAL   RECORD. 


can  get  wet  and  dry  by  exposure  to  showers." 
The  reason  of  this  is  easily  explained,  the  evapo- 
ration of  pure  water  is  complete,  and  accom- 
panied by  nothing  but  an  absorption  of  the 
action  of  heat,  and  a  consequent  reduction  of 
temperature ;  but,  in  the  case  of  sea-water, 
and  the  crystallisation  of  a  certain  portion  of 
the  salt,  which  has  been  previously  distributed 
through  the  water,  and  the  holding  of  which  in  a 
state  of  solution  requires  a  certain  action  of  heat ; 
when  the  salt  again  crystallises  this  action  is 
set  free,  and  in  so  far  counteracts  the  cooling 
effects  of  the  evaporation,  hence  it  is  a  fact  that 
there  is  greater  safety  in  being  wetted  with 
sea-water  than  with  rain.  Human  experience 
has  commonly  shown  great  truths,  ages  before 
science  has  explained. 


TREATMENT  OF  SICK    HEADACHE. 

Dr.  W.  Gill  Wylie,  of  New  York,  has  produc- 
ed excellent  results  with  the  following  method  of 
treatment.  So  soon  as  the  first  pain  is  felt,  the 
patient  is  to  take  a  pill  or  capsule,  containing  one 
grain  of  inspissated  ox-gall  and  one  drop  of  oil  of 
gaultheria  every  hour,  until  relief  is  felt,  or  until 
six  have  been  taken.  Dr.  Wylie  states  that  sick- 
headache  as  such  is  almost  invariably  cut  short 
by  this  plan,  although  some  pain  of  a  neuralgic 
character  remains  in  a  few  cases. 


THE  MONTREAL  MEDICAL  JOURNAL. 
The  Canadii  Mtdical  and  Surgical  Journal 
will  on  the  ist  of  July  change  its  name  to  "  The 
Montreal  Medical  Journal,"  and  increase  its 
pages  from  64  to  84  pages  each  number.  We 
congratulate  our  contemporary  on  this  evi- 
dence of  its  growth,  and  wish  every  possible 
prosperity. 

BEAUTIFUL  CHEMICAL  PREPARATION. 
A  snow  white  mass  of  Caffeine,  the  active  prin 
ciple  of  coffee,  (200  pounds,  and  of  great  value,) 
is  now  in  exhibition  in  the  « indow  of  William  R. 
Warner  &  Co.,  1228  Market  street.  This  beauti 
ful  crystallization  represents  ten  Ions  of  coffee,  and 
is  used  as  an  ingredient  in  the  preparation  of 
Bronie  Soda  prescribed  for  the  cure  of  headacht-s, 
migraine,  nervousness,  sea  sickness,  cScc. — Phiht- 
delphia  Inquirer. 

DIET  IN  ALBUMINURIA. 
The  Dublin    Medical    Press  says  : — "  The  con- 
dition known     as    the  '     large     white    kidney,  ' 


a  malady  of  tolerably  common  occurrence,  is 
due  in  a  large  number  of  cases  to  the  chronic 
i)  ritation  set  up  in  the  eliminatory  organs  by  the 
excretion  of  incompletely  oxidized  nitrogenous 
matter,  resulting  either  from  excess  of  nitrogenous 
material  ingested  or  from  hepatic  or  other  vis- 
ceral disease.  In  either  case  it  is  important  to 
bear  in  mind  that  the  object  to  have  in  view  is 
to  reduce,  or  at  any  rate  not  to  augment,  the 
quantity  of  these  partially  oxidized  products. 
For  this  reason  albuminuric  patients  should  avoid 
foods  containing  an  abundance  of  these  ex- 
tractives. Beef  tea,  beef  extracts,  and  the  like 
are  little  less  than  poison  to  them,  as  they  infal- 
libly accentuate  the  irritation  and  aggravate 
its  results.  It  has  been  found  that  the  systematic 
subcutaneous  injection  of  these  substances  in 
guinea-pigs  gave  rise  to  the  characteristic  renal 
lesions  with  the  usual  train  of  symptoms,  the 
severity  of  which  was  in  direct  proportion  with 
the  quantities  injected. " 


BRITISH  COLUMBIA  MEDICAL  COUN- 
CIL. 

The  regular  Semi-Annual  Meeting  of  the  British 
Columbia  Medical  Council  was  held  in  Victoria 
on  the  ist,  2nd,  3rd  and  4th  of  May.  Present  : 
Dr.  Davie  (Victoria),  Vice-President;  Dr.  Milne 
(Victoria),  Registrar  ;  Dr.  Hanington  (Victoria), 
Treasurer;  Dr.  McGuigan  (Vancouver),  Dr. 
Powell  (Victoria),  and  Dr.  DeWolf  Smith  (New 
Westminster). 

The  Treasurer's  report  showed  that  the  Coun- 
cil had  a  satisfactory  balance  on  hand,  and  it  was 
resolved  to  devote  a  portion  of  this  to  the  prose- 
cution of  unregistered  practitioners  throughout 
the  Province. 

Two  candidates  presented  themselves  for  the 
license,  but  were  referred  for  six  months. 

I'iie  election  of  officers  for  the  ensuing  year 
resulted  as  follows  :  President,  Dr.  J.  C.  -Davie ; 
Vice-1'resident,  D.  W.  J.  McGuigan  ;  Registrar, 
Dr.  G.  L.  Milne  ;  Treasurer,  Dr.  E.  B.  C.  Haning- 
ton,— the  two  latter  being  re-elected. 

The  Committee  on  Fees,  appomted  at  the  last 
meeting,  brought  in  a  report  recommending  a 
scale  of  fees,  which  was  adopted  by  the  Council, 
and  ordered  to  be  printed. 

The  Council  then  adjourned.  The  next  meet- 
ing will  be  held  in  Vancouver,  on  the  first  Tues- 
day in  November,  1888. 


THE   CANADA   MEDICAL  RECORD. 


215 


CANADIAN  MEDICAL  ASSOCIATION. 

The  twenty-first  Amiiial  Meeting  of  the  Cana- 
dian Medical  Association  will  be  held  in  the  city 
of  Ottawa  on  the  i2lh,  13th  and  i.(th  of  Septem- 
ber next.  The  following  are  the  ofiicers  of  the 
Association  : — I'resident,  J.  E.  (Iraham,  M.D., 
Toronto  ;  President  elect,  George  Ros.s,  M.D., 
Montreal  ;  Secretary,  James  Bell,  M.D.,  Mont- 
real;  Treasurer,  Charles  Stuart,  M.I).,  Toronto  ; 
Vice-Presidents — For  Ontario,  Dr.  Ecclcs,  Lon- 
don ;  Quebec,  Dr.  Christie,  Lachute ;  New 
Brunswick,  Dr.  Currie,  P'redericton  ;  Nova 
Scotia,  Dr.  Wickwire,  Halifax  ;  Manitoba,  Dr. 
Blanchard,  Winnipeg  ;  British  Columbia,  Dr. 
True,  New  Westminster.  Local  Secretaries — 
Por  Ontario,  Dr.  J.  A.  Grant,  jun.,  Ottawa  ; 
Quebec,  Dr.  Armstrong,  Montreal ;  New  Bruns- 
wick, Dr.  Lunnan,  Campbellton  ;  Nova  Scotia, 
Dr.  Trueman,  Sackville  ;  Manitoba,  Dr.  Chown, 
Winnipeg ;  British  Columbia,  P)r.  Neilin, 
Victoria. 


THE  NEW    MEDICAL    BILL    FOR    QUE- 
BEC. 

Petitions,  largely  signed  by  the  Profession, 
have  been  presented  to  the  Legislature  against 
the  new  Medical  Bill,  and,  so  far  as  we  can  judge, 
the  prospect  of  its  being  rejected  by  a  consider- 
able majority  seems  to  increase  every  day.  In 
our  next  issue  we  will  be  able  to  give  the  definite 
result. 


THE  CODE  OF  ETHICS  OF  THE  AMERI. 
CAN  MEDICAL  ASSOCIATION. 

Art.  II. — Profcssionitl  services  of  j^hi/sicians  to 
Click  other. 
I.  All  practitioners  of  medicine,  their  wives, 
and  their  children,  while  under  the  paternal  care, 
are  entitled  to  the  gratuitous  services  of  any  one 
or  moie  of  the  faculty  residing  near  them,  whose 
assistance  may  be  desired.  A  physician  afflicted 
whith  disease  is  usually  an  incompetent  judge  of 
his  own  case ;  and  the  natural  anxiety  and  solici- 
tude which  he  experiences  at  the  sickness  of  a 
wife,  a  child,  or  any  one  who,  by  the  ties  of  con- 
sanguinity, is  rendered  jieculiarly  dear  to  him, 
tend  to  obscure  his  judginent,  and  produce  timi- 
dity and  irresolution  in  his  practice.  Under  such 
circumstances,  medical  men  are  peculiarly  depen- 
dent upon  each  other,  and  kind  offices  and  pro- 
fessional  aid   should     always    be   cheerfully    and 


gratuitously  afforded.  Visits  ought  not,  however, 
to  be  obtruded  oificiously,  as  such  unasked  civi- 
lity may  give  rise  to  embarrassment,  or  interfere 
with  that  choice  on  which  confidence  depends. 
But,  if  a  distant  member  of  the  faculty,  whose 
circumstances  arc  affluent,  request  attendance, 
and  an  honorarium  be  offered,  it  should  not  be 
declined  ;  for  no  pecuniary  obligation  ought  to  be 
imposed,  which  the  party  receiving  it  would  wish 
not  to  incur. 


SACCHARINE  TABLETS. 

This  chemical  substitute  for  sugar,  now  pre- 
pared by  W.  A.  Dyer  li:  Co.,  Chemists  of  Mont- 
real, possessing  nearly  300  times  the  sweetening 
properties  of  cane  sugar,  can  be  used  with  per- 
fect safety  by  those  suffering  from  Diabetes, 
Bright's  Disease,  Dyspepsia,  Obesity  and  every 
ailment  where  sugar  is  forbidden.  The  tablets 
are  guaranteed  as  being  perfectly  free  from  cane 
or  grape  sugar,  oi'  anything  a  diabetic  patient 
should  avoid — and  will  impart  to  tea,  coffee  or 
any  other  substance  a  sweet  and  delicate  flavor, 
which  has  been  by  many  preferred  to  that  ob- 
tained from  commercial  cane  sugar. 


PERSONAL. 

Dr.  S.  A.  Thomas  (CM.,  M.D.,  Bishop's  Col- 
lege, 1S88)  has  settled  in  Escanaba,  Wisconsin. 
On  St.  Jean  Baptiste  day,  by  invitation,  Dr. 
Thomas  delivered  the  oration,  which  was  well 
prepared  and  well  delivered, — so  say  the  local 
papers,  and  we  can  well  believe  it. 

Drs.  Wilkins,  Wm.  Gardner  and  Stewart,  of 
the  Faculty  of  Medicine  of  McGill  University, 
have  left  for  a  three  months'  trip  in  Europe. 

Dr.  R.  Palmer  Howard,  Dean  of  the  McGill 
P'aculty  of  Medicine,  has  gone  for  a  much  needed 
rest,  and  salmon  fishing  on  the  Cascapedia. 

Dr.  Richard  MacDonnell  of  McGill  Faculty  of 
Medicine,  who  has  been  ill,  is,  we  are  pleased  to 
say,  rapidly  improving.  He  proposes  leaving 
for  Europe  shortly. 

The  Rev.  J.  B.  Saunders  (CM.,  M.D.,  Bis- 
hop's College,  1885)  has  resigned  the  chair  of 
Botany,  which  he  held  in  his  Alma  Mater,  owing 
to  his  removal  to  the  pastorate  of  the  Methodist 
Church  in  Pembroke,  Ont. 


216 


THE    CANADA    MEDICAL    RECORH). 


Dr.  McClure,  late  Superintendent  of  the  Mon- 
treal General  Hospital,  has  been  ordained  by  the 
Presbytery  of  Montreal,  as  a  Medical  Missionary 
to  China. 

Dr.  Clark.  (M.D.  Bishop's  College,  1888)  is 
pursuing  his  medical  studies  in  Edinburgh. 

A  few  weeks  ago,  the  .Senior  Editor  of  the 
Record  being  in  London,  England,  called  upon 
his  old  friend,  Dr.  Donald  Baynes  (M.D.,  McGill 
1876,  L.  R.  C.  P.  Lond.),  who  for  some  years 
filled  the  position  of  Professor  of  Laryngology, 
in  Bishop's  College,  Faculty  of  Medicine,  Mon- 
treal. We  found  him  located  in  Harley  Street, 
in  the  midat  of  London's  most  fashionable 
Physicians.  Dr.  Baynes  has  already  acquired 
quite  an  extensive  clientele,  and  if  we  are  not 
mistaken,  there  is  a  bright  future  in  store  for 
him. 

It  is  reported  upon  e.\cellent  authority  that  Dr. 
W.  Geo.  Beers,  Dentist,  purposes  leaving  Mon- 
treal, and  commencing  the  practice  of  his  profes- 
sion in   London,  England. 


BOOK  NOTICES. 

It  has  been  said  that  the  success  of  specialists 
is  in  great  part  due  to  their  attention  to  details. 
In  order  to  master  these  latter  in  all  theii  minute- 
ness, it  is  generally  necessary  for  the  practi- 
tioner to  devote  some  months,  or  weeks,  at  least, 
to  the  observation  of  the  Hospital  practice  of  the 
great  specialists  at  some  of  the  centres  of  medical 
teaching.  And  certainly  this  is  the  best  way  to 
acquire  such  information.  But  for  those  who 
are  unable  for  various  reasons  to  do  so,  the  next 
best  thing  is  to  provide  oneself  with  such  a  work 
as  "  the  Rules  of  Ase])tic  and  Antiseptic  Surgery," 
by  Arpad  Gerster,  M.  D.,  Professor  of  Surgery  at 
the  New-York  Polyclinic,  visiting  surgeon  to  the 
Mount  Sinai  and  German  Hospitals. 

As  the  work  is  profusely  illustrated  with  2c;i 
engravings  or  photo-lithographs,  taken  in  the 
operating  room,  during  the  progress  of  the  ope- 
rations, one  almost  imagines  in  reading  the 
book  that  he  is  standing  beside  the  operator. 
The  text  runs  in  such  a  clear  and  easy  style, 
that  perusal  of  this  book  is  not  only  not  a 
trouble  but  a  relaxation.  True  to  its  title,  it 
deals  exhaustively  of  Sejisis  and  the  means  of 
preventing  it,  giving  information  which  is  not 
yet  to  be  found  in  any  other  book.  It  is  pub- 
lished by  Appleton  &  Co.  of  New- York,  in  their 
well  known  style,  on  the  most  beautiful  of  paper 


and  with   the  clearest   of  type.     It  may  be   had 
from  Dawson  Bros.,  Publishers,  Montreal. 


For  those  who  have  not  enjoyed  the  advan- 
tages of  a  full  classical  education,  and  who  are 
about  to  commence  the  study  of  medicine,  the 
whole  couse  of  their  professional  studies  would 
be  made  very  much  easier  by  the  perusal  of  a 
treatise  entitled  "  The  Language  of  Medicine," 
by  Prof  F.  R.  Campbell,  of  Niagara  University. 
It  gives  the  e.xact  meaning  and  derivation  of 
nearly  every  word  met  with  in  Medicine,  as  well 
as  complete  rules  for  correct  prescribing  in  Latin. 
Incidentally  a  very  interesting  history  of  Medi- 
cine is  introduced.  On  this  latter  account,  as 
well  as  for  the  amount  of  erudition  displayed  in 
iis  ])reparation,  it  will  be  read  by  even  the  oldest 
practitioner  with  satisfaction.  There  are  cha 
ters  on  the  "  Latin  Element  in  the  Language  of 
Medicine,''  "  on  the  Origin  of  the  Language  of 
Medicine,"  "  on  the  Greek  Element  in  the  Langu- 
age of  Medicine,"  and  "  On  Elements  Derived 
from  the  Modern  Languages. 

The  book  is  published  by  Appleton  &  Co., 
of  New  York,  and  may  be  had  of  Dawson  Bros., 
of  Montreal. 


The  applied  anatomy  of  the  Nervous  System, 
by  Ambrose  L.  Ranney,  Professor  of  Anatomy 
jn  the  University  of  New  York.  The  name  of 
Ambrose  Ranney  is  a  sufficient  guarantee  that 
whatever  he  undertakes  will  be  thoroughly  carried 
out,  and  the  present  work,  which  although  a 
second  edition,  is  really  a  new  work,  having  been 
entirely  rewritten,  is  no  exception  to  the  rules. 
As  a  work  of  Anatomy  alone  it  should  be  in  the 
hands  of  every  teacher  of  Anatomy,  while  as  a 
work  on  Applied  Anatomy  it  is  invaluable  to 
those  who  have  anything  to  do  with  the  diag- 
nosing and  treatment  of  nervous  diseases. 
Nervous  symptoms  puzzle  us  more  than  any  others 
in  tracing  them  to  their  origin,  and  it  is  in  inter- 
preting them  that  this  work  would  be  of  the 
greatest  help.  Since  we  first  read  Hilton's  clas- 
sical work  on  "Rest  and  Pain,"  we  have  not  expe- 
rienced as  much  pleasure  in  the  perusal  of  any 
book  of  the  kind  as  we  did  in  reading  this, — the 
latest  and  perhaps  the  best  work  on  the  anatomy 
of  the  nervous  system. 

It  is  profusely  illustrated,  and  the  type  is  large 
and  clear.  It  is  published  by  Appletoa  &  Co., 
of  New  York,  and  is  for  sale  by  Dawson  Bros., 
Montreal. 


THE  CANADA  MEDICAL  RECORD. 


Vol.  XVI. 


MONIREAL,    JULY,    1888. 


No.   10, 


COHSTTEIN'TS. 


ORIGINAL  COMMUNICATIONS. 

Oyuticology  aiul  Obstetik's  

SOCIILTY   PROCEEDINGS. 

Mciiit'i»-<'liirur^k-;il  Sucirty  i>f  .Mont  real 
PROGRESS  OF  SCIENCE. 

Mi.si.il.'tl  Noteg 

liiMotiiiiia, .,, 

Aiitipyi  ill  ill  HaMUoptysis 

KlegniiL  Mouth- Wa»U 


230 


[lulcIiiiisiMi  (III  tlie  Aliiii  livt: 'rioHliii 'lit 

of  Syphilit* 

The  Value  t)f  lUti  Nuliitive  BhIIi  :iiul  ot 

Iiiiiix-tioii  ill  l>iH<;ast>8  nf  <  MiiMioii. 
Tho  I'repuvfiliun  ol  Kou<l  tor  tin- sick,  . , 

Itoi'tiil  Aliiiu'iilftti'ni  in  Cliililrcii 

Tieatiiieiil  of  lOpilaxtH  

Ilorio  Aci«l  a  r<;inciiy  torStyt: 

KilLy  AphoiisiiiH  in'Tregtiancy 

The   Hot    lialli    in    the   Treatment    of 

Sle»^Iile^siiesis 

"  PyricUiu*  Trycarboxylic  Acid  **  aa  a 

Kenieilial  Agent 

rhc  Pliarnuiceutics  of  Aiitipyrin 


An   KxainlnatioD  for    License  to    Prac- 
tice  2^16 

'rht>  La  ft'  of  Deteruiinntiou  of  the  Sexes.  '^  6 

Cocraine  In  Acute  'J'ouHillltis 'J36 

'i'lie  Treatment  of  HiliousneSH '2,Vt 

Tiie  Treatment  of  Typhoi.l  Fever 2\i7 

EDITORIAL. 

!  Over  Crowding  in  tlie  Profession    2^H 

^.u\  Ooetors. ..     'J-rj 

Asi-xuHli^-ation  as  a  Kemedy  for  Crime.    240 
'J'lie  Code  of  Ktlii<rs  «»!    the  Auierlean 
Medical  Assoeiaiiun  240 


&/'id//f{/l  ConimunimUoui. 


GYNECOLOGY  AND  OBS'l'ETRICS. 

By  A.  Lai'thorn  S.\[Itii,  B.A.,  M  D.,  M.R.C.S.,    Eng., 
l.ccUufr  on  Gyiic-cology  in  Bishop's  College,  Monlreal. 

As  leucorrhaa  is  sometimes  a  disease  which  is 
very  uncomfortable  for  the  patient  and  tedious  for 
the  ])hysician  to  cure,  it  may  be  of  interest  to 
draw  the  attention  of  the  profession  to  liie  good 
Results  to  be  obtained  by  the  use  of  Boracic  Acid. 
Its  remarkable  powers  have  been  observed  over 
and  over  again  by  me  when  used  in  purulent 
otorrinx'a,  in  which  the  odor  is  tlie  most  disagree- 
able symptom  of  the  disease.  Dr.  N.  F.  .Schwartz 
has  reported  a  number  of  successful  cases  in 
leucorriiuia.  {An-hires  of  Gi/hccoIikii/^  July 
1888.)  The  method  recommended  is  the  same  as 
that  employed  in  utorrluea,  and  is  as  follows  :  First 
irrigate  the  vagina  with  water  as  hot  as  can  be 
borne;  then  a  speculum  is  introduced,  and  the 
vaginal  walls  are  carefully  dried  with  absorbent 
cotton  pledgets;  sufficient  boracic  acid  is  poured 
through  a  cylindrical  glass  speculum  to  complctel)' 
distend  the  vaginal  vault,  and  surround  the  vaginal 
portion  of  the  cervix.  The  powder  is  held  firmly 
in  place  by  siiall  absorbent  cotton  tampons,  sup- 
ported by  a  large  aseptic  wool  tampon.  It  is 
odorless,  antiseptic,  and  healing. 

Dr.  M.  H.  Lackersteen  (in  the  Medical  Staudurd, 
August,  1886),  gives  an  important  communication 
on  the  value  of  Nitro  glycerine  in  collapse.  He 
cites  three  cases  in  which  recovery  took  place  after 
the  patient  was  apparently  dead,  by  means  of 
hypodermic    injections   of  one  to   ten  minims  of 


the  one  per  cent,  solution.  In  one  case,  a  young 
married  lady  who  was  suffering  from  the  slow  pas- 
sage of  a  gall  stone  suddenly  collapsed,  and 
brandy,  ether  and  ammonia  failed  to  revive  her. 
Neither  respiration  nor  the  heart  sounds  were 
detectable.  .She  had  been  in  this  condition  for 
nearly  half  an  hour  when  the  attending  physician 
thought  of  nitroglycerine,  and  gave  her  an  injec- 
tion of  ten  drops  ^f  the  one  per  cent,  solution. 
In  a  minute  there  was  a  gasp  but  no  pulse  ;  the 
second  minute  showed  irregular  respiration,  and 
the  heart  began  to  quiver.  An  injection  of  one- 
tenth  of  a  grain  of  Atropine  was  then  given,  and 
soon  after  the  pulse  became  perceptible,  the  blood 
began  to  circulate,  and  other  signs  of  returning  life 
appeared.  The  next  morning  she  passed  twenty- 
eight  gall  stones  and  a  large  slough.  The  second 
case  was  that  of  a  young  lady  who  fell  into  a  lake 
and  was  submerged  for  three  minutes,  and  who, 
after  some  hours  exertion  on  the  part  of  attending 
physicians,  was  given  up  for  dead.  Electricity  had 
been  apijlied  without  value.  Four  minims  of  one 
per  cent,  nitroglycerine  were  injected  over  the  pit 
of  the  stomach.  Within  three  minutes  evidences 
of  life  were  manifest. 

In  the  the  third  case  a  still-born  child  was  resus- 
citated by  the  hypodermic  injection  of  two 
minims  of  one  per  cent,  nitroglycerine,  diluted 
with  a  hundred  drops  of  hot  water,  and  a  propor- 
tionate quantity  of  atropine  which  was  injected 
into  the  cord.  In  a  minute  the  child's  heart  began 
to  beat,  and  it   is  now  living. 

Would  this  treatment  not  be  worth  a  trial  in 
failure  of  the  heart's  action  during  and  after  labour  ? 
I  can  speak  from  experience,  for  having  paid  a  visit 


m 


tHt:   CANADA  MEDICAL  EECOUfi. 


to  the  n  (1:0 -glycerine  factory  at  Belceil  near  Mon- 
treal, I  vas  promptly  affected,  as  were  the  other 
members  of  the  party,  with  a  rusli  of  blood  to  the 
head  and  palpitation  of  the  heart. 

In  the  A^ew   York  Meiiail  Journul,  Dr.  A.  H. 
Goelet  maintains  that  the  use  of  a  dilator  and  intra- 
uterine stem,  by  wiiicli  dilatation  is  maintained,  is 
a  safe,  satisfactory  and  reliable  substitute  for  ail  the 
cutting  oi)erations  upon  the  cervix  heretofore  used 
to  overcome  stenosis,  obstruction,  and  flexions  of 
tlie  cervical  can,il.     He  insists  upon  using  a  mode- 
rate amount  of  dilatation,  after  wiiich  he  employs 
the  intra-uterine  stem,  which  should  be  two  inches 
long,    tliat  is  half  an  inch  shorter  than  the  virgin 
uterus,  and  which  is  perforated  through  its  centre 
with  a   considerable   sized  channel,   which  allows 
free  drainage  from  the  uterine  cavity  while  it  is  in 
position.     It  terminates  in  a  cup-shaped  shoulder 
which  jircvents  further  entrance.     This  pessary  is 
introduced  after  the  dilatationis  completed  and  re- 
tained   in  position  by   a    cotton  tampon,  and  is 
kept  in  usually   about  a  week,  the   patient  being 
confined    to   bed.     There  are     three    sizes,    ten, 
twelve,   and  fourteen,  the  first  being  used  for  the 
first  twenty  four  hours,    the  second,  the  next  two 
days,  and  after  that  the  third  size.     To  those  who 
object   to  the  stem  as  dangerous,    he  says  that  at 
one  time  they  did  not  hesitate  to  use  a  sponge  or 
laminaria  tent,  which  blocks  the  canal,  prevents 
drainage,  and  provokes  constant  irritation  by  its 
expansive  power  as  long  as  it  is  retained.     The 
stem  is  absolutely  clean,  allows  free  drainage,  and 
provokes  no  irritation  if  the  patient  is  kept  quiet. 
In  an  experience  of  over  three  hundred  cases  he 
has  not  yet  seen  an  objectionable  symptom  follow 
its  use.     Although  this  is  a  very  good  method  I 
think  the  treatment  of  dysnienorrhoja  from  stenosis 
of  the  internal  os  by  means  of  the   negative  con- 
tinuous current  through  an  olive-shaped  electrode 
is  a  better  method.     As  an   instance  of  the  good 
result   following  the   treatment  of  dysmenorrhoea 
by    means  of  the  negative  continuous  current,   I 
might  mention  the  following  case  :  Mrs.  M.,  aged 
26,  came  to   me  on   the   23rd   of  May,  had  been 
attended  by  me  six  years  ago  for  a  miscaniage,  or 
rather  for  the  hemorrhage,  which  had  lasted  seven 
eight  weeks  when  I  saw  her.     After  appropriate 
treatment  she  became  regular  although  the  flow  was 
scanty,   only  lasting  a  day  and  a  half,  and  there 
was  a  good  deal  of  pain  on  the   first  day;  the 
uterus  was  hard  and  immovable,  and  the  sound 
went  in  with  the  greatest  difiiculty  three  and  a  half 


inches.  I  gave  her  forty  Milliamp^res,  negative 
five  minutes,  when  the  sound  came  out  with  the 
greatest  ease. 

On  the  first  of  June  I  gave  her  fifty  M,  neg.  five 
minutes  ;  the  sound  entered  quite  freely,  although 
a  similar  one  had  entered  with  difficulty  the  week 
before.     She  says  she  feels  much  better  since. 

On  the  seventh  of  June  she  informed  me  that 
she  had  menstruated  since,  and  that  it  lasted  three 
days  inste.id  of  a  day  and  a  half,  and  that  she  did 
not  suffer  at  all.  I  gave  her  75  M.,  ncjr.  five  minutes. 

July  7th  she  called  to  say  that  she  had  passed 
through  a  second  menstrual  period  without  any 
pain  whatever  ;  it  lasted  from  Wednesday  to  Satur- 
day morning,  and  was  more  profuse  than  it  had 
been  for  two  years,  but  not  more  than  norni.il. 
Her  bowels  were  regular  every  day,  and  she  passed 
water  without  any  discomfort. 

August  2nd,  she  has  now  passed  through  three 
menstrual  periods  free  from  pain.  She  has  had 
altogether  three  applications  of  the — —current, 
gradually  increasing  in  strength  from  forty  to 
seventy-five  M. 

I  have  many  similar  cases  recorded,  but  their 
history  is  pretty  much  the  same  as  this,  and  the 
result  has  been  generally  quite  as  satisfactory, 
although  in  one  case  there  was  a  slight  return  of 
the  pain,  requiring  a  few  more  applications  of  the 
current.  I  am  not  the  only  one  who  can  speak 
thus  well  of  this  method  of  treating  dysnienorrhcea, 
It  might  be  well  for  me  to  remark,  however,  that 
it  is  only  or  at  any  rate  especially  useful  in  those 
cases  of  stenosis,  in  which  the  contraction  of  the 
canal  is  due  to  an  inflammatory  condition  of  the 
endometrium,  or  of  the  fibrous  tissue  in  the  uterine 
wall  surrounding  the  internal  os.  I  have  no  doubt 
whatever  that  the  benefit  which  I  have  invariably 
found  to  follow  its  use  is  due  to  the  resorbtion  of 
this  fibrous  thickening.  I  do  not  think  that  this 
form  of  the  current  would  be  suitable  for  spasmo- 
dic cases,  as  there  is  generally  a  little  h)  peraemia 
of  the  mucous  membrane  following  the  application 
of  the  pole.  I  also  think  that  I  per- 
haps used  a  stronger  current  than  was  necessary, 
as  in  strictures  of  the  uretlira,  I  have  dilated  up 
to  twenty-eight  French  with  a  current  not  exceeding 
five  M.,  for  10  or  15  minutes. 

Doleris,  one  of  the  le.ading  gynecologists  of  Paris, 
occupying  a  position  similar  to  that  of  Munde  in 
New  York,  says  in  the  Annates  de  Gynecologie, 
that  since  1885  he  has  adopted  in  the  treatment 
of    uterine    displacements    the    combination    of 


tHB  CANADA   MEDICAL  RECORD. 


219 


plastic  operalions,  colporraphy,  jjeiineorraphy  and 
tincliL'loiiajiliy  with  sliortcning  of  the  round  hga- 
nients,  for  experience  has  sliown,  lie  says,  that 
isolated  operations  are  (luickly  followed  by  a 
return  of  the  displacemeiu.  In  thirty  cases  thus 
treated  he  has  had  twenty-seven  cures  and  three 
jiartial  failures.  In  a  private  letter  which  I  have 
lately  received  from  I)r.  Kellog,  of  liattle  Creek, 
Mich.,  he  writes  :  "  1  have  been  doing  a  consid- 
erable work  with  Alexander's  operation,  and  per- 
formed my  fifty-fourth  case  the  other  day.  I  have 
got  the  operation  down  to  a  pretty  fine  point,  so 
that  I  now  do  it  without  ether.  I  usually  find  the 
ligament  in  from  six  to  seven  minutes,  so  I  make 
short  work  of  it." 

Although  I  have  seen  \)retty  good  results 
in  suit.d)le  cases  from  this  method  alone  or  com- 
bined with  colporrhaphy,  I  have  been  inves- 
tigating in  another  direction,  namely,  to  ascertain 
whether  tone  may  not  be  restored  to  the  relaxed 
nuiscular  tibres  of  the  uterine  ligaments,  by  means 
of  the  interrupted  faradic  current.  My  paper  on 
this  subject  may  be  seen  in  the  Ann'rlciDi  .hiuniiil 
of  Olisletrics  for  June,  i88S.  I  am  inclined  to 
think  that  we  have  in  this  means  a  resource  which 
may  i^rove  of  the  greatest  possible  advantage. 
S|)eaking  of  fibroids,  my  friend,  Dr.  Kellog,  writes 
tliat  he  is  obtaining  cheering  success  with  Apos- 
toh's  method  ;  although  he  says  he  does  not 
succeed  in  getting  the  patient  to  bear  as  large  a 
current  as  I  frequently  do,  namely,  200  to  250 
miUiamperes.  'I'his  is  probably  owing  to  differ- 
ence in  size  of  the  electrodes  ;  tlie  larger  the 
electrode  the  less  the  friction  and  the  greater  the 
current  that  may  be  borne.  He  says  he  has 
discharged  several  patients  cured,  and  has  several 
more  progressing  rapidly  in  that  direction.  My 
own  success  with  Apostoli's  method  in  treating 
fibroids  has  gratified  me  more  than  anything  I 
have  ever  done ;  I  have  at  present  eight  cases 
under  treatment  in  various  stages  of  recovery. 

I  intend  to  give  a  full  report  of  every  case  1  have 
treated,  but  in  the  meantime  I  can  say  that  its  use 
has  always  been  followed  by  great  relief  or  more 
often  complete  cure  of  the  pain. 

Secondy  :  that  menstruation  has  been  rendered 
normal  both  as  to  time  and  to  quantity. 

Thirdly  :  That  the  flow  has  been  increased  when 
it  was  scanty,  and  diininished  to  normal  when  it 
was  profuse. 

Fourthly :  That  the  size  of  the  abdomen  has 
invariably  diminished,  although  in  some   cases  it 


was  not  striking,  and  in  other  cases  the  decrease 
in  the  size  of  the  tumor  has  been  counterbalanced 
by  a  large  deposit  of  fat  in  the  abdominal  wall. 
Fifthly  :  The  obstinate  constii)ation  and  the 
distension  of  the  colon  with  gas  has  invariably 
been    reinoved  ; 

And  .Sixthly :  The  canal  which  sometimes 
resists  the  intr.idiiction  of  the  sound  during  5 
or  6  seances  has  become  in  every  case  a  matter 
of  the  greate-t  facility  to  enter. 

I  frankly  admit  it  is  tedious,  requires  untiring 
attention  to  details, and  is  only  absolutely  safe  on 
the  condition  that  the  latter  are  never  for  one 
moment  negle(  led. 

As  several  cases  of  acute  poisoning  with  Bi- 
chloride of  mercury  have  been  lately  reported  in 
medical  journals  of  different  countries,  and  as  I 
have  had  one  case  which  1  have  already  reported, 
in  which  diarrhoea  and  collapse  occurred  after  an 
intrauterine  injection  of  a  one  in  three  thousand 
solution,  it  would  be  well  to  warn  obstetric  prac- 
titioners of  the  danger  of  using  bi-chloride  for 
those  ])ur[)oses.  Although  I  was  at  the  time  under 
the  impression  that  the  accident  was  due  to  my 
having  neglected  to  thoroughly  empty  the  vagina 
of  the  surplus  liquid  retained  there,  the  writers 
who  have  reported  the  cases  I  now  refer  to  seem 
to  be  of  the  opinion  that  the  absorption  took  place 
through  the  placental  site  of  the  uterus,  and  this 
opinion  would  seem  to  be  borne  out  by  the  fact 
that  I  have  given  several  thousand  vaginal 
douches  of  the  one  in  five  thousand  bichloride 
solution,  without  a  single  bad  effect.  In  any  case, 
I  think  it  would  be  belter  to  discard  the  corro- 
sive sublimate  altogether  in  obstetric  practice,  as 
we  possess  in  the  permanganate  of  potash  a  means 
totally  devoid  of  danger,  yet  probably  quite  as 
effective.  1  have  been  for  many  years  in  the 
habit  of  using  it  after  delivery  in  the  strength  of 
one  in  forty  of  the  Liquor  Pot.  Permanganaiis,  and 
invariably  with  the  result  of  speedily  reducing  the 
temperature  when  above  normal.  In  f;ict,  with  a 
thermometer  carefully  used  to  detect  the  disease 
at  the  beginning,  and  a  return  flow  Fritz-Boze- 
man's  intra-uterine  catheter,  and  plenty  of  per- 
manganate solution,  I  almost  feel  that  I  might 
bid  defiance  to  puerperal  fever,  as  out  of  367 
cases  I  have  not  lost  one  from  this  dread  disease, 
the  only  death  which  I  have  ever  had  being  a 
case  of  heart  failure  in  a  woman,  whom  I  saw  for 
a  confrere,  and  who  was  delivered  prematurely 
and   incidentally.     In    every   case    of  abnormal 


220 


TtiE  CANADA  MtiDt(3At  EfitiORD. 


temperature  the  fever  has  been  immediately- 
brought  down  by  the  removal  of  the  septic  mate- 
rial by  tie  permanganate  or  carbolic  acid  solution, 
which  I  sometimes  use  when  the  parmanganate  is 
not  at  Ik  :id.  There  is  still  a  growing  feeling  that 
the  less  the  parturient  woman  is  examined  the 
better,  even  by  the  doctor,  still  more  is  it  abso- 
lutely necessary  that  the  patient  be  warned  not 
to  allow  herself  to  be  examined  by  the  mid-wife  or 
nurse,  who  has  no  idea  of  the  germ  theory  and  the 
value  of  nail-brushes. 

From  inquiries  whicii  I  have  been  making 
among  my  confreres,  both  in  town  and  country,  1 
have  roaion  to  believe  that  tlie  death  rate  in  mid- 
wifery in  private  practice  has  very  greatly 
decreased  during  the  last  year  or  two,  although 
in  lying  in  hospitals  it  is  still  much  larger  than  it 
should  be,  owing,  no  doubt,  to  the  difficulty  in 
making  student  nurses  or  jiupils  believe  in  the 
existence  of  disease  germs.  Many  of  the  best 
teachers  on  the  continent  are  beginning  to  employ 
external  jialpation  alone  for  diagonising  the  posi- 
tion of  the  fcetus. 

I  had  tlie  pleasure  a  few  weeks  ago  of  assisting 
Dr.  Gardner  at  a  Tait  operation  for  laceration  of 
the  perineum.  Until  I  had  seen  it  I  could  not 
have  believed  liiat  it  could  have  been  so  simple, 
and  that  the  result  could  be  so  satisfactory.  It 
consists  simply  in  splitting  up  the  rectal  and 
viginal  Haps  of  the  recto  vaginal  septum  to  a 
depth  of  half  an  inch  or  so,  and  extending  upwards 
to  the  last  myrtiform  caruncle  on  either  side. 
The  tvvo  sides  are  then  brought  together  with 
three  or  four  silk  worm  gut  sutures,  which  are  left 
in  for  ten  or  eleven  days.  By  introducing  them 
a  line  inside  the  edge  of  the  skin,  the  patient  is 
saved  the  pain  which  would  be  caused  by  the 
traction  on  the  skin.  She  should  especially 
abstain  from  drinking  any  milk  for  two  weeks 
after  the  operation,  because  it  always  causes 
large,  solid  stools.  Her  principal  nourishment 
should  be  thin  gruel  and  beef  tea,  which  leave 
almost  no  residue. 

Somi§  3nmceditiqi. 

MEDICO-CHIRURGICAL      SOCIETY      OF 
MONTREAL. 
Sluied  Ale(t!n(j,  May  4th,  1888. 
James    Perrigo,    M.D.,     President,    in    the 
Chair. 
Dr.  W.  G.  Stewart  was  elected  a  member  of  the 
Society, 


Hemiglossitis. — Dr.  Shepherd  described  a  case 
of  hemiglossitis  which  had  recently  been  under 
his  care  in  the  General  Hospital.  The  patiejit 
was  a  young  man,  30  years  of  age,  and  the  glos- 
sitis was  limited  to  the  right  half  of  the  tongue. 
The  attack  was  ushered  in  by  fever  and  malaise, 
and  the  case  rapidly  recoveied.  Dr.  Shepherd 
remarked  that  this  was  a  very  rare  affection,  and 
much  less  severe  than  ordinary  glossitis.  It  usu- 
ally occurs  in  the  left  half  of  the  tongue. 

Severe  Bants  treated  hy  S/ciiigr'iftiiig. — Dr. 
BiiLL  exhibited  a  case  of  severe  burn  of  the  fore- 
arm treated  by  skin-grafting.  Patient,  aged  24, 
had  both  forearms  severely  burnt  with  boiling 
beer.  After  a  couple  of  weeks'  treatment  both 
forearms  and  arms  from  the  wrists  to  two  inches 
above  the  elbow  joints  were  found  to  be  deprived  of 
skin  and  covered  with  granulations,  with  the  excep- 
tion of  a  narrow, irregu'ar  patch  on  the  pusl^  1  ior  sur- 
face of  each  forearm  where  vesic.ition  only  had 
occurred.  On  the  6th  of  January,  18S8,  the 
granulating  surfaces  were  scraped  with  Volk- 
mann's  spoons,  thoroughly  cleansed  with  subli- 
mate solution,  and  covered  with  skin  transplanted 
from  the  thighs  by  Thiersch's  method.  The  dress- 
ings were  removed  at  the  end  of  three  weeks, 
when  it  was  found  that  the  skin  had  taken  every- 
where with  the  exception  of  a  few  small  isolated 
spots.  These  were  afterwards  transplanted  in  the 
same  manner,  and  the  skin  completely  reproduced. 
The  patient  has  now  been  at  work  for  over  a 
month,  and  his  arms  remain  perfectly  well,  the 
skin  remaining  unbroken  and  free  from  contrac- 
tion. 

PATlIOI.OeaCAL     SPECIMENS. 

Piinnchyinatous Nephritis. — Dr.  H.  A.  Lafi.eur 
exhibited  for  Dr.  R.  L.  MacDonnell  specimens 
from  a  case  of  chronic  parenchymatous  nephritis. 
Both  kidneys  were  enlarged,  soft,  and  of  a  mottled, 
reddish -yellow  color.  The  capsules  were  non-ad- 
htrent.  The  cortex  was  thickened  and  its  stria- 
tion  indistinct.  Under  the  microscope  some  of 
the  tubules  where  found  denuded  of  epithelium, 
while  in  others  the  lumen  was  occupied  by  a  fatty 
granular  detritus.  The  glomeruli  showed  com- 
mencing amyloid  change. 

Epithelioma  of  Inferior  Maxilla. — Dr.  Lafleuk 
exhibited  for  Dr.  Shepherd  half  of  the  inferior 
maxilla,  removed  for  epithelioma  secondary  to 
disease  of  the  lower  lip.  The  mass  of  new  growth 
v/as  situated  at  angle  of  the  jaw,  and  contain- 
j  ed  in  its    central    portion   a  yellowish   grumous 


THE  CANADA   MEDICAL  RECORD. 


221 


material  ami  a  thin  mucoid  fluid.     Numerous  epi- 
thelial cell-ncsts  wt'ic  seen  with    the  microscope. 
Dr.  SiiFvi'iii:i(D  stated  tliat  the  disease  had  recurr 
C(!  after  removal  of  the  lower  lip,  eighteen  months 
before.     'I'lie  patient  was  a  man  aged  50,  and  in 
good  health.     There  was  some  enlargement  of  the 
cervical   glands.     The  jaw  was   removed   witiiout 
much  difticulty  and  with  Httlc  hemorrhage,  but  in 
di.ssecting  out    the  infiltrated  glands  in    the    neck 
which  were  behind  the    vessels  the    jugular  vein 
was   lorn  and   had  to    be    ligated.     'I'he   patient 
made    a    good   recovery,  the    temperature    never 
rising  above  100 '^ .  Dr.  Shepherd  mentioned  that 
this  was  the  fourth  time  he  had  tied  the  interna' 
jugular  vein  in  the  course    of  operations   on    the 
neck,  and  had  never  seen   any  bad  results   follow. 
Exostosis  Bursa  I  a. — Dk.  Bell  exhibited  an  exos 
tosis  which  he  had  removed  from  the  inner  border 
of  the  lower  end  of  the  right   fumur  in    a    boy  10 
years  of  age.     The  bony  gtowth,  which  was  about 
the  .size  of  a   fameuse  apple,    appeared  to   spring 
from  the  linea   asjieia   below    the  epiphysal    line. 
It  had  a  bony  pedicle  about    three-quarters  of  an 
jnrh  long  and   about  half  an  inch  in  diameter,  and 
grew  upwards  and  inwards  at  an    angle  of  about 
.15  °  with  the  line  of  the  shaft  of  the    femur.     Its 
surface  was  rough   and  covered  with   cartilage    in 
small  isolated  pieces,  which  were    closely   placed, 
and  formed  a  continuous  layer  over  its  surface,  and 
the  whole  was  enclosed  in  a   perfectly  formed  sy- 
novial membrane,  which  became  continuous  with 
the  ]ieriosteum  of  the  pedicle  at    the  cartilaginous 
border  of  the  tumor,  and  contained   about  half  an 
ounce    of  clear,    amber-colored,  viscid    synovial- 
like  secretion,  in    which  floated    loosely    fifty-four 
small  cartilaginous  bodies   exactly    corresponding 
to  the  "  floating  cartilages  "   occasionally  found  in 
joints,  especially  the  knee  and  elbow.     The  tumor 
was  said  to  have  been  noticed  nine   years   ago  as 
a  small  soft  and  iiKicahh  growth,   about    as    large 
as  a  marble.     It  grew  steadily,  but  only  four  years 
ago  it  became  fixed  and  lelt  hard.     It  never  gave 
any  pain  or  other  symptom  except  inconvenience 
■   and  fatigue  of  the  muscles  in    walking,   and  espe- 
cially in  going  upstairs.     The  only  record  of  any 
similar  cases  which  Dr.  Bell  has  been  able  to  find 
was  in  a  paper  read  by  Dr.  Fehlei.sen   at  the  faur- 
teenth  Congress  of  the  "  Deutschen    Gesellschaft 
for  Chirurgie  "  in  Berlin  in  1885.     In  his  paper  en- 
titled   "    Ziir    Casuistik   Jer  E.cnstosi's  Burmt"^, " 
Dr,  Fehleisen  reports  a  case  which  had    ocriirred 

in  Prof.  Bergmanii's  Klimk,  and  refeta  to  another 


which  had  occurred  in  Billroth's  klinik  in  1863, 
and  which  he  believes  to  be  the  only  one  on  record 
at  this  time  (April,  1885).  These  two  cases  corres- 
ponded with  the  case  related  by  Dr.  Bell  in 
every  particular.  In  Bergmann's  case  the  sy- 
novial membrane  contained  about  500  loose 
cartilaginous  bodies  (486  were  collected),  and  in 
Billroth's  case  35  were  found. 
The  latter  case  was  carefully  investigated  by  Rind- 
flicsch,  who  came  to  the  conclusion  that  it  had' 
originated,  not  as  an  ordinary  exostosis  from  the 
intermediary  epiphysal  cartilage,  but  as  an  ecchon- 
drosis  of  the  cartilage  of  the  joint,  which  had  push- 
ed out  a  portion  of  the  synovial  menbrane,  which 
in  time  had  become  cut  off  from  the  joint,  and 
formed  a  separate  sac  over  the  tumor.  Fehleisen, 
however,  attributes  these  tumors  to  a  develop- 
mental error  by  which  a  group  of  cells,  separated 
from  the  joint  and  lying  dormant  as  an  indifferent 
cell  mass  for  a  variable  period,  springs  into  active 
growth,  and  produces  this  special  form  of  exostosis. 
He  also  points  out  that,  although  the  ordinary 
exostosis  which  frequently  grow  from  the  epiphysal 
line  at  the  ends  of  the  long  bones,  especially  the 
femur  and  humerus,  are  often  covered  or  partially 
enclosed  in  bursoe  mucosas,  these  cavities  never 
contain  free  cartilaginous  bodies.  Moreover,  he 
ascribes  the  origin  of  the  free  "  floating  cartilages" 
to  tufts  of  the  synovial  membrane,  in  which  are 
found  minute  islands  of  hy.iline  cartilage,  which  de- 
velop and  are  set  free  into  the  cavity  of  the  syno- 
vial sac,  both  in  the  larger  joints  and  in  the  exostosis 
bursata. 

Discussijm. — Dr.  Shepherd  said  the  case  was  a 
most  interesting  one  from  the  light  it  threw  on  the 
formation  of  floating  cartilage  in  joints.  He  was 
convinced  that  the  little  buds  of  cartilage  growing 
from  the  inside  of  the  synovial  meinbranes  were 
the  origin  of  the  free  cartilaginous  bodies.  They 
no  doubt  grew  till  they  fell  off  from  their  own 
weight.  This  form  of  exostosis  he  had  never  seen 
before  ;  the  ordinary  exostosis  is  comparatively 
common,  and  grows  from  the  epiphysal  cartilage, 
and  stops  growing  with  the  maturity  of  the  indi- 
vidual. He  had  seen  two  well-marked  cases  within 
the  last  few  weeks ;  one  was  in  a  boy  of  16,  which 
had  reached  a  considerable  size  and  was  continu- 
ally growing.  Billroth,  in  his  Clinical  Surgery, 
mentions  a  case  of  exostosis  bursata  olecrani. 

Dr.  Fenwick  said  that  thi^  c,ase  was  a  unique 
one,  so  far  as  his  experience  went.  He  had  in  his 
po5§e§sion  a  It^rge  exostosisj  or  the  lower  end  of 


222 


THE  CANADA  MEDICAL   RECORD. 


the  femur.  It  had  firm  compact  tissue  on  the  out- 
side, but  inside  it  was  made  up  of  loose  cancellous 
tissue  with  a  number  of  free  pieces  of  bone.  He  had 
obtained  this  from  the  dissecting-room,  and  he  was 
unable  to  say  whether  or  not  there  was  a  bursa  in 
connection  with  it,  but  it  was  covered  Yith  cartil- 
age. 

Patent  Foramen  Ovale.— Dr.  Richard  Mac- 
DoNNELL  exhibited  a  heart  showing  a  patent  for- 
amen ovale.  The  heart  had  been  found  in  the  dis- 
secting-room last  winter.  The  body  from  which 
it  was  taken  was  that  of  a  young  woman,  age  25, 
who  had  died  in  the  Montreal  General  Hospital  of 
phthisis  with  empyema.  Dr.  MacDonnell  first  saw 
the  case  in  1883,  when  she  came  to  the  out -door 
department,  suffering  from  primary  syphilis.  She 
was  very  thin  and  delicate,  but  there  was  no  evi- 
dence in  life  that  she  suffered  from  any  vascular 
derangement.  Her  mental  faculties  were  defective. 
During  that  year  she  was  a  constant  attendant  a 
the  clinic,  presenting  many  well-marked  symptoms 
of  secondary  syphilis,  notably  alopecia,  sore  throat, 
and  iritis.  In  1884  and  1885  she  was  admitted 
to  the  wards  on  several  occasions,  and  her  chest 
was  frequently  examined,  but  no  evidence  of  car- 
diac disease  was  ever  found.  The  last  admission 
was  on  May  8th, when  distinct  evidences  of  phtliisis 
were  seen.  She  died  June  7th,  1887,  with  e.Ntensive 
softening  of  right  lung  and  a  thickened  pleura  con- 
taining pus.  Dr.  MacDonnell  thus  had  the  case  up. 
der  observation  for  four  years,  without  having  noti- 
ced any  cardiac  symptoms  or  physical  signs  of  defec 
tive  heart  action.  The  opening  in  the  fossa  ovalis 
was  of  large  size. 

Suprapubic  Cystotomy. — Dr.  Roddick  exibited 
a  calculus  weighing  15  drachms,  which  he  had  re- 
moved from  a  man,  aged  52,  by  the  suprapubic 
operation.  Twelve  years  ago  he  had  removed  a 
stone  from  the  same  man,  by  the  lateral  operation. 
He  remained  well  up  to  eighteen  month  ago,  when 
symptoms  of  stone  reappeared.  He  preferred  the 
suprapubic  operation  on  this  occasion,  because  of 
the  large  size  of  the  stone,  and  because  he  had 
formerly  performed  the  lateral  operation.  He  did 
not  suture  the  bladder. 

Discussion. — Dr.  Fenwick  was  present  at  the 
operation,  and  congratulated  Dr,  Roddick  on  the 
success  of  his  operation.  He,  however,  saw  no  iea> 
son  why  a  previous  operation  should  contiaiiidicitt 
a  second  one.  He  had  several  times  operated  4  se- 


cond time  with  success  ;  on  one  patient  he  had  ope- 
rated four  times  successfully.  He  thought  tliat 
entering  the  bladder  by  the  perineum  is  the  most 
natural  way,  and  there  is  no  danger  of  hemorrhage 
and  infiltration  of  urine  as  in  the  suprapubic.  He 
had  removed  very  large  stones  by  the  lateral 
method  by  cutting  both  sides  of  the  prostate. 

Dr.  Shepherd  could  not  agree  with  Dr.  I""en- 
wick  that  lateral  lithotomy  was  the  most  natural 
and  easiest  operation.  In  cases  of  suprapubic 
lithotomy  he  preferred  to  introduce  a  drain  in 
the  abdominal  wound  and  to  sature  the  blad- 
der, so  that  if  the  bladder  did  not  unite  by  first 
intention  there  would  be  an  outlet  for  the  mine. 
The  bladder  should  be  drained  by  a  catheter  in 
the  urethra. 

Dr.  Hkll  said  the  bladder  could  not  be  tho- 
roughly drained  tiirough  the  penis.  He  believed 
the  ojieration  of  the  fiiture  will  be  suprapubic 
lithotomy  with  drainage  through  the  perineum. 

Dr.  Roddick.,  in  reply,  said  tliat  the  chief  rea- 
son why  he  had  made  use  of  the  high  operation 
was  on  account  of  the  large  size  of  the  stone. 
With  regard  to  suturing  the  bladder,  recent  disas- 
trous results  had  been  reported  by  Thompson 
and  others. 

Poisoning  hy  Bichromate  of  Potash.  — Dr.  RuT- 
TAN  read  for  Dr.  Lafieur  and  himself  a  paper  on 
bichromate  poisoning. 

Dr.  Stewart  asked  Dr.  Ruttan  if  the 
ordinary  symptoms  produced  by  nitrites  could 
be  explained  by  the  formation  of  haemoglobin. 

Dr.  Reed  referred  to  a  case  of  bichromate  poi- 
soning reported  in  the  London  Lancet  in  which 
death  occurred  in  55  minutes.  The  man  had 
taken  four  drachms  of  salt.  Cases  of  recovery 
after  taking  10  to  15  grains  had  been  reported. 
Sym|>toms  were  vomiting,  pain  and   hernorrhage. 

1)K.  Ruttan,  in  reply  to  Dr.  Stewart,  said  that 
while  the  toxic  symptoms  of  nitrites  were,  in 
his  opinion,  undoubtedly  due  to  methjemoglobin, 
the  ordinary  nervous  symptoms  produced  by 
nitrites  could  not  be  so  easily  accounted  for. 
The  methsemoglobin  in  the  blood,  by  preventing 
the  projjer  oxidation  of  cerebral  centres,  must 
uiipair  their  functional  activity.  The  lowered 
temperature  after  the  administration  of  nitrite  of 
amvl  and  potassium  nitrite  is  more  easily  ex- 
plainsd  by  deficient  oxidation  produced  by  this 
blocd  change  ;han  any  other  way. 


TOE   CANADA   MEDICAL    RECORD. 


223 


Stated  Meeting,  Afoi/  18th,  1888. 
Dr.  Trenholmk  in  thk  Chair. 

iV;^  .Wemhers.—Drs.  J.  H.  Bell,  R.  ('.  Kirk- 
patrick,  J.  A.  Springle  and  J.  E.  Orr  were  olectL-d 
menihcrs  of  the  Society. 

Miditjinnit  Tumor  I// the   Sphir. — Dr.  LaflEUR 
exhihited  specimens  and  sections  from  a  case  of 
alveolar    .sarcoma    of    the    vertebrae.       At    the 
autopsy    performed    by    Dr.    Bell,  a  tumor  was 
found  involving  the  posterior  part  of  the  bodies 
and    the    laminre  of    the    9th   and     loth  dorsal 
vertebrae    and     the      inter-vertebral     cartilage. 
'J'here    was    in     this     situation    unusual    mobi- 
lity   of  the  vertebral  column  and  slight   prom- 
inence   of    the    spinous  processes.      The    new 
growth  could  also  be  felt  anteriorly  at  the  base  of 
the  pleural  sac  as    a  conve,\    bony    ring  half  an 
ini  h  in  thickness,  which  was  found  to  be   the  ex- 
panded and  ossified  edge  of  the  9th  inter-vertebral 
i.lisk.      There  was  no  involvement  of  the  preverte- 
bral structures,  but  the  spinal   muscles  on   both 
sides  of  the  affected  vertebra;  were  infiltrated.    A 
longitudinal  section  of  the  vertebra;  showed  that 
the  cord  was  affected  only  from  pressure  by  the 
new   growth,    which   completely   surrounded    it. 
Below  the  point  of  pressure  the  cord  was  soften- 
e.l .   The  ninth  inter-vertebral  disk  was  destroyed, 
all  that  remained  being  a  thin  calcareous  plate 
between  the  vertebrae  and  the  ossified  edge  of  the 
cartilage  before  mentioned.     On  the  under  sur- 
face  of  the  left  lobe    of  the  liver   there  was  a 
secondary  nodule  as  large  as  a  small  hazel-nut,  and 
of  a  pinkish-white  color.     This  was  the  only  me- 
tastatic growth  in  the  body.  Microscopically  the 
growth  was  found  to  be  an  alveolar  sarcoma,  con- 
sisting of  somewhat  large  oval    cells,  with  large 
nuclei   in    an   alveolated    fibrous    stroma.      The 
cells  did  not  lie  free  in  the  alveolus,  but  wereheld 
together  by  a  network  of  fine  fibres  derived  from 
the  alveolar  wall.     In  the  secondary  nodule  from 
the  liver  the  alveolar  structure  was  more  obscure. 
Patient  suffered  from  chronic   cystitis  and  bed- 
sores, and  the  immediate  cause  of  death   was   a 
double  basic  pneumonia. 

Dr.  Bell  gave  the  following  history  of  the  case  ; 
-^The  patient  was  a  man,  age  60  years,  who  had 
long  been  a  hard  drinker,  but  who  had  never  had 
venereal  disease  of  any  kind.  He  began  to  com- 
plain of  "  lumbago  "  in  November,  18S7,  which 
grew  worse  until,  in  the  early  part  of  March,  his 
legs  grew  so  weak  that  he  coiikl  not  get  .about. 


Complete  paraplegia  soon  followed,  incontinence 
of  urine,  loss  of  sensation  around  the  abdomen. 

A  jiainlul  [jrominence  was  noticed  over  the  fourth 
and  fifth  dorsal  vertebra;,  and  he  e.xperienced  great 
pain  in  this  region  when  being  moved.  He  sank 
rapidly,  and  died  from  a  hypostatic  pneumonia. 

Dr.  Stewart  said  that  he  saw  the  patient,  and 
found  loss  of  motor  power  and  partial  loss  of  sen- 
sation, which  were  strong  indication  of  pressure. 
The  systemic  disturbance  was  too  great  to  be  ac- 
counted for  except  by  the  presence  of  malignant 
disease. 

Some  Cluiiail  Obscrvalunis  on  Si/i'hilis. — Dr- 
Roddick  read  a  paper  on  the  above  subject. 

T)iscussioH. — Dr.BELL  said  that  Dr.  Roddick's 
interesting  series  of  cases  suggested  several  cases 
in  his  experience  in  which  the  disease  had  been 
contracted  in  an  unusual  way.  One  case  was  that 
of  a  young  lady  who  had  a  doubtful-looking  sere 
on  her  lip  which  was  followed  by  secondary  symp- 
toms. The  cause  of  the  primary  sore  was  traced 
to  her  having  been  kissed  by  a  man  who  at  the  time 
was  under  treatment  for  secondary  syphilis.  Later 
the  patient  showed  many  symptor,-,s  of  secondary 
syphilis.  In  his  experience,  cases  treated  with 
potassium  iodide  are  not  relieved  so  rapidly  and 
certainly  as  when  treated  by  mercury,  except  in 
the  tertiary  stage  of  the  disease.  He  had  met 
cases  supposed  to  be  receiving  treatment  without 
mercury  which  were  really  undergoing  mercuria 
treatment. 

Dr.  MacDonnell  said  that  the  peculiar  liability 
of  glass  blowers  to  take  syphilis  is  mentioned  by 
very  old  writers  on  this  subject.  It  is  strange  there 
is  not  more  extragenital  syphilis  contracted  than 
there  is.  The  habit  of  using  public  combs  and 
brushes  in  hotels  and  in  barber  shops  is  very 
dangerous,  yet  he  had  never  heard  of  a  case  where 
the  disease  was  contracted  in  this  way.  With  re- 
gard to  treatment,  he  believes  in  the  use  of  mercury 
from  the  very  first.  Cases  where  treatment  is  delay- 
ed are  apt  to  be  more  violent.  Dr.  MacDoNNELL 
asked  Dr.  Roddick  in  what  cases  of  chancre  he 
would  recommend  the  use  of  mercury  at  once. 

Dr.  Shepherd  had  seen  secondary  symptoms 
follow  in  the  case  of  a  girl  bitten  by  another  girl  on 
the  lower  lip.  A  small  indolent  but  well-defined 
sore  marked  the  spot  where  the  wound  was  made. 
Dr.  .Shepherd  also  referred  to  the  case  of  a  medical 
man,  who  would  not  be  likely  to  overlook  a  specific 
sore  on  himself,  that  e^me  tg  him  with  marked 


224 


THE   CANADA   MEDICAL   RECORD. 


secondary  symptoms,  but  could  give  no  idea  of  how 
he  had  contracted  the  disease  beyond  the  fact  that 
he  was  exposed  to  it  in  the  course  of  his  practice. 
He  had  never  had  anytiiing  resembHng  a  primary 
sore.  With  regard  to  treatment,  he  did  not  believe 
it  was  always,  not  even  generally,  possible  to 
abort  the  secondary  symptoms  by  immediate  treat- 
ment. The  Germans  are  divided  between  the 
value  of  baths  and  of  mercury.  He  believed  that 
mercury  at  least  had  the  i)ower  of  postponing  the 
secondary  rash.  He  was  in  the  habit  of  waiting  until 
the  early  secondary  symptoms  ajtpeared  before 
beginning  specific  treatment.  He  had  lately  seen 
several  cases  of  multiple  chancre  where,  after  a 
week  or  ten  days,  one  or  more  would  take  on  the 
appearance  of  a  hard  chancre,  and  then  only  yield 
to  mercurial  treatment.  Hutchinson  thinks  that 
cases  can  be  cured  from  the  beginning,  but  this  has 
been  disputed.  A  class  of  patients  that  are  diffi- 
cult to  treat  are  those  in  which  severe  salivation 
follows  very  small  doses  of  mercury.  He  always 
uses  mercury  in  the  |)rimary  and  secondary  stages, 
but  prefers  potassium  iodide  in  the  tertiary. 
Where  potassium  iodide  disagrees  with  the  patient, 
the  ammonium  salt  is  often  found  serviceable. 
Some  recent  observations  and  comparisons  go  to 
show  that,  in  Portugal,  at  any  rate,  syphilis  is  not 
of  so  virulent  a  type  as  formerly. 

Dr.  J.  C.  Cameron  held  Hutchinson's  opinion 
as  to  the  curability  of  the  disease.  He  finds  in 
many  cases  small  doses  of  grey  powder  a  very 
efficient  way  of  introducing  mercury.  He  had 
seen  cases  of  soft  external  sores  that  subsequently 
took  on  a  specific  appearance  from  contamination, 
owing  to  the  presence  of  an  unsuspected  hard 
sore  in  the  urethra.  He  did  not  think  medical 
men,  as  a  rule,  expressed  themselves  strongly 
enough  regarding  the  best  means  of  prophylactic 
treatment.  This  is  a  matter  that  should  be  taken 
up  and  dealt  with  by  every  Board  of  Health. 
He  advocated  a  ligid  system  of  inspection,  In 
cities  in  Europe  where  this  has  been  done  the  fre- 
quency of  the  disease  has  rapidly  decreased.  He 
was  lately  imformed  by  a  surgeon  of  a  case  where 
one  hundred  men  had  been  infected  from  one 
source.  At  a  recent  meeting  of  the  Ac.idemy 
of  Physicians  in  Paris,  several  sessions  were  de- 
voted to  the  discussion  of  this  important  subject. 

Dr.RoppiCK,  in  reply,  said  he  quite  agreed  with 
the  last  speaker,  that  sotnethiiig  should  be  di>r.e  i-^ 
protect  innocent  persons  from  this  disefts-,  In 
answer  to  Dr.  MacDonnell,  he  said  that  thy  hisioiy 


of  a  sore  was  the  best  guide  to  the  treatment.  He 
finds  that  if  the  sore  comes  on  over  ten  days  after 
exposure,  in  at  least  85  per  cent,  it  is  hard  chan_ 
ere.  In  doubtful  cases  he  wails  for  the  appear, 
ance  of  enlarged  glands  in  the  groin.  It  is  not  to 
be  forgotten  that  soft  sores  sometimes  take  on  a 
specific  character  after  a  few  days.  He  had  given 
grey  powder  in  one-grain  doses,  but  not  habitu- 
ally. He  usually  administers  mercury  in  the  form 
of  j{  grain  jirotiodide  pills.  He  has  found  that 
where  ])otassium  iodide  disagreed  with  a  ]iatient, 
sodium  iodide  could  be  substituted  with  advantage. 
Ill  conclusion,  Dr.  Roddick  said  he  was  satisfied 
that  syphilis  was  less  virulent  now  than  formerly. 
The  aggravated  rupial  syphilis  of  the  older  writers  is 
now  very  rare  ;  doubtless  the  poison  is  becoming 
attenuated. 


Stated  Meeting,  June  \st,  1888. 
Ja.s.  Perrigo,    M.D.,  President,  in  the  Chaib. 

Dr.  C.  W.  Haentschel  was  elected    a    member. 

Fihroiis  Titmar  of  the  Tlu'yh Dr.  Lafleur  ex- 
hibited the  specimen  for  Dr.  Fenwick,  and  said 
that  the  tumor,  a  fibro-sarcoma,  was  oval  in  shape, 
7  in.  long,  4  in.  wide  and  3  in.  thick,  very  firm 
and  hard,  and  invested  in  a  fibrous  capsule.  On 
section  the  central  part  was  found  to  be  ossified, 
and  of  a  greyish  white  colour,  while  the  outer 
portions  were  soft  and  of  a  pinkish-white  colour- 
The  latter  showed  under  the  microscope  inter- 
lacing bundles  of  spindle  cells,  with  oval  nuclei, 
while  the  former  consisted  of  an  irregular  alveolar 
structure  simulating  bone,  with  very  few  spindle 
cells. 

Dr. Fenwick  said  that  the  tumor  was  removed 
from  a  woman  aged  45.  The  patient  had  no  con 
stitutional  symptoms  of  cancer,  and  there  was  no 
enlargement  of  the  inguinal  glands.  The  tumor 
felt  quite  movable,  but  was  bound  down  by  fascia. 
It  was  eight  years  in  growing,  and  its  appear- 
ance as  a  flat,  firm  swelling  could  be  traced 
(O  a  strain  caused  by  lifti  ng  a  sewing  machine. 
The  patient  said  that  she  remembered  feeling 
something  give  way  at  the  time.  It  was  for 
most  of  the  time  quite  painless,  but  latterly,  on  ex- 
ertion, sharp  paroxysmal  pain  was  produced.  There 
was  nn  tenderness  on  pressure,  and  no  spots  of 
sufieinng  could  be  felt.  The  operation  was  diffi- 
cult, as  the  growth  was  deeply  seated  on  the 
anterior  surface  of  the  ri-ht  thigh,  beneath  the 
n).isf.!ey,  and  was  firmly  attached  to  the  deep 
f4scia,    I'he  [.'atient  W(\s  now  convalescent. 


fflE  CANADA  MEDICAL  RfeCORD. 


226 


Enhirgcd  Testicle Dr.   Laflhiur  exhibited  an 

enlarged  testis  recently  removed  by  Dr.  Roddick. 
'J'esticle  was  the  size  of  a  turkey's  egg,  uniformly 
enlarged,  and  very  firm  and  elastic  to  the  feel. 
On  section  the  epididymis  was  found  to  be  en- 
tirely converted  into  a  somewhat  firm  caseous 
mass  of  a  dull  yellow  colour.  'I'he  body  of  the 
testis,  which  was  of  a  greyish  color,  was  studded 
with  gelatinous-looking  nodules,  having  the  size 
and  appearance  of  boiled  tapioca  grains,  and  in 
the  centre  of  each  of  these  was  a  minute  cas- 
eating  ])oint.  Towards  the  epididymis  these 
caseating  points  coalesced,  forming  bands  from 
the  Body  of  Highmore  to  the  circumference  of 
the  testicle.  Microscopic  examination  showed 
that  eachca  seating  point  corresponded  to  a  seminal 
duct,  the  lumen  of  which  was  filled  with  a  granular 
detritus,  while  the  caseating  process  extended  to 
some  distance  around  each  tubule.  The  inter- 
cellular tissue  was  greatly  increased,  and  consisted 
of  a  coarse  reticulum,  in  the  meshes  of  which  were 
small  lymphoid  cells  and  several  multinucleated 
giant  cells.  The  spermatic  cord  was  thickened 
and  hard,  and  showed  a  small-celled  infiltration 
around  its  lumen  which  was  filled  with  a  granular 
debris.  The  case  appeared  to  be  a  somewhat  an- 
omalous one  of  tubercular  testis,  the  change  affect- 
ing the  body  of  the  testis  generally  as  well  as  the 
ejiididymis  ;  the  rapidity  of  the  process  was  re- 
markable, and  might,  perhaps,  account  for  the 
absence  of  a  usual  solt  semi-fluid  caseous  matter 
generally  found  in  such  cases. 

The  following  history  was  furnished  by  Dr. 
Roddick  :  The  patient,  a  thin,  anaemic  looking 
man  about  46  years  of  age,  good  family  history, 
had  had  two  attacks  of  gonorrhceal  orchitis  several 
years  before,  from  which  he  ai)|)arently  perfectly 
recovered.  The  present  trouble  liegan  suddenly 
in  October  last  without  ajiparent  cause,  the  tes- 
ticle becoming  hard  and  enlarged  after  an  emis- 
sion. The  pain  was  never  great,  although  the 
swelling  gradually  increased  until  it  reached  the 
size  of  a  large  turkey's  egg.  It  was  dense  in  feel, 
with  the  exception  of  a  spot  on  the  anterior  aspect 
which  fluctuated,  and  from  which  about  a  drachm 
of  straw-colored  fluid  was  withdrawn  with  the  hy- 
podermic needle.  Dr.  Wilkins,  who  first  saw  the 
case,  strapped  the  testicle,  and  thus  gave  great  re- 
lief from  the  dragging  sensation  experienced.  He 
handed  the  case  over  to  Dr.  Roddick,  who  applied 
counter-irritation  in  various  forms,  but  with  very 
""indifferent  results.     Latterly  the  cord  became  firm- 


er and  more  thickened  than  normal,  and  on  the 
20th  of  June  the  testicle  was  excised.  The  case 
was  looked  ui)on  as  a  very  obscure,  and  no  diag- 
nosis was  made. 

Tumor  of  the  Spinal  Cord. — Dr.  Lafi.kur  ex- 
hibited for  Dr.  R.L.  MacDonnell  a  small,  oval 
tumor  removed  from  the  si)inal  cord  at  an  autopsy. 
'1  he  timior,  which  was  somewhat  bean-shaped, 
being  2.5  centimelresin  length, 1.00  cm.  in  breadth, 
and  1. 00  cm.  in  thickness,  was  situated  in  the 
anterior  and  right  surface  of  the  cord,  at  the  level 
of  the  sixth  pail  ()f  dorsal  nerves,  17.50  cm.  from 
the  Cauda  e{iuina.  It  lay  between  the  layers  of 
the  arachnoid  and  was  freely  movable,  being 
nowhce  attached  either  to  the  cord  or  to  the  dura 
mater.  Two  small  nerve  filaments  from  the  cord 
pa.ssed  behind  it,  but  were  only  superfically  attach- 
ed to  it.  The  tumor  was  moderately  firm  and  elas- 
tic, and  was  invested  by  a  distinct,  thin,  fibrous 
capsule.  On  section,  it  was  of  uniform  consistency, 
and  of  a  yellowish-grey  color.  Under  the  micros- 
cope, it  was  found  to  consist  entirely  of  irregularly 
distributed  bands  of  nucleated  fibrous  tissue.  No 
nerve  elements  and  few  bloods  vessels  were  found 
in  it.  The  cord  below  the  tumor  was  very  soft 
and  shrunken. 

Dr.  MacDonnell  said  that  the  patient  was  a 
man  about  50  years  of  age  and  of  laige  frame. 
Three  years  ago  he  began  to  have  difficulty  in 
walking,  and  complained  of  severe  pains  in  limbs. 
The  gait  at  this  time  was  spastic,  the  reflexes  were 
increased,  and  there  was  marked  ankle  clonus. 
The  paresisin  lower  extremities  increased  gradually, 
the  patient  becoming  finally  completely  paraplegic, 
with  loss  of  reflexes  and  sensation,  and  loss  of 
jiower  in  the  anal  and  vesical  sphincters.  He 
remained  in  this  condition  for  eighteen  months,  dur- 
ing which  time  he  had  complete  use  of  his  upper 
extremities  and  trunk  muscles.  The  cause  of  death 
was  a  double  basic  broncho-pneumonia.  The 
diagnosis  of  spinal  tumor  was  not  made,  the  patient 
being  supposed  to  suffer  from  sclerosis  of  the  late- 
ral columns  of  the  cord. 

Dr.  Spendlove  then  read  the  following  paper, 
entitled 

Some  Observations  upon  Tapeworms. 
Having  met  with  a  number  of  cases  of  tapeworm 
during  the  past  four  years.  I  propose  to  make  some 
remarks  upon  what  I  have  observed  in  connection 
with  them,  and  the  treatment  which  I  have  found 
the  most  successful  in  their  removal. 

Of  the  several  species  of  tapeworm,  two  only  are 


•226 


1?HE  CANADA  MEDiCAL  RECORO. 


commca  lo  America — the'  Taenia  solium,  or  pork 
tapewo  m,  and  the  Tsenia  medio-canellata,  or  beef 
tapeworm.  The  pork  tapeworm  is  most  frequently 
met  with  in  the  Southern  States  ;  the  beef  tape- 
worm in  the  Northern  States  and  Canada.  The 
oiigin  of  both  species  in  man  is  fiom  eating  raw  or 
underdone  measley  pork  or  fish,  in  the  case  of  the 
pork  tapeworm ;  and  raw  or  undergone  measley 
beef,  in  the  case  of  the  beef  tapeworm.  The  mea- 
sle  is  SLen  as  a  round  or  oval,  hard  and  whitish 
body,  from  the  size  of  a  mustard  seed  to  that  of  a 
pea;  it  contains  a  sac  of  connective  tissue  enclos- 
ing the  so!exor  larvce  tapeworm.  When  the  measle 
is  swallowed  by  man,  the  covering  of  connective 
tissue  is  digested  in  the  stomach,  IJie  solex  is  releas- 
ed, passes  into  the  small  intestines,  becomes  attach- 
ed to  the  mucous  memlirane  by  its  head,  develops 
and  grows  into  the  adult  worm.  The  time  usually 
taken  for  the  growth  of  an  adult  worm  is  from  three 
to  four  months. 

The  jjrincipal  differences  between  the  two  species 
of  adult  tapeworms  are  the  greater  length  of  the 
Tngnia  medio-canellata,  the  larger  size  of  the  head, 
the  absence  of  hooks,  the  greater  length,  breadth 
and  thickness  of  the  individual  joints,  and  the 
more  fully  developed  sexual  oi-gans. 

Regarding  the  symptoms,  there  are  none  which 
are  diagnostic  of  tapeworm ;  it  is  only  when  some 
of  the  joints  have  been  passed  that  we  can  arrive 
at  a  positive  diagnosis.  Yet  there  are  certain 
groups  of  symiitoms,  principally  of  a  reflex  nature 
that  should  make  us  suspicious  of  its  presences 
For  example,  when  we  meet  with  certain  case, 
where  several  well-marked  nervous  symptoms  are 
present,  without  reference  to  any  special  lesion  of 
the  nervous  system, — if  there  are  periods  of  perfect 
or  nearly  perfect  freedom,  and  especially  if  to  these 
are  added  various  ill-defmed  .symptoms  of  digestive 
disturbance,  if  we  do  not  in  these  cases  have  tape- 
worm in  the  mind's  eye,  we  often  do  an  injustice 
to  our  patient,  an  injury  to  our  professional  reputa 
tion,  besides  helping  to  feather  the  nest  of  the 
quacks. 

Treatment. — It  is  the  treatment  with  pumpkin- 
seed.s,  Ciicurhita  pepo.  tb.at  1  wish  to  direct  your 
attention,  and  [larticularly  the  manner  of  giving 
them,  which  I  have  found  the  most  successful,  and 
which  is  as  follows  :  First  allow  the  patient  to  take 
a  good  dinner  in  the  middle  of  the  day;  to  eat 
nothing  at  night ;  before  going  to  bed  take  a  dose 
of  sulphate  of  magnesia  (Epsom  salts)  sufficient  to 
cause  a  free  movement  of  the  bowels  ;  after  this  has 


taken  place,  give  half  to  two-thirds  of  a  teacupful 
of  pumpkin  seeds  free  from  the  shell,  direct  them 
to  be  eaten  slowly,  to  be  well  chewed,  and  to  be 
taken  dry.  About  three  hours  after  give  the  second 
dose  of  sulphate  of  magnesia;  after  that  the  patient 
can  take  his  regular  meals.  In  the  majority  of 
cases  the  worm  appears  from  5  to  9  p.m. 

I  would  paiiicularly  call  your  attention  to  the 
manner  of  giving  the  seeds  dry,  to  be  well  chewed, 
and  not  made  into  an  infusion  or  emulsion,  as 
generally  directed. 

Regarding  the  iiiddits  tqicrandi  of  the  seeds  upon 
tapeworm,  from  the  fact  that  they  act  best  given 
dry  and  well  chewed  (which  is  the  best  method 
for  the  absorption  of  their  active  jirinciple,  a  fixed 
oil),  and  from  the  fact  that  in  every  case  the  tape- 
worms have  come  away  unbroken,  and  in  many 
cases  alive,  including  the  head,  I  am  of  the  ojiinion 
that  it  acts  through  the  circulation  upon  the  head, 
and  not  as  an  irritant  to  the  body  of  the  worm. 
I  will  cite  a  few  of  the  more  important  cases  only, 
to  sliow  the  action  of  the  medicine. 

Case  I. — Painter  by  trade;  brought  me  some 
joints  of  a  beef  tapeworm  he  had  passed.  The  only 
symptoms  were  slight  abdominal  uneasiness,  if  he 
did  not  have  his  meals  at  regular  intervals.  Gave 
sulphate  of  magnesia  and  pumpkin  seeds  in  the 
form  of  an  emulsion  ;  no  effect.  A  few  days  after 
gave  magnesia  and  the  seeds  dry;  Taenia  medio- 
canellata,  twenty-five  feet.  Three  months  after, 
more  joints  passed  ;  gave  magnesia  and  seeds  as 
directed;  Taenia  medio-canellata  twenty  feet.  I 
subsequently  obtained  some  smaller  worms  of  the 
same  species  from  this  patient.  I  then  gave  him 
a  mixture  of  potassic  bromide  and  infusion  of  gen- 
tian. There  has  been  no  return  in  three  years. 
I  have  found  this  mixture  very  efficacious  in  remov- 
ing the  abnormal  condition  of  the  bowels  which  is 
so  frequently  met  with  in  these  cases. 

Case  2. — Middle-aged  gentleman,  born  in  Malta  ', 
uses  tobacco  and  liquors  in  moderate  quantities, 
but  habitually  and  for  a  long  time;  brought  me 
several  joints  of  a  Taenia  solium  that  he  had  passed. 
Gave  magnesia  and  seeds  as  directed.  Taenia  so- 
lium of  seventy  feet.     No  return  in  three  years. 

Case  3. — Mechanic,  born  in  the  Southern  Mates  ; 
had  tape-worm  for  twelve  years  ;  repeated  attempts 
at  removal  during  this  time,  but  never  successful 
in  getting  the  head,  and  it  rapidly  grew  again. 
Two  years  previous  lo  his  consulting  me  he  con- 
tracted syphilis  ;  secondary  symptoms  severe  and 
obstinate ;  had  taken  mercury  for  nearly  two  years, 


TUE   CANADA   MEDICAL   RECORD. 


227 


consulted  nic  for  the  syphilitic  lesions  and  not  for 
the  tapeworm  ;  said  he  had  given  up  all  hopes  of 
having  it  entirely  removed,  and  it  gave  him  no 
inconvenience  beyond  the  disagreeable  sensations 
jirodiiced  by  its  coming  down  when  he  was  walking^ 
sometimes  as  far  as  the  knees,  returning  again  to 
its  former  abode.  Gave  magnesia  and  seeds ;  Taenia 
solium  twenty  feet ;  no  return  in  four  years. 

Case  No.  i  shows  the  rapidity  with  which  the 
tapeworm  grows  ;  the  whole  niunber  being  remo- 
ved within  eight  months,  the  second  one  of  twenty 
feet,  three  months  after  the  first  one. 

Cases  No.  2  and  3  show  that  the  habitual  use  of 
tobacco  and  liquors,  that  syphilis  and  tlie  jirolonged 
use  of  mercury,  have  no  effect  upon  tapeworm. 


Sm;^lcU  of  Science. 


HOSPITAL  NOTES. 

Quinsy.  — Fancoast  showed  a  case  of  acute  ton- 
sillitis, for  which  he  applied  the  antiphlogistic 
knife  to  the  affected  organs,  and  directed  the 
]ialient  tn  steam  it  well.  Take  an  ounce  of  tinct. 
of  myrrh,  a  pint  each  of  water  and  of  vinegar,  boil- 
ing hot  ;  throw  a  towel  around  the  patient's  head, 
and  let  him  inhale  the  steam  until  he  is  in  a  pro- 
fuse persi'iralion.  This  is  very  soothing  to  the 
uiHamed  mucous  inembrane. 

Nas.al  Catarrh.— Fancoast  advises  the  follow- 
ing as  very  useful  in  acute  or  chronic  catarrh  : 

Borax  3  ss 

Tincture  of  myrrh 3  ss 

Honey 3  ij 

Infusion  of  cinchona,  q.  s.  ad  f  3  iv. 

M.S. — A  little  to  be  poured  in  a  cup  of  cool 
water,  and  snuffed  up  the  nose  occasionally. 

For  Anemia  with  Constipation: 

R     Klix.  cinchona; 

Sp.  aromatici  aa  part  aq 

M.  S — f  3  j  to  f  3  ss  several  times  daily. 

R     Ext.  ignatise  amar£e gf-^i 

Quininre  sulphat gr.  ij 

Capsici  pulv r.  % 

M.  ft.  pil.     S — Thrice  daily. 

A  little  carbolic  acid  may  be  added  if  the  stools 
be  fetid.— Fancoast. 

University  Hospital. — Pepper  reports  the 
expulsion  of  tasnia  solium  with  head.  The  follow- 
ing was  the  procedure:  The  patient  fasted  dining 
,  the  day,  and  took  a  saline  purge  in  the  evening  ;  the 
next  day  f  3  ij  of  oleo-resin  of  male  fern  was  given^ 
rubbed  up  with  sugar, at  7  a.  m.,  8  a.  m.  and  10  .4.M, 
With  the  last  dose  a  saline  purge  was  given,  }-j'o 
says  it  is  useless  to  trifle  with  sii)aller  dgsgg  gf  }iia}e 
fern, 


.-VcupuNCTURE  IN  Lumbago  and  Sciatica. — 
Pepper  strongly  recommends  this  little  oi)eration, 
which  savors  so  strongly  of  empiricism.  It  should 
be  done  aseptically,  and  the  needles,  or  rather 
strong  steel  pins,  rather  less  than  half  the  diameter 
of  steel  knitting  needles,  should  be  thrust  to  the 
bone.  His  theory  as  to  tlie  relief  often  afforded  is, 
that  the  intlamniat'ivy  exudation  confined  by  dense 
filirous  structures,  and  which  causes  the  pain,  is 
drained  off  by  the  punctures. 

Rheumatoid  Arthritis. — Osier  recommends 
arsenic  in  the  form  of  Fowler's  solution.  He  be- 
gins with  gtt.  iiiij  thrice  daily,  gradually  increasing 
to  the  limit  of  tolerance,  as  shown  by  diarrhoea  or 
slight  ophthalmia.  He  has  given  35  minims  three 
times  a  day  without  bad  results. 

Hepatic  Chills. — Osier  showed  the  liver  and 
duodenimi  from  a  marked  case  of  Charcot's  hejjatic 
intermittent  fever.  A  gall  stone  about  three  quarters 
of  an  inch  in  diameter  was  impacted  at  the  mouth  of 
the  common  duct.  The  patient  had  chills  and  a 
temperature  of  (04°  F.,  at  irregular  intervals- 
followed  by  marked  jaundice.  Prof.  Osier  rega>ds 
these  attacks  as  analogous  to  those  caused  by  the 
passage  of  an  urethral  instrument. 

Irritable  Bladder.— Goodell  gives  from  30- 
40  grs.  ofasafcetida  per  day.  He  has  had  incon- 
tinence after  dilatation  of  the  urethra  by  the  finfer 
in  only  one  case.  This  patient  loses  two  or  three 
drops  only,  when  she  lauglis  or  sneezes,  but  thinks 
nothing  of  this. 

Scrofulous  Abscesses.— These  Agnew  evacu- 
ates, removes  all  broken  down  tissue  with  curette 
and  scissors, ligates  bleeding  points,  inserts  a  drain- 
age tube.  After  sewing  up  the  wound  he  applies 
the  usual  antiseptic  dressing. 

Medico-Chirurgical  Hospital — After  a.i  at- 
tack of  syphilitic  laryngitis,  the  vocal  cords  rirely 
regain  either  their  normal  color  or  smoothness  ; 
and  if  tlie  patient  has  a  singing  voice,  his  voice 
will  never  again  be  as  clear,  or  have  as  high  a 
compass  as  before. 

Iodide  of  potassium  will  seldom  relieve  super- 
ficial syphilitic  laryngitis,  but  the  iodides  of  nier- 
cury  will  remove  the  trouble,  sometimes  with 
almost  startling  rapidity. — Stern. 

Chronic  Eczema. — A  case  of  general  eczema 
shown,  contracted  during  the  war.  From  head  to 
foot  the  man's  skin  is  rough,  scaly  and  indurated. 
For  some  time  he  has  been  treated  by  the  mouth, 
but  iiis  alimentary  canal  is  in  so  poor  a  condition 
that  medicine  by  that  route  seenio  not  to  get  into 
his  system.  This  is  the  class  of  cases  in  which 
hypodermatic  medication  often  succeeds  where 
everything  else  fails.  He  was  ordered  nothing 
but  hypodermatic  injections,  every  other  day  of 
gr.  j-'o  arsenlte  of  sodium  ;  the  dose  fo  be  gradually 
Irjereased  to  gr,  j. 

Milk  Diet. — In  ptesciibing  a  milk  diet  prin- 
tjpally,  the  milk  should  be  ta)-;en  between  meals, 
>yhen  regular  meals  are  taken  ]  and  at  any  rate  the 


•228 


THE   CANADA   MEDICAL   RECORD. 


milk  should  be  taken  in  small  quantities  at  any 
time,  in  order  to  be  the  more  easily  and  quickly 
taken  up  by  the  lacteals. 

Quinine  is  a  most  valuable  tonic  for  children, 
and  is  not  prescribed  enough.  In  this  case  he 
gave: 

B     Ferri  et  quininae  citratis 3j 

Syrupi  aurantiicorticis 3  iij     M. 

Sig. — Teasjioonful  three   times  a  day. 
Predigested  foods  are  also    of  much    value    in 
cases  like  this. 

Magnesia  Dangerous. — Stewart  advises  against 
the  giving  of  dose  upon  dose  of  carbonate  of 
magnesia,  when  it  fails  to  inirge. 

It  is  likely  to  make  a  dangerous  stone-like  im- 
paction in  the  intestine.  He  has  known  several 
cases  of  death  from  this  cause. 

"Obstetrical  Aphoris.ms"  —  Ste<Oart. — In 
cases  of  post  partnm  hemorrhage,  where  the  patient 
is  dangerously  weak  from  loss  of  blood,  do  not 
neglect,  along  with  f)ther  measures,  to  elevate  the 
foot  of  the  bed  so  that  the  brain  may  more  easily 
receive  blood. 

Alum,  3  j  to  the  pint,  is  a  cheaj)  and  good  wash 
for  excoriated  nipples  ;  so  is  tincture  of  catechu. 
If  the  excoriation  is  very  bad,  try  arg.  nit.,  gr.  vj. 
to  the  ounce  of  rosewater.  Have  the  nippies 
washed  though,  before  the  child  is  applied.  Pro- 
tect the  nipples  with  a  shield  from  being  rubbed 
by  the  clothing;  and  if  these  measures  are  not 
sufficient,  have  the  nijiple  covered  by  a  shield 
while  the  child  is  sucking. 

Within  forty-eight,  or  the  so-called  "  three  days," 
you  may  have  milk  fever.  The  temperature  may 
rise  even  as  high  as  103°  or  104°  This  fever 
can  usually  be  avoided  by  keeping  the  mother 
on  mild,  unstimulaling  diet  for  the  first  three  days 
after  child  birth. 

In  treating  this  fever,  I  have  found  that  a  con- 
tinuation of  saline  purgatives  will  much  decrease, 
or  peihaps  stop,  the  flow  of  milk. 

Accordingly  I  use  other  preparations — com- 
pound licorice  powder,  a  good  3  to  a  dose  ;  or, 
better  still,  castor-oil.  When  the  milk  is  deficient, 
cocoa  in  some  form  is  generally  of  good  Service 
to  increase  the  flow. 

Uterine  Hfmokrhage  in  Pregnancy. — Par- 
ish.— Case  of  hemorrhage  from  the  uterus  in 
a  women  eight  months  pregnant.  Whether  a  case 
of  placenta  previa  or  not,  Dr.  Parish  said  that  the 
proper  treatment  here  was  to  put  the  woman  to 
bed  and  keep  her  there,  and  not  allow  her  to  rise 
from  it  for  any  purpose  whatever.  He  advises 
a  physician  who  has  a  case  of  placenta  previa  or 
suspected  placenta  previa  on  hand,  to  provide 
himself  with  a  Barnes'  dilator.  In  a  dangerous 
hemorrhage,  this  will  not  only  dilate  the  os  for 
delivery,  but  will  act  as  a  tampon. 

It  is  not  well  to  keep  a  dil.itor  in  the  Office  as 
you  keep  other  instiunients,  because  the  rubber 
loses  its  elasticitj'in  iibout  two  roomhs,  auU  ip' 
then  useless 


If  you  have  no  dilator,  use  the  tampon  ;  though 
of  course  only  when  absolutely  necessary.  He 
does  not  approve  of  absorbent-cotton  for  tam|)on- 
ing,  as  recommended  by  Parvin  ;  for  he  says  that 
the  cotton,  on  account  of  its  great  attraction  for 
fluids,  is  likely  to  favor  the  hemorrhage  rather 
than  to  check  it. 

For  his  own  jiart,  he  prefers  a  long  strip  of 
muslin  or  linen,  such  as  an  ordinary  roller  bandage, 
soaked  in  bi-chloride.  Sjiecial  care  should  be 
taken  that  the  material  is  tightly  packed  around 
the  os;  then  the  vagina  is  to  be  filled  ;  and  finally 
external  pressure  kept  up  by  a  T-bandage. 

If  in  delivery  it  be  necessary  to  perform  version, 
give  an  anajstlietic,  in  order  to  relax  the  uterus, 
and  thus  avoid  the  laceration  of  it,  otherwise 
almost  certain. 

After  delivery,  hypodermic  injections  of  ergot, 
injections  into  the  uterus  of  hot  water,  or  even  a 
styptic  a])plied  to  the  internal  surface  of  the  uterus, 
will  stop  the  bleeding  if  the  inertia  of  the  uterus  is 
too  great  for  jiroper  contraction. 

When  a  patient  comes  to  you  complaining  of 
redema  of  the  prepuce,  without  local  disease  or  in- 
jtiry,  or  cedenia  elsewhere,  look  for  Bright's  disease 
—the  cirrhotic  form. —  Waiigh. 

Wills  Eye  Hospital — Kryser. — For  a  case  of 
pJdyctandar  conjunctivitis,  Keyser  prescribed  this 
ointment. 

li      Hydrargyri    oxidi    flavi..,, &■'■% 

Adipis  benzoati 5  j 

A  case  oi p'trali/sis  n/the  right  external  rictus 
came  before  him  a  short  time  since.  A  specific 
origin  was  suspected,  and  the  man  was  put  on  doses 
of  gr.  v.  iodide  of  potash.  In  a  week  the  justness 
of  the  treatment  was  proved  by  removal  of  the 
trouble. 

A  New  Aniiseptic. — Keyser  considers  the 
new  antiseptic,  silico-fluoride  of  sodium  as  the 
best  in  treating  the  eye.  He  uses  it  in  his  cata- 
ract operations,  and  also  in  gonorrhceal  ophthal- 
mia, instead  of  boric  acid  ;  and  finds  it  much  more 
ia|)id  and  certain  in  its  action.  Thesohilion  used 
IS  i  saturated  one — gr.  }i  to  the  f  3  ■ 

Facial  Kpithf.lioma. — Keyser  has  good  suc- 
cess in  treating  epithelioma  of  the  face  with  pow- 
dered chlorate  of  potash.  It  is  kept  constantly 
api^lied  to  the  spongy  growth,  and  the  irritation 
thus  set  up  effectually  removes  the  growth.  This 
is  of  use  only  where  the  growth  is  soft. 

Calomel  is  good  in  all  phlyctenular  troubles; 
but  do  not  use  it  in  phlyctenular  keratitis  during 
the  stage  of  severe  inflammation.  Dust  the  calo- 
mel in  the  eye,  and  with  the  finger  gently  roll  the 
lids  over  the  ball,  till  tears  are  started.  If  you 
stop  short  of  this,  the  calomel  will  cake  in  the 
eye. 

AkdoiminalSukgerv. — In  cases  of  removal  of 
the  ovaries,  Mongomery  prefers  braided  silk  liga- 
tures for  ligating  the  pedicle,  as  he  is  then  certain 
that  the  ligature  will  reniain  on  long 
avoid  all  danger  of  hemorrhage. 


enough  tg 


TIIR    CANADA   MEDICAL   RECORD. 


229 


In  the  course  of  over  forty  operations  of  this 
character,  he  has  had  no  untoward  result  from  the 
presence  of   the  ligature. 

For  sewing  up  the  al)doniinal  incision  he  uses 
silk  gut.  Two  small  needles  are  put  on  each 
suture,  one  at  either  end.  Each  needle  in  the 
jiasscd  from  witiiin  out,  care  being  taken  that  the 
peritoneum  is  iiK  lutlcd  well  within  the  suture. 

Asa  dressing  fcjr  the  wound,  he  em|>loys  simply 
a  few  layers  of  surgeon's  lint  soaked  in  carbolic 
acid  and  glycerine,  I  to  12  ;  and  over  this  is  ])laced 
a  package  of  absorbent  cotton  ;  the  whole  held  in 
place  by  siri]«  of  adhesive   plaster. 

The  giving  of  ice  and  cokl  viaicr  tends  rather 
to  increase  thirst,  so  he  gives  instead  an  enema 
of  a  [lint  of  warm  water.  Thus  not  only  is  the 
thirst  allayed,  but  the  blood  is  also  not  materially 
increased,  and  consequently  the  danger  of  hemorr- 
hage is  lessened.  He  checks  the  vomiting  usually 
following  the  administration  of  ether,  by  two- 
drop  doses  of  a  four  per  cent,  solution  of  hydro- 
chlorate  of  cocaine  every  fifteen  minutes  or  half 
hour, 

A  tendency  to  tympanites  may  generally  be 
overcome  by  placing  layers  of  cotton  on  the  abdo- 
men, and  then  tightly  passing  around  the  body 
strips  of  adhesive  p)laster.  This  keeps  up  the  in- 
traabdominal  pressure. 

Inkantile  Colic. — When  children  complain 
of  pain  in  the  stomach.  Dr.  Atkinson  says  that  a 
possible  neuralgic  character  should  be  borne  in 
mind.  This  is  frequently  not  recognized.  He 
advises  an  orange  before  breakfast  for  children, 
or  for  anyone  suffering  from  loss  of  ajjpetite. 
The  acidity  of  !he  orange  will  often  create  a  de- 
sire for  more  food. 

Acid  Indigestion. — -With  great  acidity  of  the 
stomach,  there  is  generally  a  burning  pain  along 
the  line  of  the  oesophagus.  Patients  frequently 
complain  of  "heartburn,  "  too.  For  digestive 
trouble  in  a  girl  often,  from  acidity,    he  gave: 

y     Spiriti  ammoniae    aromatici 3  ij 

Sodn  bicarbonatis 3  i 

Syru])i 3  i 

Aquw f  iij    M 

Sig. — A  dessertspoonful  every  3  hours. 

If  there  should  be  much  pain  in  the  stomach, 
he  advised  the  mother  to  apply  flannel  wrung  out 
of  hot  water. 

Indigestion. — Girl  of  five  ;  has  lost  much  flesh 
in  the  last  six  weeks  ;  has  cough  and  general 
malaise  ;  is  in  the  habit  of  eating  an  apple  and  a 
banana  for  breakfast.  Dr.  Atkinson  is  strongly 
opposed  to  the  banana  diet.  He  cited  a  case  in 
which  severe  convulsions  followed  the  eaiing  of 
two  bananas  by  a  child.  With  great  difticuity  it 
was  brought  through  the  attack.  The  loving 
father  then  repeated  the  dose,  contrary  to  the 
strictest  orders  ;  and  this  time  nothing  could  save 
the  victim. 

Bananas  for  chiidien  should  be  few  and  far 
between. 


INSOMNIA. 

While  insomnia  or  inal)ility  to  sleep  is  not  a  dis- 
tinct disease,  it  is  at  times  productive  of  much  dis- 
tress, and  interferes  so  seriously  with  the  proper 
|)er(()rmance  of  the  functions  of  the  various  organs 
of  the  body,  that  the  best  efforts  of  the  physician 
are  demanded  for  its  relief  Insomnia  is  geierally 
the  result  of  ]irolonged  mental  study  or  intense 
excitement.  .'Xt  other  times  it  is  due  to  the  action 
of  malaria  upon  the  nervous  .system.  It  not  infre- 
(pientlv  follows  the  excessive  use  of  tea,  tobacco, 
alcohol,  etc.,  due  to  arterial  and  nervous  e.Kcite- 
ment  caused  by  these  agents.  Pathologically,  all 
cases  of  insomnia  can  generally  be  divided  into 
two  classes,  as  that  which  results  from  nervous  e.\a'- 
tation,  characterized  by  an  increase  in  the  force  and 
frequency  of  the  pulse,  and  that  which  results  from 
nervous  depression  witli  a  diminution  in  the  volume 
of  the  pulse,  often  followed  by  an  an:emic  condi- 
tion of  the  cerebral  arterioles.  The  treatment,  to 
be  successful,  must  vary  with  the  cause  and  patho- 
logical conditions  present.  Physicians  are  well 
aware  that  opium,  chloral,  etc.,  are  often  used,  and 
sometimes  give  relief;  but  the  patient  becomes 
habituated  to  the  drug,  must  have  the  dose  increas- 
ed, and  thereby  a  habit  is  formed,  for  which  the  best 
efforts  of  the  physician  are  called  on  to  check  a  habit 
which  is  worse  than  the  sleeplessness  for  which  the 
patient  was  treated.  Bromide  of  soda  and  also  the 
potassium  salt  is  often  used,  and  great  benefit  has 
resulted.  In  the  treatment  of  neurasthenia  great 
benefit  has  resulted  from  the  use  of  the  bromides  of 
soda  and  potash,  especially  when  in  combination 
with  a  salt  that  will  counteract  the  depressing 
effects  resulting  from  the  use  of  bromide.  .Such 
preparations  are  the  bromo  .soda  and  bromo-potash, 
prepared  by  Wm.  R,  Warner  &  Co.,  and  in  the 
treatment  of  nervousness,  debility  and  neuras- 
thenia which  can  generally  be  ascribed  to  insom- 
nia, they  aie  especially  efficient  and  agreeable. 
The  bromo-soda  preparation  contains  thirty  grains 
of  bromide  of  soda  and  one  grain  caffein.  The 
bromo-potash  preparation  contains  twenty  grains 
of  bromide  of  potash  and  one  grain  of  cailein. 
Phys*cians  will  readily  see  that  the  merits  of  these 
two  preparations  need  hardly  be  questioned,  and 
they  can  not  be  disappointed  in  the  therapeutic 
effects  resulting  from  their  use.  They  are  put  up 
in  granular  form,  which  makes  a  delightful  effer- 
vescing draught,  and  gives  the  patient  a  desire  to 
take  these  preparations,  which  ai  e  extremely  pallat- 
able  and  beneficial.  The  preparation  of  bromo- 
soda  was  partly  suggested  by  the  late  Dr.  J.  S. 
Jewell.  Physicians  have  met  with  unfailing  success 
in  the  use  of  bromo-soda  in  the  treatment  of  ner- 
vous headache  and  the  conditions  resulting  from 
an  overworked  and  run-down  system.  The  ther- 
apy of  the  pre[)aration  need  hardly  be  questioned, 
as  by  its  use  the  patient  feels  a  relief  noc  given  by 
any  other  preparation  given  for  the  same  symp- 
t<;nii, —  Atlt'  Eii'jland  Mtdicui  MoiUldy. 


23u 


THE   CANADA   MEDICAL   RECORD. 


ANTIPYRIN  IN   HAEMOPTYSIS. 

In  the  Mi'dizlnakoil  Obozrenie,  Dr.  M.  BvvAL- 
KEVITCH,  at  tlie  Vilna  Military  Hospital,  states 
that  antipyrin  is  an  excellent  remedy  for  pulmon- 
ary hemorrha'^'e  of  every  kind.  This  statement  is 
based  on  ten  cases  of  hemoptysis  in  patients  suf 
fering  from  phthisis,  bronchiectasis,  cardiac 
diseases,  and  traumatic  injury  of  the  chest.  The 
following  mixture  was  invariably  emisloyed  by  Dr. 
Byvalkevitch  :  K  Antipyrini,  3  ss ;  aq.  destil,  f  ^ 
iv  ;  essentia;  menthae  pip.  gtt.  xv  Mix.  Dose,  one 
tablespoonful  every  two  or  three  hours.  In  none 
of  these  cases  were  more  than  two  doses  of  the 
mixture  required  to  completely  arrest  hemopty- 
sis, even  when  the  daily  loss  of  blood  amounted  to 
two  Huid  pounds.  In  soitie  of  the  patients,  ordinary 
haemostatics,  such  as  ergot,  ergotm,  digitalis, 
atropine,  and  Haller's  elixir,  had  been  previously 
tried  without    eftcct — British  Med.  Junniid. 


ELEGANT  MOUTH-WASH. 

Edina  sends  a  sample  of  a  mouth-wash,  half  a 
tea-spoonful  of  which  in  a  wineglassful  of  water  is 
used  to  refresh  the  mouth.  It  is  a  pale  crimson 
and  transparent  solution,  with  the  odor  of  oil  of 
wintergreen.  Its  composition  is  fairly  represented 
by  the  following  formula  :  Oil  of  wintergreen,  3  j ; 
Oil  of  ])eppermint,  .Mxv  ;  rose-aniline  hydro- 
chlorate  (or  magenta),  gr  ss  ;  water,  3  ss  ;  gly- 
cerine, ;  iij  ;  rectified  spirit  to  Oj.  Dissolve  the 
oils  in  the  si)irit,  and  the  rose  aniline  in  the  water  ; 
mix  the  latter  solution  with  the  glycerip.e,  and 
pour  it  into  the  perfumed  spirit.  Mix  -Clunnist 
and  DnujfjiM. 


HUTCHINSON   ON    THE    ABORTIVE 
TREATMENT  OF  SYPHILIS. 

In  a  recent  address  on  this  subject.  Dr.  Jona- 
than Hutchinson  (  Tlie  British  Medical  Journal) 
informs  us  that  for  many  years  past  he  has  been 
in  the  hatiit  of  assuring  patients  who  came  to  him 
with  indurated  chancre,  but  without  any  other 
symptoms,  that  they  would  in  all  probability  wjiolly 
escape  the  secondary  stage.  As  the  result  of  in- 
creasing experience,  he  now  holds  out  this  hope 
with  more  confidence  than  ever. 

The  best  treatment  of  syphilis  is  of  unquestioned 
importance,  and  so  eminent  an  authority  as  Hut- 
chinson is  certainly  entitled  to  a  full  hearing,  even 
if  his  views  are  al  variance  with  those  held  by 
others  of  equal  prominence  with  himself.  The 
author's  doctrine  is  clearly  opposed  to  the  most 
recent  teachings  of  the  Gtrnian  and  French 
schools. 

This  is  what  he  says  :  "  My  treatment  has  been 
almost  uniform,  and  has  consisted  in  giving  mer- 
cury in  the  form  of  gray  i3<jwder  in  one  grain  doses 
three  times  a  day,  at  least,  and  more  frequently 
if  die  symptoms  did  not  iiuickly  yield.  I  liavc 
always  told  the  patient  that  he  n)ur>t  take  these 
pills  for  six  montlis  at  lessf,     'i'hg  lesijlts  haye 


also  been  very  uniform,  or  have  varied  chiefly 
according  to  the  period  of  the  disease  at  which 
the  treatment  was  begun.  The  effect  of  the 
medicine  in  softening  the  induration  is  usually 
quite  evident  within  a  week,  and  may  be  expec- 
ted to  be  complete  in  the  course  of  a  month  or  a 
little  more.  After  this  the  patient  remains  without 
symptoms  till  the  end  of  the  course,  except,  per- 
haps, some  slight  persisting  enlargement  of  the 
inguinal  glands.  At  the  end  of  the  six  months,  if 
the  treatment  is  left  off,  there  not  very  infrequently 
follows  in  three  weeks  or  a  month  an  erythe- 
m.itous  general  eruption.  This  eruption  is  never 
severe,  never  becomes  papular  or  scaly,  and 
always  vanishes  in  a  few  days  if  the  mercury  is 
resumed.  It  is  never  attended  by  failure  of  health, 
and  but  rarely  by  sore  throat.  On  account  of  its 
frequency  after  six  months'  courses,  I  have  lately 
been  in  the  habit  of  continuing  the  treatment  for 
nine  or  twelve  months,  and  am  willing  to  admit 
that  it  might  be  wise  to  contintie  it  for  still  longer 
periods.  As  regards  relapses  at  still  longer 
periods,  I  must  state  that,  in  a  certain  proportion 
of  cases,  .sores  in  the  mouth  or  scaly  patches  in 
the  pahns,  or  liability  to  transitory  erythemata  on 
the  skin  have  occurred,  but  they  have  generally 
been  in  connection  with  some  special  kind  of 
irritation." 

Hutchinson  maintains  that  it  is  quite  possible, 
by  the  earl)'  and  continuous  use  of  mercury,  to 
suppress  the  secondary  stage — in  other  words,  to 
make  it  abortive.  In  exceedingly  few  cases, 
where  it  has  been  possible  to  use  mercury  without 
interruption  in  this  way,  has  he  known  a  well- 
characterized  secondary  eruption  era  typical  sore 
throat  to  occur.  In  ca«es  where  diarrhoea  or 
sudden  ])tyalism  has  caused  the  course  to  be 
interrupted,  the  success  has  been  less  complete. 
But  where  the  patient  is  careful,  and  can  bear  the 
drug,  he  believes  that  it  is  easily  possible  to  pre- 
vent secondary  symptoms.  This  assertion  is  not 
by  any  means  the  same  as  saying  that  it  is  po.ssi- 
ble  to  cure  syphilis,  for  it  does  not  concern  itself 
with  the  tertiary  stage. 

In  concluding  his  instructive  remarks,  Hutchin- 
son emphasizes  the  points  which  he  has  made,  as 
follows  ;  ''  The  early  use  of  mercury  does  not 
only  greatly  shorten  the  duration  of  the  primary 
phenomena,  but  it  also  much  modifies,  and  in 
many  instances  entirely  prevents,  these  of  the 
secondary  one.  When  circumstances  favor  the 
fcltrile  stage  of  the  exanthem,  syphilis  may  be 
rendered  wholly  abortive.  If  we  can  accept  this 
proposition,  we  shall  have  gained  a  step  in  the 
orderliness  of  our  future  work,  and  in  reference  to 
this  the  following  [iroblems  seem  to  lie  before  us  : 

'■  What  plan  of  treatment  is  most  successful  in 
suppressing  the  febrile  or  secondary  stage? 

'  Does  the  suppressing  of  this  stage  tend  to 
prevent  what  are  called  reminders,  or  those  minor, 
a-id  for  the  most  part  local,  symptoms  which 
often  intervene  between  tlic  febrile  stage  ancj 
tertiary  pheuoinena  ? 


tUE  CANADA  MEDICAL  RECORD. 


^31 


"  Arc  tliosc  ill  wliom  the  febrile  stage  lias  been 
aborted  by  aitificial  means  more  or  less  tiian 
others  liable  to  tertiary  i)henomeiia  ? 

"  Is  it  possible,  by  anticipatory  treatment,  to 
prevent  or  abort  the  jihenomeiia  of  the  primary 
stage  ;  and,  if  this  be  done,  what  is  the  inlluence 
iilion  the  further  course  of  the  disease?" 

It  will  remain  for  the  atcimiulaling  experience 
of  the  entire  profession  to  give  decisive  answers 
to  this  scries  of  suggestive  (piestions. —  Tin  Mnlirnl 
lii'.cord. 


THE  VALUE  OF  THE  NUTRITIVK  HATH 
AND     OF    INUNCTION    IN     DISEASES 
OF  CHILDREN. 

By  GI'.orgk  Edw.  Hoi'Kixs,  M.  D. 
Fiom  The  Mfdical  Record. 

In  the  more  chronic  bowel  disorders,  in  which 
the  child  suffers  thro'.igh  a  period  of  several  weeks, 
the  whole  alimentary  tract  being  implicated,  death 
finally  takes  place  from  exhaustion — essentially 
from  starvation ;  for,  no  matter  how  carefully 
nursed  and  fed,  the  nourishment  is  not  appropri- 
ated by  the  system.  The  blandest  food  acts  rather 
as  an  irritant  to  the  inflamed  surfaces.  The 
stomach  itself  however,  if  there  be  no  vomiting,  is 
probably  still  capable  of  absorbing  such  material 
as  requires  no  bowel-digestion.  Here  the  most 
appropriate  aliment  is  the  whey  of  milk,  and  the 
white  of  an  egg  thoroughly  beaten  with  water 
to  considerable  thinness,  and  lightly  salted. 
These  may  be  given  alternately.  Alilk  itself 
is  of  doubtful  utility  in  these  cases.  If  not 
digested,  it  becomes  only  a  source  of  irritation. 
Gentle  friction  of  the  abdomen  with  some  warm, 
bland  oil  is  extremely  useful.  The  absorbents 
of  the  skin  are  exceedingly  active  during  such 
disease,  and,  if  the  friction  be  continued  very 
gently  for  several  minutes  at  different  periods  of 
the  day,  considerable  nourishment  may  be  thus 
obtained.  Some  oils  are  more  appropriate  than 
others,  from  being  more  easily  absorbed. 

Following  each  inunction,  great  relief  is  afforded 
by  warm  fomentations  of  camphor.  Fold  a  light 
linen  tissue  (as  a  large  handkerchief)  three  or  four 
thicknesses,  of  asize  to  cover  the  whole  abdomen  ; 
dip  this  in  water  warmer  than  the  hand,  ring  out 
the  drip,  and  sprinkle  the  warm  surface  lightly 
with  spirits  of  camphor,  apply  it  quickly  to  the 
abdomen.  Then  cover  all  with  dry  Hannel  under- 
clothing. The  warm  camphorized  vapor  has  a 
most  soothing  effect. 

There  are  cases  of  these  disorders  in  children  in 
which  the  stom.ach  will  retain  nothing.  Even  a 
teaspoonful  of  cold  water  is  often  rejected.  Here 
it  is  m.anifestly  impossible  to  do  anything  in  the 
way  of  the  stomach-feeding,  and  we  must  resort 
to  other  means.  It  is  in  these  cases  that  the  "soup 
bath"  becomes  a  boon  beyond  all  price.  It  not 
only  relieves  the  thirst)  which  may  be  accomplish- 
ed also  by  prolonged  immersion  in  tepid  water),  but 
it    imparts    sufficient    nourishment   to   tide    the 


patient  over  the  critical  period.  V/e  have  noticed 
a  child's  life  most  evidently  saved  by  this  simple 
means.  Let  some  pieces  of  mutton  or  other  meat, 
sufficient  for  making  soup,  be  first  simmered  for 
an  hour,  and  then  boiled  sufficiently  long  to 
thoroughly  soften  and  extract  the  juices.  In  skim- 
ming do  not  take  aw.iy  all  the  fat.  This  latter 
may  be  skimmed  off  while  cooling,  and  kept 
warm  for  inunction  later.  I'our  ihu  soup,  when 
ready,  into  the  little  bathtub,  and,  when  siiffi- 
cieiUiy  cool,  immerse  the  child  in  it  for  a  ])eriod  of 
twenty  minutes.  It  should,  of  course,  have  suffi- 
cient depth  to  cover  the  entire  body,  the  head 
being  supported  by  liie  nurse's  hand.  This  should 
be  repeated  twice  daily,  the  bath  being  rewarmed 
for  second  use,  and  a  new  soujj  made,  if  po.isi- 
ble,  each  day.  Let  the  bath  be  followed  by  inunc- 
tion of  the  entire  body  with  the  fat  that  was  set 
aside.  After  two  or  three  days,  if  the  case  im- 
prove, the  stomach  will  begin  to  retain  light  noui- 
ishment.  In  the  me.'intime,  the  fomentations  of 
camphor  may  be  continued.  Atlemptsat  nourish- 
ment by  the  rectum  are  ajjt  to  be  futile  in  the  e 
cases,  as  may  be  readily  seen. 


THE  PREPARATION  OF  FOOD  FOR  THE 
SICK. 

In  making  a  beef  tea  t'lC  round  of  a  good  piece 
of  beef  should  always  be  selected,  and  cut  into 
small  cubes  not  larger  than  half  an  inch  in  dia- 
meter. It  should  then  be  put  to  soak  for  two 
hours  on  the  back  of  the  range,  in  an  earthen-ware 
pipkin,  with  one  pint  of  cold  water,  and  allowed 
to  simmer  for  about  fifteen  minutes  and  boil  for 
three  minutes.  After  adding  half  a  teaspoonful 
of  salt  a;id  a  little  pepper,  the  tea  is  ready  for 
use. 

In  the  preparation  of  soups  the  first  thing  is  the 
making  of  the  so-called  stock  or  basis  for  the  soup. 
There  are  two  distinct  stocks  :  one  which  may  be 
known  as  the  brown  stock,  the  other  as  clear  or 
coiiS'iinmi  stock.  For  the  preparation  of 
brown  stock  take  four  pounds  of  shin 
of  beef,  four  quarts  of  cold  water,  ten  whole 
cloves,  four  pepper  corns,  a  bouquet  of  herbs 
(sweet  marjoram,  summer  savory,  thyme,  and 
sage),  one  tablespoonful  of  salt,  three  small  onions, 
one  turnip,  one  carrot,  two  stalks  of  celery,  two 
s]u-igs  of  parsley.  Cut  the  meat  from  the  bones, 
after  which  place  the  bones  and  half  of  the  meat 
in  a  soup  kettle  and  allow  to  stand  for  half  an 
hour  in  cold  water.  Heat  gradually  and  allow  to 
simmer  for  six  or  seven  hours.  Brown  the 
remainder  of  the  meat  in  two  tablespoonfuls  of 
beef  drippings  and  add  with  the  other  meat  and 
with  the  vegetables  chopped  fine,  when  the  kettle 
is  put  on  the  fire  to  simmer.  After  it  has  sim- 
mered the  required  time  the  stock  is  strained 
and  set  aside  to  cool,  the  fat  being  removed  from 
the  top.     The  stock  is  then  ready  for  use. 

Out  of  the  brown  stock  may  be  made  St.  Jul- 
ienne soup  by  the  following    process  :     In  niak- 


232 


THte  CANAfiA  MEDICAL  RECOBO. 


ing  these  soups,  the  stocks  must  never  be  allowed  to 
boil,  or  at  most  must  be  brought  only  for  a  ninnient 
to  theboiling  point.  ForSt.  Julienne  put  one  pint  of 
the  brown  stock  on  the  fire  to  lieat,  after  which  a  pint 
of  finely  chojiijed  vegetables  (turnip,  carrot,  etc.), 
with  half  a  teaspoonful  of  salt,  sliould  be  put  on 
with  a  little  water  to  parboil.  This  being  done, 
add  the  vegetables  to  the  stock,  season  witli  half  a 
saltspoiinful  of  ]icpper.  \'einiicein  soup  is  made  by 
addnig  half  a  cup  nf  vernioelli  to  a  jjint  of  the 
brown  stock.  Cook  the  vermicelli  for  ten  minutes 
in  salted  boiling  water,  season  with  a  half-tea- 
spoonful  of  salt  and  a  lialf-salt-^poonful  of  jiepper, 
and  add  to  the  warm  stock. 

CoHso'iniiii  stock  is  to  be  made  in  exactly 
the  same  way  as  the  brown  stock,  except  that 
three  potnids  of  the  knuckle  of  veal  are  to  be 
added  to  the  meat,  and  all  the  meat  is  to  be  put 
in  at  once  without  browning.  After  the  stock  has 
been  formed,  in  order  to  clear  it,  add  the  white 
and  shell  of  one  egg,  the  juice  and  rind  of  one 
lemon,  beating  them  all  np  together;  then  put  on 
the  fire,  bring  to  the  boiling-point,  strain  through 
a  sieve  and  again  through  a  napkin,  without  pres- 
sure or  squeezing,  and  serve. 

For  making  chicken  broth,  take  three  pounds 
of  chicken  well  cleaned,  cover  with  cold  water, 
boil  from  three  to  five  hours  (until  the  meat  falls 
to  pieces),  strain,  cool,  and  skim  off  the  fat.  To  a 
pint  of  this  add  salt  and  popper  and  two  table- 
spoonfuls  of  soft  rice,  which  has  been  previously 
thoroughly  boiled  in  salt  water  ;  bring  the  broth  to 
a  boil.  In  preparing  th  e  rice  half  a  cupful  should  be 
boiled  for  thirty  minutes,  with  a  teaspoonful  of  salt 
in  a  jiint  of  water.  To  make  mutton  broth,  take 
one  pound  of  lean,  juicy  mutton,  chopped  fine. 
• —  Tlieiiij>eiitic   UdXtttc. 


RECTAL  ALIMENTATION  IN  CHILDREN. 

Jacobi,  in  the  Archives  of  Pidiatrics,  advises  as 
follows  : 

The  rectum  absorbs  but  it  does  not  digest. 
Whatever,  therefore,  is  to  enter  the  circulation 
through  tlie  lower  end  of  the  alimentary  canal 
must  be  dissolved  before  being  injtcted.  Suspen- 
sion alone  does  not  usually  suffice.  Water  can 
be  introduced  in  cjuantities  of  from  twenty  five  to 
one  hundred  grammes  (one  to  three  ounces),  every 
one,  two  or  three  hours,  and  may  thus  save  life 
by  adding  to  the  contents  of  the  thirsty  lymph 
ducts  and  empty  blood  vessels.  Salts  in  a  mild 
solution  will  thus  be  absorbed.  Food  must  be 
more  or  le.ss  [jeptonized  before  being  injected. 
The  peptones  mentioned  above  are  readily  absorbed 
when  fairly  diluted.  When  too  thick  they  are  not 
absorbed,  become  putrid,  and  a  source  of  irrita- 
tion. Milk  ought  to  be  peptonized.  The  white 
of  eggs  becomes  absorbed  through  the  addition 
of  chloride  of  sodium.  Kussmaul  beats  two  or 
three  eggs  with  water,  keeps  the  mixture  through 
twelve  hours,  and  injects  it  with  some  starch 
decoction.     The    latter  is   partly     changed    into 


dextrin.  Fat,  when  mixed  with  alcohol,  becomes 
apt  to  be  partly  absorbed,  .\ndrew  H.  Smith 
recommends  the  injection  of  blood.  Its  soluble 
albumen,  salts  and  water  are  readily  absorbed, 
more  we  ought  not  to  expect.  Still,  he  has  ob- 
served that  the  evacuations  of  the  next  day  con- 
tained none  of  the.  injected  blood.  Whatever  we 
do,  however,  not  more  than  one-fourth  part  of  the 
food  required  for  sustaining  life  can  be  obtained  by 
rectal  injections,  and  inanition  will  follow,  though 
it  be  greatly  delayed.  Finally,  children  are  not 
so  lavorably  situated  in  regard  to  nutritious  ene- 
mata  as  adults.  In  these  the  lengthening  of  the 
nozzle  of  the  syringe  by  means  of  an  elastic  cath- 
eter permits  of  the  introduction  of  a  large  quan- 
tity of  liquid  ;  indeed,  a  pint  can  be  injected,  and 
will  be  retained.  But  the  great  normal  length  of 
the  sigmoid  Hexure  in  the  infant  and  child,  wliich 
results  in  its  being  bent  upon  itself,  prevents  the 
introduction  of  an  instrument  to  a  considerable 
height.  It  will  bend  upon  itself;  besides,  a  large 
amount  of  contents  will  be  expelled  by  the  feeble 
or  resisting  young  patient.  When  a  solid  instru- 
ment is  used,  it  is  apt  to  be  felt  high  up  in  the 
al)domen.  This  is  the  result  of  a  large  portion  of 
the  intestine  being  pushed  upward. — Medical 
News. 


TREATMENT   OF  EPISTAXIS. 

Dr.  J.  Robinson,  of  Kansas,  speaking  of  the 
treatment  of  this  affection  in  the  Therapeutic  Gazette, 
says : 

It  is  a  well  known  fact  to  anatomists  and  others, 
that  the  hemorrhage  in  the  vast  majority  of  cases 
proceeds  from  the  septum-nares,  and  is  supplied 
by  a  branch  of  the  superior  coronary,  a  branch  of 
the  facial,  which  ramifies  in  the  septum-nares.  It 
enters  the  opening  of  the  nose  just  below  the  alae 
nasi,  crossing  the  superior  maxillary  bone  at  that 
l^oint. 

Now,  in  a  practice  of  nearly  thirty  years,  I  have 
had  many  cases  of  epistaxis,  and  have  never  in  a 
single  case  failed  to  arrest  the  bleeding  by  com- 
pression of  the  aforesaid  artery,  with  the  finger 
applied  overits  track,  making  firm  pressure  against 
the  bone.  This  will  arrest  the  bleeding  in  nine 
hundred  and  ninety-nine  cases  in  a  thousand.  I 
have  been  called  to  see  cases  when  other  physicians 
had  plugged  the  nostrils,  and  injected  solutions 
of  ferri  persulphas,  ice  water,  etc.,  without  benefit, 
and  have  at  once  arrested  all  hemorrhage  instantly 
by  the  above  simple  means.  Tell  them  to  try  it. 
— Sdiilh  Ciili/(irnia  I'ract. 


BORIC   ACID  A  REMEDY  FOR  STYE. 

A  simple  and  effective  remedy  for  stye  has  been 
found  by  me  to  be  a  solution  of  fifteen  grains  of 
boric  acid  to  an  ounce  of  water.  By  applying  this 
solution  three  times  a  day  to  the  inflamed  part  of 
the  eyelid,  by  means  of  a  camel's  hair  brush,  this 
painful  and  annoying  aflettion  will  be  conquered 
very  rapidly. — George  Reuliiij,  M.D.,  Baltimore, 
Md. 


THE   CANADA   MEDICAL   RECORD. 


233 


FIFTY  APHORISMS  IN  PREGNANCY. 

Dr.  Iv  |.  Keinpf  (Ainerirdii  /'/■■irlillom  r  (iml 
X,,rs): 

(jiimt'il,  .iphdiisms. —  I.  'rhc  s.ifcst  plan  is  to 
consider  every  woman,  wlietlier  married  or  single, 
who  comes  to  yon  for  treatment,  as  piegnant 
iinlil  you  iiave  satisfied  yourself  to  the  contrary. 

2.  The  physician  or  midwife  shoidtl  inform  himself 
or  herself  all  about  the  patient's  lormer  labors, 
general  physical  status,  condition  of  lungs  and 
heart,  etc.,  the  jiresentation  and  position  and  con- 
dition of  the  child,  and  the  location  of  the  placenta, 
by  external  manipulation,  several  weeks  before 
delivery. 

3.  To  find  day  of  confinement,  take  last  day  of 
menstruation,  say  February  loth,  count  backward 
three  months  to  November  lotli,  and  add  seven 
days — November  17th.  An  exact  leckoiiing  of 
the  date  of  confinement  is  impossible,  errors  of 
one  or  two  weeks  being  sometimes  inade. 

4.  Diiect  the  pregnant  woman  to  :  t,  keep  the 
bowels  regular;  2,  that  the  diet  be  p.ain  and  nutri- 
tious ;  3,  to  take  frequent  baths ;  4,  not  to  get  cold 
or  wet  ;  5,  to  take  moderate  exercise;  6,  to  do  tiie 
usual  light  housework  ;  7,  to  be  in  the  open  aii 
often  ;  8,  not  to  worry  or  get  excited  ;  9,  that  the 
dress  should  be  warm,  loose,  and  there  shoidd  be 
no  pressure  on  the  breasts,  waist  or  abdomen  ;  10 
to  wear  an  abdominal  bandage  ;  it,  to  liathe  the 
nip])!es  in  some  astringent  solution  it  they  are  sore; 
12,  to  consult  the  family  physician  for  any  indis- 
position   (iMunde.) 

5.  Moderate  coition    is    allowable  during    the 
first  seven  months  of  pregnancy,    and  fondling  of 
ll;e  breasts  and  nipples  by  tlie  husband  during  the   j 
latter  months  is  advisable.      (Spiith,    Geburtseii- 
kunde,  1857.) 

6.  Si<jii-i  ■mil  Si/iiipfoms  of  Pregnrincij.- — Morn- 
ing sickve-s  occiiis  during  the  end  of  the  first 
month,  ihe  setoiidand  third  months,  and  some 
times  durini;  the  fourth  and  fifth  months.  Occui  ring 
after  that  it  is  [Moliably  abnormal.  (Munde) 

7.  Men-.trual  supjjression  is  the  rule  during  all 
tlie  months.  The  menses  may  occur  during  the 
first,  second  and  third  months,  rarely  afteiward. 
Conception  may  occur  when  menstruation  is  nor- 
mally absent,  as  in  young  girls  before  menstruation 
is  established,  and  after  the  change  of  life  and 
during  lactation. 

8.  .\l  the  beginning  of  the  third  month  mam- 
mary areolae  become  turgid.  This  is  not  a  reliable 
sign,  as  it  may  occur  in  uterine  or  ovarian  dis- 
ease.    (Playfair.) 

9.  Abdomen  begins  to  enlarge  during  the  third 
month,  and  becomes  marked  during  the  fourth, 
when  the  uterus  rises  three  fingers' breadth  above 
the  symphysis  pubis;  during  the  fifth  it  occuijies 
t'lc  hypogastric  region  ;  during  the  sixth  it  rises 
to  the  umbilicus;  during  the  .seventh  two  inches 
u|jvvard  ;  during  the  eighth  and  ninths  niondis  it 
gradually  enlarges  until  it  reaches  the  ensiforni 
wnilagc.    For  about  4  week  before  delivery   the 


uterus   sinks    somewhat   into    the   pelvic    cavity. 

(i'layfair.) 

io.  Fetal  movements  start  in  at  about  the 
middle  of  the  fifth  month.  These  movements 
m.iy  be  simulated  by  irregular  contractions  of 
abdominal  muscles  or  tlatus  within  the  bowels. 
(Playfair.) 

II  IJallolemcnl  will  be  of  service  at  the  end  of 
the  fourth  iiKjntr,  to  the  eiul  of  the  sixth  month. 
(Playfair.) 

I  2.  Uterine  soufile  c  an  be  heard  at  the  end  of  the 
fourth  month,  and  until  the  term  ends.  (Playfair.) 

13.  Fetal  heart  sound  can  be  made  out  during 
the  fifth,  sixth,  seventh,  eighth  and  ninth  months. 
The  |)ulsaiion  is  likened  to  the  tic-tac  of  a  watch 
under  a  pillow.  Steinbach  makes  the  beat  131 
for  male  children  and  138  for  females,  but  this  is 
not  i)ractical.  'I'he  beat  is  most  easily  heard 
when  the  back  of  the  child  lies  to  the  abdomen  of 
the  mother.  An  accelerated  or  irregular  beat, 
])receding  or  during  labor,  means  danger  to  the 
child.  There  is  no  relation  between  the  fetal  and 
maternal  pulse. 

14.  'J'he  most    valuable  signs  of  pregnancy  are 
fetal  heart  pulsation,  letal  movements,  ballotenient  ■ 
and  intermittent  contractions  of  the  uterus. 

15.  Miscellaneous  signs  of  pregnancy  are  dusky 
hue  of  the  vagina,  dentalgia,  fiicial  neuralgia,  ten- 
dency to  syncope,  salivation,  unusual  gratification 
during  some  particular  act  of  coitus.     (Mund,e.) 

16.  The  unimpregnated  uterus  measures  two 
and  one-half  inches,  and  weighs  one  ounce,  at  term 
it  measures  si.x  times  as  many  inches  and  weighs 
twenty-four  times  as  many  ounces.  The  cervix 
uteri  does  not  shorten  dtiring  pregnancy  except 
during  the  fortnight  preceding  delivery,  which  is 
due  to  incipient  uterine  contraction.  The  cervi.x 
begins  to  soften  by  the  end  of  the  fourth  month  ; 
by  the  end  of  the  sixth  month  one-half  is  thus  alte- 
red ;  by  the  eighth,  the  whole  of  it.  The  os  is 
generally  patulous.  (Playfair.) 

17.  Dloiinosisof  Prcf/naiiri/  1)1/  ExternnJ Muni- 
piil'itiiiii. — By  inspection  we  may  learn  the  gene- 
ral contour  of  the  abdominal  enlargement,  whether 
it  be  of  the  usual  jiear  shape  or  broader,  as  is  the 
case  with  shoulder  presentations.  Where  there 
are  twins,  side  by  side,  there  is  usually  a  depres- 
sion or  sulcus  between  them,  and  the  uterus  is 
broader  transversely.  If  the  twins  be  pLaced  one 
in  front  of  the  other,  no  difference  can  be  noted  in 
the  breadth  of  the  uterus. 

18.  By  percussion  we  mike  out  the  outlines  of 
the  uterus. 

iQ.  By  palpation  we  feel  the  outlines  of  the 
uterine  tumor,  the  prominent  parts  of  the  child, 
the  round,  hard,  bony  head,  the  soft  breech,  the 
knees,  the  feet,  the  elbows,  the  round  arched  back 
and  the  movements  of  the  child. 

20.  By  auscultation  we  may  learn  tlie  condition 
the  pivsentaiion,  the  po^iiion,  and  the  sex  of  the, 
fetus  and  the  location  cf  th'_-  placenta.  (Wilson.) 

?l,  'I'hc   position    of  fetus  is  j^nerally    head 


234 


THE   CANADA    MEDICAL   RECORID. 


downward,  and  breech   toward  the  fundus  uteri. 
(Playfair.) 

22.  Spnriiias  Pir(pi.ivn/. — Pregnancy  is  simply 
by  pelvic  or  abdominal  tumors,  obesity,  ascites, 
tympanites,  distension  dui  to  retained  menstrual 
blood,  amenorrhcea,  etc.  A  careful  physical  ex- 
amination is  the  only  guard  against  a  mistake. 
(Munde.) 

23.  Ahtwrmnl  Prrgnanqj. — Extra-uterine  gesta- 
tion— early  treatment,  the  faradic  current,  late 
treatment,  laparotomy — is  very  dangerous. 
Molar  pregnancy,  be  it  hydatiform,  carneous  or 
S|)urious,  calls  for  complete  removal  of  the  mass. 
Hydramnios  may  necessitate  permature  delivery. 
(Munde.) 

24.  Disorihrx  of  Firgiumn/. — Vomiting  of  preg- 
nancy, as  a  rule,  needs  no  treatment,  but,  if 
excessive,  it  is  relieved  the  quickest  by  the  appli- 
cation of  cocaine  and  vaseline  (one  in  fifty) 
against  the  os  uteri,  and  by  one-sixteenth  of  a 
grain  of  cocaine,  internally,  frc(|uently  re[)caled. 
When  vomiting  of  pregnancy  becomes  so  persis- 
tent that  it  resists  all  treatment  and  threatens  to 
destroy  the  ]iregnant  female,  abortion  or  prema- 
ture labor  may  become  necessary,  but  should 
never  be  undertaken  without  a  consultation. 
(Munde.) 

25.  Anemia — the  best  treatment  for  this  is 
good  food,  light  air,  exercise,  iron  and  arsenic, 
and  removal  of  the  cause  if  possible. 

26.  Plethora  may  call  for  saline  laxatives  and 
restriction  of  albuminoid  food. 

27.  In  constipation  direct  a  regular  hour  of  the 
day  for  going  to  the  closet,  and  give  compound 
licorice  powder,  or  cascara  sagrada,  or  enemata. 

28.  Diarrhcea  should  never  be  neglected,  as  it  may 
lead  to  abortion  or  premature  labor.  Give  pare- 
goric and  tincture  of  catechu,  or  acetate  of  lead, 
opium  and  ipecac,  and  kee[)  the  patient  quiet. 

29.  Leucorrhoja  calls  for  vaginal  washing  with 
carbolized  tepid  water. 

30.  Pruritus,  which  may  be  general  or  local, 
treat  with  soda  baths  if  the  former,  and,  if  the 
latter,  treat  with  carbolic  acid  in  glycerine,  nitrate 
of  silver  in  mild  solution,  cocaine  in  rose  water, 
h)drate  of  chloral  in  water,  etc. 

31.  Frequent  micturition  may  often  be  relieved 
by  an  abdoniiiial  supporter.  So  also  in  incontinence 
of  urine,  .Strvchnia,  belladonna,  or  cantharides  may 
be  tried  m  both  troubles. 

32.  In  varicose  veins,  besides  applying  a  flannel 
bandage  or  a  silk  stocking,  instruct  the  woman 
how  to  apply  a  compress  and  bandage  in  case  of 
rupture  of  a  vein,  as  the  hemorrhage  may  be 
great. 

33.  Diabetes,  albuminuria,  jaundice,  neuralgia, 
hemorrhoids,  etc.,  during  pregnancy,  call  for  the 
same  treatment  as  when  occurring  at  other  times. 

34.  Uterine  displacements  call  for  replacement, 
followed  by  the  a|)plication  of  an  approjiriate  pes- 
sary and  supporter. 

35.  False  pains  may  come  on  at  any  time   dui' 


ing  pregnancy,  and  cannot  be  told  from  true  pains, 
except  that  the  former  are  relieved  by  opium. 

36.  High  temperature  in  the  mother  is  not 
necessarily  incompatible  with  fetal  life. 

37.  Iiiimahn-e  Dnliven/. — Abortion  is  the  expul- 
sion of  the  ovum  before  the  formation  of  the 
placenta  (twelfth  week);  miscarriage,  its  expulsion 
before  the  period  of  viability  (twenty. eighth  week); 
premature  delivery,  its  expulsion  between  the 
twenty-eighth  and  thirty-eighth  week.     (Munde.) 

38.  Causes  of  immature  delivery  are  predispos- 
ing, dependent  on  constitutional  affection,  and 
exciting,  dependent  on  mechanical  or  emotional 
violence.  Sym|)toms  are  pain  and  hemorrhage 
and  dilatation  ol  the  os  uteri.  Dangers  to  mother 
from  sepsis,  fatal  liemorrhage,  perimetric  inflam- 
mation, carneous  moles.  Dangers  to  child — want 
of  viability. 

39.  Treatment  is  prophylactic  by  fluid  extract 
black  haw,  and  removal  or  avoidance  of  cause ; 
preventive  by  rest,  opium  and  black  haw  ;  and,  in 
inevitable  cases  of  abortion,  empty  the  uterus  and 
check  the  bleeding  by  rest  and  ergot,  by  tampon, 
and  after  dilatation  of  cervix  by  finger  or  dull 
curette.     (Munde.) 

40.  Miscarriage  should  be  treated  like  abortion, 
and  ]jremature  labor  like  labor  at  full  term. 

41.  Artificial  abortion  is  best  performed,  up  to 
the  fifth  month,  by  dilatation  of  the  cervix  with 
the  steel  branched  dilator  ;  it  is  done  because,  i, 
persistent  vomiting,  2,  organic  visceral  lesion,  3, 
incarcerated  uterus,  4,  deformity  of  pelvis,  5,  pre- 
sence of  large  tumors.     (Munde.) 

42.  Premature  labor  is  best  induced  by  cath- 
eterization of  the  uterus — not  rupture  of  mem- 
branes, for  I ,  dyspnoea  from  enormous  distention  of 
the  abdomen  from  any  cause,  2,  hemorrhage 
from  placenta  previa,  3,  uncontrollable  vomiting, 
4,  organic  heart  trouble,  5,  habitual  death  of  the 
fetus,  6,  pelvic  contraction  of  moderate  degree,  7 
hopeless  condition  of  the  mother,  8,  where  in  pre- 
vious labors  there  have  been  unusually  large  chil- 
dren.    (Munde.) 

43.  Fetus.  Fetus  at  first  month  is  rarely  to  be 
detected  in  abortions.  At  second  month  it  weighs 
sixty  grains,  measures  six  to  eight  lines,  head  and 
extremities  are  visible,  eyes  are  two  black  spots 
on  side  of  head,  umbilical  cord  is  straight,  the 
calvicle  and  inferio  rmaxillary  bone  begin  to  ossify. 
At  third  month  the  embryo  weighs  from  seventy 
to  three  hundred  grains,  measures  from  two  to 
three  inches,  forearm  is  formed,  fingers  can  be 
traced,  placenta  is  formed.  At  fourth  month 
weight  is  from  four  to  six  ounces,  length  six  inches, 
sex  of  the  child  can  be  made  out.  At  fifth  month 
weight  ten  ounces,  length  ten  inches  ;  hair  and 
nails  beginning.  At  six  months  weight  one 
pound,  length  eleven  to  twelve  inches;  membrana 
pupillaris;  eyebrows.  At  seven  months  weight 
three  or  four  pounds,  length  thirteen  to  fifteen 
inches;  eyelids  are  open  ;  testicles  in  scrotum; 
clitoris  prominent,     At  eight   months  four  to  five 


THE   CANADA   MEDICAL    RECORD. 


235    ^ 


pounds,  length  sixteen  to  eighteen  inches  ;  nails  ; 
mcnibraii.'i  pupill.iris  has  clisa|ipe;ired.  At  nine 
ni  mths  weight  six  to  eight  jxninds,  length  nine- 
teen to  twenty  indies  ;  males  soincwiiat  heavier 
than  females.     (I'layfair.) 

44.  Sig>i-'<  "/  Oiiith  'if  Ff/n.i.  I'efore  labor  the 
signs  (if  death  of  the  fetus  are,  1,  loss  of  fetal 
heart-heat,  2',  loss  of  fetal  motion,  3,  sense  of  dull 
weight  in  the  uterine  region  felt  by  mother,  4, 
sense  of  coldness  in  the  womb,  5,  putrescent  fetor 
in  the  discharges,  6,  discharge  of  flatus  from  the 
uterus. 

45.  Jli.i;  Placenta  Liquor  Amiiii,  etc.  The 
]ilacenta  supplies  n\ilrinient  to  and  aerates  the 
l)lood  of  the  fetus,  it  may  be  situated  anywhere 
in  the  uterine  cavity.  The  umbilical  cord  is  the 
channel  of  communication  between  the  fetus  ai.d 
placenta.  The  placenta  at  full  term  is  a  moist 
mass,  containing  a  great  deal  of  blood  ;  spongy  in 
texture  ;  about  seven  inches  in  diameter,  u.snally 
oval ;  one  surface  smooth,  facing  the  cavity  in  which 
the  fetus  lies,  the  other  surface  rough,  fastened  to 
the  walls  of  the  uterus.  The  color  is  reddish,  but 
varies  in  tint  according  to  the  condition  of  the 
blood. 

46.  I,ic|uor  amnii  is  secreted  by  the  amnion 
and  the  allantois,  it  affords  a  fluid  medium  in 
which  the  fetus  floats,  and  so  is  protected  from 
shocks  and  jars,  it  saves  the  uterus  from  injury 
from  the  movements  of  the  fetus,  and  in  labor 
it  lubricates  the  passages.  It  has  nothing  to  do 
with   the    nourishment   of  the  fetus. 

47.  riie  uterine  and  placental  murmurs  are  not 
usually  taken  notice  of  in  the  diagnosis  of  preg- 
nancy. 

48.  Knots  in  the  umbilical  cord  are  brought 
about  by  passage  of  the  child  through  a  loop  in 
the  cord,  generally  during  labor. 

49.  \n  twins,  triplets,  etc.,  there  may  be  one 
placenta  or  more  than  one.  If  two  fetuses,  iliey 
may  be  joined  by  two  cords  to  one  placenta.  This 
cannot  be  m  ide  during  pregnancy. 

50.  So-called  material  impressions,  monstrosi- 
ties, marks,  etc.,  are  the  result  of  arrest  of  evolu- 
tion due  to  pressure  by  amniotic  bands,  pressure  by 
the  umbilical  cord,  adhesions  of  the  placenta,  or 
to  some  pathological  condition  of  the  fetus  or  its 
memftranes,  or  to  heredity. 


THE  HOT   BATH  IN    THE  TREATMENT 
OF  SLEEPLESSNESS. 

Mr.  S.  Eccles.  in  the  Practitioner,  states 
that  to  secure  sleep  by  means  of  the  hot  bath, 
the  lollowing  precautions  have  to  be  attended 
to: — The  bathroom  must  be  heated  to  about 
70*^  F.,  then  the  patient  must  be  stripped  in  the 
bath-room,  the  head  and  face  being  rapidly 
douched  with  water  at  100°  F.    By  this  means 


the  body  is  cooled,  whilst  a  rush  of  blood  is  sent 
to  the  head.  Then  the  whole  body,  excluding 
the  head  and  face,  is  immersed  in  the  liath  at  9S  ° 
F.  rapidly  raised  to  105°  or  110°  !•'.  In  about 
eight  to  fifteen  minutes  the  jiatient  feels  a  sensa- 
tion of  pleas;int  languor,  when  he  must  be  wrap- 
lied  in  warm  blankets,  and  jiroceed  to  the  bed- 
room with  as  little  personal  effort  as  possible. 
Hy  the  time  the  bed  rocnn  is  reached  the  mois- 
ture oil  the  surface  of  the  body  will  have  been 
absorbed  ;  the  patient  must  then  jjut  on  his 
night-clothes  and  get  into  bed,  lying  with  the 
head  raised,  hot  bottles  to  the  feet,  and  well 
covered  with  bed-clothes.  No  conversation  or 
moving  about  the  room  should  be  allowed,  and 
all  light  must  be  excluded.  In  a  few  minutes  the 
])atient  will  be  found  in  a  quiet,  refreshing  sleep. 
The  theory  of  the  method  is  based  on  the  sudden 
exjjosure  of  the  body  contracting  the  arterioles 
of  the  skin,  causing  thereby  a  corresponding 
dilatation  of  the  vessels  of  internal  organs,  which 
in  the  case  of  the  brain  is  further  induced  by  the 
application  of  hot  sponging.  The  immersion  of 
the  whole  body  next  causes  a  dilatation  of  the 
vessels  of  the  surface,  except  the  head  and  face, 
with  contraction  of  the  vessels  of  the  brain  and 
gradual  slowing  of  the  heart's  action,  thus  placing 
the  brain  in  the  most  favorable  condition  for 
complete  functional  rest.  There  are  certain  con- 
ditions, however,  in  which  this  method  is  contra- 
indicated.  Persons  suffering  from  ansemia  or 
emaciation,  or  from  aortic  valvular  disease,  or  in 
whom  signs  of  atheioma  are  recognized,  should 
not  be  subjected  to  such  rapid  variations  of 
local  arterial  tension  as  this  process  entails.  In 
such  cases  massage  may  give  good  results. — 
Glii^ijdic  Med.  Journal. 


"PYRIDINE  TRYCARBOXYLIC  ACID"  AS 
A  REMEDIAL  AGENT. 

BV    DR.    S.    BRZOZOWSKI. 

This  compound  has  been  lately  introduced  to 
the  profession  as  an  antipyretic  and  anti/ymotic. 
As  the  literature  upon  this  medicine  has  been 
very  meagre,  I  thought  that  probably  my  expe- 
rience with  this  drug  might  be  of  some  interest 
to  the  readers  of  your  Journal  as  well  as  the 
profession  at  large. 

IN    TYPHOID    FEVER. 

In  this  disease  I  have  given  this  drug  a  fair 
and  impartial  trial  as  an  antipyretic.  1  always 
administer  it  in  solution, and  give  ten  grains  every 
3  hours,  until  the  temperature  is  reduced  from 
10352  or  1041-2  to  loi  or  loi'i-,  evening  tem- 
perature. 

Under  this  treatment  the  fever  generally  runs 
its  course  in  twenty-one  days,  and  leaves  no  bad 
sequels.  I  have  n  ver  seen  any  unpleasant 
effects  of  this  drug.     It  is  agreeable  to  the  taste, 


236 


THE    CANADA   MEDICAL    RECORD. 


the  stomach  retains  it  readily,  it  produces  no 
cerebral  disturbances  ;  it  is  in  fact  all  that  can 
be  desired  in  the  treatment  of  this  disease. 

IN    PNEtTMONIA, 

I  also  use  this  drug  simply  as  an  antipyretic, 
and  since  I  have  been  using  it  I  prefer  it  to 
verat  virid,  aconitum,  tartar  emetic, or  any  of  the 
old  remedies  used  for  reducing  the  temperature. 
Mv  reason  of  jsreference  is  that  this  drug  will 
reduce  the  temperature,  if  given  in  large  enough 
■,doses,  and  that  it  requires  no  watching,  as  it  is 
perfectly  harmless. 

IN    "  BLOOD    POISONING." 

It  frequently  hap|)ens  in  jiractice  that  you  are 
called  to  a  case  of  5  or  6  days  after  delivery  ;  you 
find  your  patient  suffering  with  pain  in  the 
abdomen,  which  is  increased  liy  [jressure.  By 
])lacing  the  thermometer  in  the  axilla  you  find 
the  temperature  104  or  lo^y,.  The  countenance 
is  indicative  of  great  pain,  the  patient  complains 
of  great  restlessness.  Ui)on  inquiry,  you  learn 
that  the  secundines  have  all  been  removed. 
l^pon  examination,  you  find  nothing  that  is 
contrary  to  the  statement  of  the  midwife  ;  but 
unquestionably  some  septic  poisoning  has  taken 
place. 

In  these  cases,  you  will  find  the  pyridine 
tricarboxylic  acid  a  great  remedy,  both  as  an 
antipyretic  and  antizymotic,  if  given  in  doses  of 
tea  grains  every  three  hours.  I  treated  cases 
like  this  where  you  would  expect  a  puerperal 
fever,  which  got  well  in  three  or  four  days. 

"  Pyridine,     and     Pnridine      Trvcarboxvlic 
Acid." 

There  seems  to  be  some  misunderstanding  in 
regard  to  these  two  drugs. 

P)ridine  is  not  Pyridine  Tricarboxylic  Acid. 
Pyridine  is  a  liquid  alkaloid  that  is  miscible  with 
water,  and  is  generally  found  in  bone-oil.  But 
Pyridine  Tricarboxylic  .'\cid  is  a  crystalline  body, 
and  prepared  from  quinine,  by  oxidizing  the 
alkaloid  conqjietely  with  permanganate  of  potash. 

If  any  doubt  exists  in  the  mind  of  the  profes- 
sion in  regard  to  my  statement,  all  I  ask  of  them 
IS  to  try  the  drug,  and  if  my  statement  is  not 
borne  out  in  full. I  stand  corrected. — Mni.  Herald, 
Loidsril/e,  Koitucki/,  Juniinry,  i8S8. 


THE  PHARMACEUTICS  OF  ANTIPYRIN. 

Antipyrin,  although  a  fairly  stable  chemical  body, 
undergoes  decomposition  in  contact  with  certain 
substances,  occasionally  with  an  undesirable  result. 
One  of  the  most  noteworthy  incompalibles  is  the 
spirit  of  nitrous  ether.  This  mix  uro  gives  rise  to  a 
green  co'or,  and  although  the  jireci.e  nature  of  the 
resulting  conq  ound  is  not  known,  a  child  suffering 
from  a  slight  fever,  to  whom  it  was  given,  died 
shortly  after  with  syniioins  strongly  pointing  to 
poison.  It  is,  thefLfore,  highly  desirable  that  this 
incompatibility  should  be  made  known  as  widely 
as  possible. — Medml  Frem, 


AN    EXAMINATION    FOR    LICENSE    TO 
PRACTICE. 

The  Board  of  Health  of  Dakota  recently  exa- 
mined an  applicant  for  a  license  to  practice 
medicine.  He  had  been  practicing  medicine 
for  years  in  Dakota.  Here  are  some  questions 
and  answers  : 

"  What  medical  paper  do  you  take.  Doctor?" 
"  Well,  I  get  along  without  them." 
"  What  books  have  you  in  your  library  ?  " 
"  Gunn's    Family    Physician    and    Common- 
Sense  Home  Doctor." 

"  Name  the  three  great  cavities  of  the  body." 
"  'I'he  head,  the  belly  and  the  diaphragm." 
"  Name  contents  of  abdominal  cavity." 
"  Kidneys  and  the  prostate  gland." 
"  Have   you   treated    any    cases    of  enkarged 
prostate  ?  " 

"  Lots  of  them." 
"  With  what  success?" 
"  Ti))top  !  never  lost  a  case." 
"  Did  you  ever  treat  any  female  for  enlarged 
prostate  ?  " 

"  Oh,  yes  ;  numbers  of  them." 


THE    LAW    OF    THE    DETERMINATION 
OF  THE  SEXES. 

So  many  laws,  founded  upon  insufficient  data, 
have  been  advanced  lately  as  determining  the  sex 
of  the  child,  that  we  are  led  to  give  our  own, 
which  has  been  deducted  after  the  compilation 
and  careful  examination  of  a  vast  quantity  of  sta- 
tistics. If  the  mother,  while  ])regnant,  sees  a  bow- 
legged  flea,  with  a  wart  on  its  left  knee,  the  child 
will  be  a  male.  If  the  wart  is  on  the  right  knee, 
a  female.  In  case  the  flea  is  cross-eyed,  and  lacks 
its  eye-teeth,  these  indications  are  reversed. — St. 
Luids  ]Ve<kh/  Medical  Nci'iew. 


COCAINE  IN  ACUTE  TONSILLITIS. 

Recently  I  began  to  suffer  from  a  very  sharp 
attack  of  acute  tonsillitis  of  the  right  side,  with 
a  considerable  injection  of  the  surrounding 
|)arts.  Two  days  after  I  experienced  the  most 
excruciating  pain  in  swallowing,  also  severe 
pain  in  the  right  ear,  and  I  could  only  with  great 
diffit'ulty  speak.  In  the  afternoon  of  this  day 
my  friend  INIr.  Thomas  swabbed  out  my  throat 
three  or  four  limes  with  a  four-per-cent.  solution 
of  cocaine,  and  poured  a  few  drops  of  the  same 
into  my  ear.  The  relief  which  I  experienced 
was  so  great  that  I  could  soon  after  speak  fairly 
easily,  and  swallow  with  very  much  less  dift'i- 
culty.  I  continued  to  apply  the  cocaine 
every  two  hours  during  the  day  with  continued 
success  for  five  days,  then  a  day  in  the  countr)-, 
l)ut  me  right, — F.  Bhi/s  Grijjithn,  and  British  Med, 


TBE  CaKADA   MEDtCAt   RECORD. 


237 


THE  TREATMENT  OF  BILIOUSNESS. 

According  to  the  Bostnu  Mnlirnl  rnul  Sitrijiail 
Jo  toil  1 1 1, ihi:  treatment  of  l)ilioiisness  is  piopliylaciic, 
alimentary,  and  medicinal.     I'lophylaxis  is    con- 
cerned with  avoidance  of  all  the  known  causes, 
whether  of  a  toxic,  malarial,  or  alimentary  charac- 
ter.    A  jilain  diet,  of  bread,  milk,  oatmeal,  veget- 
ables, and    fruits,   with  lean   meat  or  fresh  fish   in 
moderation,  and  abstinence  from  alcoholic   stim- 
ulants,  seem  to  be  the  ideal  fare  for   the  biliously 
predisposed.     This  kind  of  diet  is  especially  apitli- 
cable    for    hot    weather,    when   albuminoids    are 
apt  tO/  clog  the  portal  system,  and  pastries  are  an 
abomination,  and  when  a  broiled  schrode,  a   little 
chicken  or  a  mutton  broth,  with  l)rcad  and  stewed 
fruit,  will  make  a  more  healthful  meal  than  the  more 
sumptU(  u;  fare  of  a   modern  fashionable    dining 
saloon.     Exercise  in  the  open  air  is  of  recognized 
utility  in  promoting  oxidation  and  elimination, en- 
hancing  the  digestive  and  assimilative   processes, 
and    lightening  the  burdens  of  the  liver.     More- 
over,   exercise    (whether   by  rowing,   horseback- 
riding,  gardening,   or  walking)  hinders  absorption 
ot  bile  by  the  hepatic  venous  radicals, and  ])romotes 
the   passage  of  that  fluid    into    the   duodenum, 
through  the  increased  compression  exerted  on  the 
liver  by  the  diaphragm  and  abdominal   muscles ; 
this  is  in  accordance  with  a  recognized  physiologi- 
cal law.     The  victim  of  an  acute  bilious  attack 
will  generally  get  righted  in  a  k\v  days  by,  first, 
abstinence  from   all  food,  then  a  diet  of  porridge 
and  milk,  or  skimmed  milk  alone,    and  a   very 
gradual  return   to   solid   food,  which  for  several 
days  should  be   restricted  to   toast,  a   little  lean 
meat,  or  broiled  fish,  with  some  succulent  veget- 
ables   or    ripe    fruit.     As   for   medicines,    saline 
aperients,    such  as  sulphate  of  soda,  Epsom    or 
Rochelle  salts  in  full  doses  in  the  morning,  or  the 
now  fashionable  tumblerful  of  Hunyadi  Janos,  will 
generally  suffice  to  clear  the  jjitmn  vice;  the  latter 
has    especially  a  reputation  for  evacuating    bile. 
The  striking  relief  obtained  by  free  bilious  evacua- 
tions has  often  been    remarked,    and  the  veteran 
transgressor  resorts  to  his  blue  pill  or  podophyilin 
with    every    recurrence    of  his   malady.     Of  late 
enonymin  has  come  much  into  use  as  a  cholagogue. 
Harley  recommends  to  persons  who  seem  to  have 
a  more  than  usual  tendency  to  biliousness,  trace- 
able to  sluggish  biliary  secretion,  and  where  there 
seems    also  to  be  defective  nerve  action,    small 
doses  of  nux  vomica  or  strychnia  after  their  meals. 
This  may  be  combined  with  belladonna  and  aloes 
as    in  the  aloin,  strychnia,  and   belladonna   pill. 
The  bilious  person  is  generally  constipated,  hence 
such  a  pill  has  a  special  utility.     Fothergill's  pill 
of  ipecac,  capsicum,  and  pil.  aloes  et  myrrh,  has 
done  good  service  in  such  cases.     Nitro-muriatic 
acid  and  taraxacum  have  a  reputation  which  is 
probably  not  altogether  built  on  imaginary  results. 
But    bilious    dyspeptics,    while    they    should    be 
attentive    to  the    functions  of  eliminations    (and 


doubtless  the  ancient  predilection  for  purgatives 
has  been  justified  by  moclern  .scientific  research, 
which  tinds  in  intestinal  sc|)tica;mias  and  alkaloids 
of  putrefaction  many  of  the  evils  formerly  attri- 
buted to  peccant  humors  and  atrabiliaiy  disorders; 
should  aim  especially  to  be  good  hygienists,  and 
learn  to  live  right;  but  this  is  counsel  which 
everybody  gives  and  nobody  takes. 


In  obstinate  hiccough,  always  suspect  aneurism, 
and  carefully  examine  for  such. 

Iodine  is  recommended  by  Professor  Parvin  as 
one  of  the  best  uterine  hieinostatics  and  antiseptics. 

Dr.  Mus.ser  states  that,  after  all  operation  on 
pelvic  viscera,  it  is  always  well  to  make  a  routine 
practice  of  giving  opium  by    su|)i)Ository. 

Uterine  cancer,  in  the  vast  majority  of  cases,  is 
of  the  cervix  ;  .sarcoma  is  of  the  body.  One  third 
of  all  cancers  found  in  women  are  of  the  uterus. 

For  constipation  in  infants  Professor  Parvin  re- 
commends equal  i)arts  strained  oatmeal  gruel  and 
milk.  If  this  does  not  act  efficiently  he  prescribes 
from  3   ss- 3  j  of  sodii  phos])has  in  twenty-four  hour.*. 

For  irritable  stomach  of  cholera  infantum,  Pro- 
fessor Parvin  speaks  highly  of  counter-irritation  of 
epigastrium  by  means  of  mustard,  and  the  internal 
adminstration  of  gr.  v  of  bismuth  with  gtt.  iij  of 
aromatic  spts.  ammonia  every  hour. 

For  thread-worms,  at  night  give  gr.  j  of  calomel 
andgr.  ij-iv  of  santonin  ;  the  following  morning  in- 
ject a  cleansing  enema  of  water,  and  follow  this 
by  the  infusion  of  quassia. 

To  properly  examine  a  woman's  breast,  she 
should  be  lying  on  her  back.  If  examined  in  any 
other  position  it  can  be  so  manipulated  as  to  con- 
vert it  into  any  tumour.  When  on  her  back,  exa- 
mine by  pressing  the  tips  of  the  fingers  back 
through  the  breast  against  the  chest  walls,  and  not 
by  pinching  the  structures  up  between  the  fingers. 
Dr.  Allis  says  the  great  secret  of  applying 
plaster-of-Paris  bandages  is  to  have  all  the  sizing 
out  of  the  material  used,  so  when  a  piece  of 
muslin  to  be  used  is  thrown  upon  water  it  sinks 
readily  ;  if  it  does  this  it  will  readily  absorb  water 
and  plaster,  and  will  set  quickly  ;  a  little  salt  added 
to  the  water  is  an  advantage  ;  a  roller  made  of 
lint  is  better  than  cotton  to  be  applied  next  to 
the  part. 


THE  TREATMENT  OF  TYPHOID  FEVER. 

Dr.  J.  C.  Wilson,  Physician  to  the  Jefferson 
Medical  College  Hospital,  treats  his  cases  of  enteric 
fever  by  the  systematic  use  of  la.xative  doses  of 
calomel  during  the  first  ten  days,  and  by  carbolized 
iodine,  as  originally  suggested  by  Professor  Bar- 
tholow,  throughout  the  course  of  the  disease. 
The  most  careful  attention  is  given  to  the  details 
of  nursing,  dietetics,  and  hygiene,  and  symptoms 
are  treated  as  they  become  prominent. 


238 


fHte  dAlJADA  MEDICAL  RECOtiO. 


Due  regard  being  had  to  tlie  peciiliarilies  of  in 
dividual  cases,  the  general  plan  is  as  follows  : 

Upon  the  evening  of  admission,  the  patient  re- 
ceives seven  and  a  half  to  ten  grains  of  calomel  in 
combination  with  ten  grains  sodiiun  bicarbonate, 
at  a  single  dose.  If  the  case  be  still  in  the  first 
week,  which  is  not  usual  with  hospital  patients, 
this  dose  is  repeated  every  second  night  until  its 
tliird  adminstration  ;  if  already  in  the  second  week 
a  single  dose  only  is  given.  After  the  tenth  day 
it  is  given  cautiously,  or  omitted  altogether.  If 
there  be  constipation,  the  first  dose  of  calomel  is 
followed  by  two  or  three  large  stools,  mostly  of 
the  consistency  of  mush,  the  latter  dose  by  stools 
decidedly  liquid.  Diarrhceais  not  regarded  as  a 
con  ra-iudication.  On  the  contrary,  it  almost  al- 
ways becomes  less  troublesome  after  the  action  of 
the  mercurial.  During  the  subsequent  course  of 
the  disease,  constipation  is  not  allowed  to  continue 
at  any  lime  beyond  the  third  day  ;  but  is  relieved, 
as  a  rule,  by  eight-ounce  enema  of  warm,  thin  gruel, 
slowly  injected,  or  exceptionally  by  a  five  or  seven 
and  a  half  grain  dose  of  calomel,  the  choice  being 
influenced  by  the  character  and  prominence  of  ab- 
dominal symptoms.  Under  this  ]jlan  of  treatment 
dia.rhcea  is  not  commonly  excessive.  When 
necessary,  it  is  treated  by  one-grain  suppositories 
of  the  aqueous  extract  of  opium. 

From  the  beginning  the  jjatient  receives  at  in- 
tervals of  two  hours  during  the  day,  and  three 
hours  during  the  night,  and  immediately  after  the 
administration  of  nourishment,  two  or  three  dro]is 
of  a  mixture  of  two  jjarts  tincture  of  iodine  and 
one  part  pure  liquid  carbolic  acid.  This  dose  is 
administered  in  an  ounce  of  iced  water. 

Unless  the  temperatuie  exceeds  104  °  F. ,  the 
fever  calls  for  no  special  treatment,  beyond  cold 
sponging,  which  is  practiced  in  every  case  at  least 
twice  in  the  twenty-four  hours.  A  higher  temper- 
ature receives  prompt  attention. 

After  trial  of  the  list  of  new  antipyretics,  the 
choice  is  antipyrin.  It  is  used  in  single  doses  of 
ten  to  fifteen  grains,  and  repeated  when  the  tem- 
perature again  rises  beyond  104  °  F.  If  this  re- 
luedy  fails  of  its  effect,  large  compresses  of  several 
thicknesses  extending  across  the  chest  and  abdo- 
men from  the  neck  to  tlie  pubes,  and  freely  wet 
with  iced  water,  are  used.  The  gradually  cooled 
bath  is  held  in  reserve. 

Alcohol  has  no  necessary  part  in  the  routine 
treatment  of  enteric  fever.  Many  cases  do  not 
require  it  ;  some  are  imquestionably  benefitted  by 
it,  while  to  a  considerable  i>roportion  it  is  an  abso- 
lute necessity.  Dr.  Wilson  believes  that  the  em- 
ployment of  alcohol  in  the  treatment  of  fevers 
should  be  regarded,  not  as  a  dietetic,  but  invariably 
as  a  medicinal  measure. 

.Space  does  not  i>ermit  the  discussion  of  the 
treatment  of  complications,  nor  of  the  management 
of  convalescence.  If  perforation  occurs  during 
or  after  the  period  of  defervescence,  namely,  in  the 
fourth  week  or  later,  laparotomy  should  be  per- 
formed.— Medical  Ne,ws. 


The  Canada  Mkdical  Record 

A  Monthly  Journal  of  Medicine  and  burgerv- 

EDITORS  : 
FRANCIS    W.CAMPBELL,   M.A.,  M.D  .,  L.K.C.P.  LOND 

Editor  and  Proprietor. 
R.  A.  KENNEDY,  M. A.,  M.D. 

ASSISTANT  EDITOR: 

A,  LAPTHORN  SMITH,  B.A.,   M.D  ,  M  RC  S.  Eng.,   F.OS. 

LONDON. 

SUBSCRIPTION    TWO    DOLLAHS    PER    ANNCM. 

All  cuiiniiunictitions  and  Kicfuuigps  must  be  aJtl^essed  to 
the  Editor s,  IJrawermi,  Post   Vffice,  Mniitreul. 


MONTREAL,  JULY,  1888 


OVER  CROWDING  IN  THE  PROFESSION. 

For  several  years  past  there  have  been  appear- 
ing ominous  warnings  in  the  columns  of  the  medi- 
cal journals  of  Great  Britain  anent  the  crowded 
state  of  the  profession  there.  Individual  practi- 
tioners have  been  relating  the  indignities  and 
hardships  which  they  have  had  either  to  put  up 
with  or  starve.  Highly  educated  men  with  the  very 
best  dijilomas  and  degrees  have  told  how  they 
were  compelled  to  make  visits,  and  even  in  some 
cases  to  provide  the  medicine  as  well,  for  the 
wretched  remuneration  of  three  pence.  It  might 
be  said  that  they  should  not  make  visits  for  so  lit- 
tle ;  but  if  they  did  not  there  were  plenty  of  others 
who  were  glad  to  make  them  for  that  rather  than 
starve.  When  in  England  a  year  ago  we  took  the 
trouble  to  make  close  inquiries  into  this  question, 
and  we  were  informed  by  many  country  practi- 
tioners and  qualified  assistants  that  they  were  trea- 
ted by  the  public,  their  patients,  in  a  manner  in 
wliich  they,  the  medical  men, would  not  dare  to  treat 
the  coachman.  In  fact,  they  said,  the  coachman 
was  treated  with  a  great  deal  of  respect.  We  could 
easily  understand  the  reason  why.  The  coachman 
who  was  offended  and  left  his  situation  was  an 
employee  who  was  very  difficult  to  rc])lace,  while 
the  highly  qualified  and  educated  assistant  could 
be  replaced  a  hundred  times  in  a  day  without  any 
trouble.  The  cash  value  of  doctors,  after  all, 
just  like  gold,  or  silver  or  wheat,  obeys  the  law  of 
supply  and  demand.  Just  as  the  same  wheat  may 
be  worth  so  much  a  bushel  to-day  and  twice  as 
much  this  day  next  year,  so  without  any  diminu- 
tion in  the  intrinsic  worth  of  the  physician,  his 
value  as  a   necessity  to  the   public   may  be    very 


TMe  CANADA  MEDICAL  RECoftO. 


239 


much  lowered  or  raised,  by  the  mere  fact  tliat  the 
sii])ply  of  doctors  is  greater  tlian  the  demand. 

It  is  evident  that  siicii  a  state  of  things  must 
lead  to  a  terrible  struggle  for  existence,  and  in  that 
struggle  the  only  wonder  is  that  so  few  resort  to 
disrejMitable  practices.  With  Inniger  staring  in 
the  face  himself  and  probably  his  wife, — for  custom 
wisely  exacts  that  the  physician  should  be  married 
■ — with  very  likely  a  large  family  to  be  provided  for, 
for  his  knowledge  of  the  results  would  prevent  liim 
from  resorting  to  those  means  of  limiting  his  off- 
si:)ring,  )»'hich  are  unfortunately  too  frequently 
employed  at  the  present  day,  it  is  not  to  be  won- 
dered at  that  he  takes  the  three  pence  or  sixpence 
when  he  can  get  it.  Now,  who  is  to  blame  for 
this  state  of  affairs?  Certainly  not  the  man  who 
has  gone  through  a  long  and  expensive  course  of 
training  to  fit  him  for  a  profession,  in  which  he  finds 
out  only  when  it  is  too  late  that  there  are  already 
too  many.  The  ones  who  arc  to  be  blamed, 
we  think,  are  the  licensing  corporations,  which,  for 
the  sake  of  the  money  which  it  brings  them  in,  are 
willing  to  sacrifice  the  welfare  of  the  thousand  by 
turning  adrift  every  year  several  hundreds  more 
practitioners  than  they  well  know  there  is  room 
for.  That  they  do  so  wilfully  is  evidenced  by  the 
fact  that  they  have  for  so  long  been  throwing  every 
obstacle  in  the  way  of  those  schemes,  which  from 
time  to  time  have  been  proposed  for  controlling 
and  limiting  the  number  of  admissions  to  the  pro- 
fession. 

In  the  United  States  the  same  difficulty  seems 
to  be  arising,  although,  owing  to  the  enormous 
expansion  of  the  population,  the  evils  of  over- 
crowding will  take  longer  to  manifest  themselves 
than  in  England.  Happily  in  Canada  we  have  as 
yet  no  cause  to  complain.  .So  far,  any  one  with 
average  ability,  who  devotes  himself  heart  and  soul 
to  his  work,  is  pretty  sure  of  obtaining  a  compe- 
tence. But  it  is  well  that  we  should  be  prepared 
for  the  emergency  when  it  arises.  Let  us  there- 
fore consider  the  means  we  have  at  our  disposal 
for  limiting  the  number  of  graduates.  There  are 
two  ways  of  doing  it.  First,  by  raising  the  stan- 
dard of  admission  to  the  study  ;  and  secondly,  by 
making  the  pass  examination  more  difficult.  Of 
the  two  the  former  is,  we  think,  much  the  better; 
for  it  is  no  hardship  to  turn  a  man  back  at  thethresh- 
hold  from  a  life  of  hardship  and  toil,  while  he  is  yet 
youngenough  todirecl  his  energies  into  some  other 
channel ;  but  after  having  devoted  four  of  the  best 
years  of  his  life  to  the  study  of  it,  it  is  an  acknow- 


leged  hardshij)  to  tell  him  that  he  will  not  suit. 

I,et  us  insist  upon  our  representatives  on  the 
licensing  boards  maintaining  a  high  standard  of 
preliminary  education,  so  that  when  the  student 
receives  his  dijjloma  he  may  be  a  doctor  in  deed 
as  well  as  in  word. 


C.IRl,  DOCl'ORS. 
On  the  much  vexc-d  (jucstion  as  to  whether 
women  should  be  allowed  to  compete  with  men  for 
the  practice  of  the  medical  profession,  we  have 
always  held  the  opinion  that  no  obstacle  should  be 
thrown  in  the  way  of  their  having  a  chance.  If  it 
is  an  easy  way  of  making  a  handsome  living,  by  all 
means  we  say  women  have  as  much  rigiit  to  it  as 
men.  At  the  same  lime  on  the  question  as  to 
whether  such  women,  whose  mental  endowments  are 
such  as  to  fit  them  fur  a  physician's  duties,  are  likely 
to  have  the  necessary  physical  strength,  is  a  ques- 
tion upon  which  we  have  always  had  our  doubts. 
As  the  editor  of  the  Mcd!c  d  Times,  Philadelphia, 
says  :  "  There  are  certain  responsibilities  which  the 
physician, — man,  or  woman, — must  assume.  In  no 
walk  of  life  is  a  shirk  more  out  of  place.  Office 
work  and  attendance  on  the  wealthy  make  no  se- 
rious calls  upon  one's  strength,and  as  long  as  ladies' 
work  is  limited  to  these  easy  tasks,  she  may  do  very 
well."  We  commend  the  following  case  to  which  he 
refers  to  the  attention  of  any  lady  who  is  thinking 
of  entering  our  profession.  A  young  girl  of  his 
acquaintance  started  out  in  her  professional  life, 
precisely  as  a  young  man  must  do.  She  had  no 
means,  and  she  began  with  the  poor — "  the  alley 
folks."  She  took  a  poor  district  ;  turned  out  of 
her  bed  at  night  in  all  sorts  of  weather  to  visit  the 
filthy  denizens  of  the  seventeen  family  house,  and 
similar  places  ;  was  cheated  most  unmercifully  by 
tho.se  she  served  ;  and,  in  a  word,  did  just  what  any 
young  male  physician  in  similar  circumstances  must 
do  to  get  a  start.  He  noticed  her  when  she  gra- 
duated as  a  bright,  pretty  girl, with  so  much  intelli- 
gence that  one  could  not  help  sympathizing  with 
her  desire  to  make  of  herself  something  more 
than  ordinary.  It  was  five  years  later  when  he 
saw  her  again.  The  struggle  foe  existence  had 
told  heavily  upon  her  ;  she  had  aged  greatly,  and 
her  fresh,  youthful  beauty  was  gone,  and  hard  lines 
on  her  face  told  of  the  severity  of  the  struggle. 
She  was  disheartened  and  weary,  and  in  less  then 
six  months  more  she  was  dead.  He  felt  satisfied 
that  she  had  died  in  the  hopeless  endeavor  to  show 
that  women  can  fill  men's  place  in  the  world. 


40 


fHfe  CANADA  itEDICAL  RECORD. 


ASEXUALIZATION    AS  A    REMEDY  FOR 
CRIME. 

It  is  generally  admitted  that  in  otir  present 
methods  of  dealing  with  crime  and  criminals  by 
imprisonment,  we  not  only  utterly  fail  to  remedy 
the  tendency  to  evil  doing  among  the  criminal 
classes,  but  by  keeping  peoijje  of  varying  degrees 
of  badness  closely  associated  together,  we  bring 
them  all  down  to  tlie  level  of  the  worst.  So  that,  as 
a  rule,  the  criminal  conies  out  of  prison  very  much 
worse  than  when  he  went  in.  It  is  also  well  known 
that  the  criminal  tendi-ncies  of  the  father  are 
transmitted  to  the  offspring  to  a  greater  or  less 
extent ;  and  as  there  is  nothing  to  limit  the  number 
of  children  a  hardened  criminal  may  leave  behind 
him,  the  country  is  being  burdened  every  year 
more  and  more  with  the  support  of  these  parasites 
on  society.  Although  the  honest  citizen  is  pro- 
tected for  the  period  of  the  criminal's  incarcera 
lion  from  the  latter's  depredation,  still  the  former  is 
punished  as  well  as  the  criminal,  for  he  has  to 
work,  not  only  for  the  support  of  himself  and  his 
own  faniily,  but  he  has  to  contribute  largely 
toward  the  feeding  and  clothing  of  the  burglai 
and  his  numerous  progeny. 

Moreover,  under  our  present  system,  the  cost  of 
supporting  the  criminal  class  may  be  considered 
a  fixed  charge  on  the  community.  There  is  no 
hope  of  it  ever  being  any  less,  but  on  the  contrary 
it  may  be  taken  for  granted  that  it  will  continuall}' 
increase,  and  the  worst  of  it  is  the  honest  and 
industrious  have  to  bear  the  expense  of  raising  a 
great  generation  of  criminals  who  will  in  due  time 
prey  upon  them.  Another  injury  which  the 
habitual  criminal  inflicts  upon  the  working  class 
is  the  competition  of  convict  labor  with  free  labor. 

And  yet  a  remedy  for  all  these  defects  is  easily 
found:  Dr.  Orpheus  Everts,  in  an  able  article 
in  the  Cincinii'tti  Lancet  Clinic,  recommends  asex- 
ualization as  a  penalty  for  crime  and  the  reforma- 
tion of  criminals.  He  formulates  his  propositions 
thus  :  "  Surgical  asexualization  of  all  criminals 
convicted  of  offences  that,  circumstancially  con- 
sidered, indicate  constitutional  deformities  that 
are  recognized  as  transferable  by  heredity,  is 
not  only  practicable  but  ex|)edient  for  the  pro- 
tection of  society  against  the  ever  impending 
danger  of  invasion  by  the  savages  of  civilization, 
known  as  the  vicious,  criminal,  or  defective  classes, 
— and  would,  properly  enforced  by  law,  eventuate 
in  an  effectual  diminution  of  crime  and  the  reform- 
ation of  criminals." 


There  was  a  well  known  case  recorded  of  one 
jirostiiute  or  female  tramp,  having  left  a  progeny  of 
over  150  criminals,  including  [)erpetrators  of 
nearly  every  kind  of  crime  in  the  calendar.  Had 
she  been  spayed  on  her  second  or  third  convic- 
tion,— she  was  convicted  a  great  number  of  times, 
— the  country  would  have  been  saved  the  care  of 
this  siiiall  army  of  outlaws. 

The  wiitLi  terminates  his  article  as  follow^  : 
"  Imprisonment  alone  for  short  terms  at  labor  or 
in  solitude,  liowever  cruelly  or  hummely  practised 
with  Usual  instruction  or  without,  protects  society 
but  partially  and  for  short  intervals,  and  fails 
signally  to  reform  the  imprisoned  or  diminish  the 
number  of  the  classes  to  which  they  belong. 
Were  each  man  or  woman  retmned  to  society 
from  penitentiaries  deprived  of  reproductive 
cai.>abilities,  how  different  would  be  the  story. 
Public  sentiment  might  not  now  sustain  such  an 
innovation.  The  public  sentiment  of  the  future  is 
destined  to  be  more  improved  by  .science,  and 
will  eventually  adopt  its  suggestions  in  matters  of 
state  craft  and  social  economics,  including  crim- 
inal jinisprudence,  as  well  as  in  other  affairs  of  lile.'' 


THE  CODE  OF  ETHICS  OF  THE  AMER- 
ICAN  MEDICAL  ASSOCIATION. 
Art.    III. —  0/ the  duties  of  physicians  as  resi^ects 
vic'irloiis  DJJicrs. 

I.  The  affairs  of  life,  the  pursuit  of  health,  and 
the  various  accidents  and  contingencies  to  which 
a  medical  n>an  is  peculiarly  exposed  sometimes 
require  him  temporarily  to  withdraw  from  his  du- 
ties to  his  i)atients,  and  to  request  some  of  his  pro- 
fessional brethern  to  officiate  for  liim.  Compliance 
with  this  request  is  an  act  of  couitesy,  which 
should  always  be  performed  with  the  utmost 
consideration  for  the  interest  and  character 
of  the  family  physician;  and  when  exercised  for  a 
short  period,  all  the  pecuniary  obligations  for 
such  service  should  be  awarded  to  him.  But  if 
a  member  of  the  profession  neglect  his  business 
in  quest  of  pleasure  and  amusement,  he  cannot  be 
considered  as  entitled  to  the  advantages  of  the 
frequent  and  long-continued  exercise  to  this  fra- 
ternal couitesy,  without  awarding  to  the  physician 
who  officiates  the  fees  arising  from  the  discharge  of 
his  professional  duties. 

In  obstetrical  and  important  surgical  cases, 
which  give  rise  to  unsual  fatigue,  anxiety  and 
responsibilty,  it  is  just  that  the  fees  accruing 
therefr.'m  should  be  awarded  to  the  physician  who 
officiates. 


THE  CANADA  MEDICAL  RECORD. 


Vol.  XVI. 


MONIREAL,    AUGUST,    1888. 


No.    II, 


COnSTTEilSrTS. 


ORIGINAL  COMMUNICATIONS. 


Ventilation  of  OceHn  Steamers 241 

Sulphonal 245 

On  tlio  Removal  of    Opacities  of  tlie 
Cornea  by  means  of  Galvanism 210 


SOCIETY  PROCEEDINGS. 

New  York  Academy  of  Medicine— Pe- 
diatric Section 


PROGRESS  OF  SCIENCE. 

The  Diagnostic  Signlticance  of  Hema- 

tnria     ., 2r>0 

Review    of    the    Recent    Progress   of 

Electricity 254 

The  Therapeutical   Value  of  Bismuth 

Salicylate 258 

Peppermint  Water  in  Pruritus  Pudendi  259 
Electricity  in  theTreatment  of  Fibroids 

of  the  Uterus 259 

Flooding 260 

How  to  treat  Cramps  in  the  Legs 261 

2461  Pneumonia  in  Children 261 


Anti  pyrin  in  Migraine HGI 

Weak  Throat 261 

Boric  Acid  a  Remedy  for  Stye 262 

EDITORIAL 

Contagiousness  of  Phthisis 262 

Canadian  Medical  Association 263 

The  Code  of  Ethics  of  the  American 

Medical  Association 263 

Personals : 264 

Reviews  264 


^n^inui  BommunktdmnS'. 


VENTILATION    OF  OCEAN  STEAMERS. 

Read   before   the  British  Association  for  the   Advancement 

of  Science. 
By  a.  Lapthors  Smith,  B.A.,  M.D.,  M.R.CS.  Eng. 

Any  one  comparing  the  steamship  of  twenty- 
five  years  ago  with  that  of  to-day  cannot  fail  to 
be  impressed  with  the  vast  improvements  which 
have  earned  for  the  latter  the  title  of  "  floating 
palaces." 

In  some  respects,  however,  there  is  still  room 
for  improvement,  and  in  none  more  so  than  in 
the  matter  of  ventilation. 

That  the  ventilation  of  ocean  steamships  is,  at 
the  present  day,  far  from  perfect,  is  a  fact  which 
will  be  generally  admitted  by  nearly  every  one 
who  has  crossed  the  ocean.  Were  any  proof 
necessary  I  have  the  evidence  of  more,  than  a 
hundred  reliable  witnesses,  including  several 
captains  of  steamers,  whom  I  have  questioned, 
as  well  as  my  own  experience,  to  testify  that  this 
important  department  of  the  sanitary  arrange- 
ments has  not  kept  pace  with  the  other  profuse 
and  elaborate  provisions  for  the  passengers'  health 
and  comfort. 

Many  have  expressed  the  opinion  that  the 
feeling  of  discomfort  and  malaise  is  more  often 
due  to  ship  sickness  than  to  sea-sickness  ;  while  I 
would  venture  to  go  a  step  further  and  call  it  by 
what  I  think  should  be  its  real  name, — partial 
asphyxia  or  suffocation. 

Many  have  told  me  that  as  long  as  they 
remained  on  deck  they  were  perfectly  free    from 


any  discomfort,  no  matter  how  much  the  vessel 
might  be  rolling ;  while  others,  who  having 
succumbed  to  the  first  night's  deprivation  of  air, 
were  too  weak  to  get  on  deck  again  during  the 
remainder  of  the  voyage,  have  assured  me  that 
weeks,  and  in  some  cases  months,  elapsed,  before 
they  had  completely  recovered  from  the  effects 
of  it. 

My  own  experience  was  this:  I  crossed  the 
Atlantic  six  years  ago  in  the  best  steamer  of  one 
of  the  best  lines,  and  having  my  choice  of  rooms 
I  chose  one  amidships,  on  the  main  deck.  It 
measured  about  six  and  a  half  by  seven,  by  eight 
feet,  and  as  I  had  the  room  all  to  myself  it  allowed 
me  364  cubic  feet  of  space,  less  the  amount 
occupied  by  my  own  body,  two  beds,  a  sofa  and 
other  furniture,  and  my  valise;  leaving  about 
300  cubic  feet  of  air  for  myself 

I  was  obliged  to  keep  my  door  locked  and  the 
regulations  forbade  the  opening  of  the  port  hole. 
I  did  not  notice  however  until  next  morning  that 
the  obliging  steward  had,  at  the  request  of  the 
previous  chilly  occupant  of  the  room,  pasted 
paper  over  the  tiny  perforations  at  the  top  of 
the  partitions,  which  were  supposed  by  a  flight  of 
fancy  to  fulfil  the  purposes  of  ventilation. 

But  next  morning  my  aching  head  and  furred 
ongue  made  me  realize  that  I  was  breathing  an 
insufficiently  oxygenated  atmosphere,  rendered 
poisonous  moreover,  with  carbonic  acid  gas. 

For  all  authorities  on  sanitary  science  are 
tagreed  that  the  smallest  quantity  of  fresh  air 
consistent  with  health  is  3000  cubic  feet  per 
hour  for  each  adult  human  being ;  which  would 
suppose  that  the  air  in  my  above  mentioned  300 


242 


THE   CANADA    MEDICAL   RECORD. 


cubic  feet  of  space  was  completely  changed  ten 
times  in  every  hour.  On  the  contrary  it  was 
not  changed  once  during  the  nine  hours  I  remain- 
ed in  my  room. 

Even  if  the  perforations  in  the  top  of  the 
partition  had  not  been  closed  up,  I  could  not  have 
obtained  the  minimum  amount  of  ventilation 
necessary  for  health,  for  we  have  no  reason  to 
suppose  that  such  a  heavy  gas  as  cold  carbonic 
acid  could  perform  such  a  miraculous  feat  as 
to  climb  to  the  top  of  the  partition  and  crawl 
through  those  little  holes. 

On  the  contrary,  under  the  most  favorable  cir- 
cumstances with  natural  ventilation,  it  is  admit- 
ted that  the  air  in  "a  room  cannot  be  changed  of- 
tener  than  three  times  in  an  hour.  How  utterly 
impossible,  therefore,  with  similar  means,  to 
change  ten  times  in  an  hour  the  atmosphere  of  a 
room  so  especially  unfavorably  situated  for  venti- 
lation as  a  stateroom  helow  or  even  hetween  the 
decks  of  a  ship. 

What  would  have  been  the  result  if  there  had 
been,  as  the  room  was  intended  to  contain,  three 
occupants  instead  of  one  ?  I  dread  to  think  of  it. 
Perhaps  our  fate  would  have   been  that  of  the 
seventy  persons  who  were  found  dead  next  mor- 
ning out  of  the  one  hundred  and  fifty  passengers 
who  were  shut  up  in    the  cabin    of    the    Irish 
steamer  "  Londonderry,"  during  a  stormy  night 
in  1848.     What  must  be  the  feeling   of  the  emi- 
grant, who  according  to  the   regulations  of   the 
British  Board  of  Trade    is    allowed  seventy-two 
cubic  feet  of  space  ?     Is  the  air  in  the  "  steerage  " 
changed  forty-three  times  in    an    hour,  which  it 
should  be  in  order  that    each  occupant   of  the 
above   seventy-two  cubic   feet  of  space  should 
receive  the  necessary  three  thousand  cubic  feet  of 
fresh  air  ?  Manifestly  not,  since  by  natural  means 
the  air  in  a  room  can  only  be  changed  three  times 
in  an  hour.     If  there  are  twelve  hundred  passen- 
gers below  deck,  as  there  frequently  are,  all  night, 
they  would  require  at  last  three  million  six  hun- 
dred thousand  cubic  feet   of  air   per  hour,    while 
ten  funnels  or  ventilators  one   foot  square,  into 
which  the  wind  is  blowing  at    the  rates  of   thirty 
miles   an  hour,   would  only    deliver  one  million 
five  hundred  and  eighty-four   thousand  feet,    or 
nearly  two  million  feet  per  hour,   short  of  the 
requirements  of  health. 

Professor  de  Chaumont  says  :  "  Air  is  the 
prime  necessity  of  life.  Food  or  water  may  be 
abstained  from  for  a  considerable  length  of  time, 


and  we  may  thus  have  an  opportunity  of  replac- 
ing either  should  we  doubt  its  purity  or  health- 
fulness,  but  the  atmosphere  around  us  we  must 
breathe  or  die.  Hence  the  paramount  necessity 
of  having  it  pure.  But,  he  continues,  though  this 
is  apparently  so  obvious,  attention  to  its  impor- 
tance has  been  very  generally  omitted.  I  may 
add,  that  while  defective  ventilation  has  caused 
thousands  of  deaths  on  shore,  the  above  remarks 
are  especially  true  when  applied  to  ships,  For 
it  is  a  well  known  and  generally  admitted  fac^ 
that  ship  fever  was  due  to  the  emigrants  being 
compelled  to  breathe  over  and  over  again  an 
atmosphere  charged  with  organic  matter  in  a 
state  of  decomposition ;  while  only  the  thin  walls 
of  the  vessel  stood  between  them  and  an  unlimit- 
ed supply  of  the  purest  of  pure  air." 

Although  the  Merchant  Shipping  Act  of  1855, 
by  forbidding  the  carrying  of  passengers  in  the 
hold,  and  by  limiting  the  number  to  be  carried 
on  deck  to  one  for  every  seventy-two  cubic  feet 
of  space,  put  an  end  to  such  wholesale  slaughter, 
still  I  think  it  is  evident  from  what  I  have  said, 
that  with  the  present  system  of  ventilation,  that 
amount  of  space  is  only  barely  enough  to  sustain 
life,  without  even  mentioning  comfort  or  health. 
But  whether  the  ocean  traveller  gets  even  this 
small  amount  of  space  or  not,  is  left  very  much 
to  the  discretion  of  the  emigration  officer  at  the 
port  of  embarkation,  who  may  or  may  not 
understand  the  importance  of  a  sufiicient  supply 
of  air. 

Should  anyone  doubt  the  exactness  of  the 
scientific  experiments  and  calculations  of  the 
most  eminent  authorities,  such  as  Richardson 
Parkes,  de  Chaumont,  Hammond  and  others,  on 
whose  authority  I  have  made  the  above  state- 
ments, let  him  go  down  into  the  steerage  or  even 
staterooms  of  an  ocean  steamer,  just  arriving  from 
sea,  and  his  nostrils  will  testify  to  the  truth  of 
these  assertions. 

Dr.  Heber  Smith,  in  the  United  States  Marine 
Hospital  report  for  1871,  says:  The  sickness 
rate  among  seamen  is  probably  greatly  augmented 
by  the  want  of  light  and  air,  and  by  the  presence 
of  dampness  and  filth  so  often  observed  in  the 
forecastles  Df  even  the  largest  and  best  equipped 
sailing  and  steam  vessels.  Many  of  the  forecas- 
tles which  he  examined  illustrated  the  bottle  form 
of  ventilation,  for  where  the  hatches  were  closed^ 
as  they  generally  are  in  rough  weather,  the  bottle 
was  complete,  even  to  the  cork. 


TUE   CANADA   MEDICAL  RECORD. 


243 


'I'o  these  causes  he  attributes  the  constant 
deterioration  going  on  in  tlie  ranks  of  the  llnited 
States  niercliant  marine  and  the  lamentable  short 
average  of  tlie  mariner's  Hfe,  which  is  only 
twelve  years,  seventeen  thousand  becoming  unfit 
for  service  or  dying  every  year. 

"  Is  it  any  wonder,  "  he  says,  "  that  there  is  a 
scarcity  of  efficient  sailors?  that  vessels  leave 
port  short-handed  every  day?  that  shipwrecks 
and  loss  of  life  grow  more  frequent  year  by 
year'?" 

It  is  true  the  latest  additions  to  the  fleet  of 
ocean  steamers  are  provided  with  a  considerable 
number  of  funnels  or  air  shafts ;  but  under  the 
most  favorable  circumstances,  that  is  when  the 
wind  is  blowing  against  them,  the  air  only  gets 
into  the  passages  into  which  the  air  shafts  open, 
but  not  into  the  rooms  ;  while  on  the  contrary 
when  the  wind  and  the  steamer  are  both  going  in 
the  same  direction  and  at  about  the  same  rate  of 
speed,  no  air  is  forced  down  [the  ventilators  at 
all. 

Now,  lest  the  owners  and  architects  of  ocean 
steamers  might  think  that  I  was  asking  too 
much  for  the  cabin  and  steerage  passengers 
and  seamen,  whose  supply  of  air  is  respectively 
bad,  worse  and  worst,  let  me  refer  them  to 
Wilson's  standard  text  book  on  Hygiene,  p.  90, 
where  the  author  says  that  the  Barrack  Commis- 
sioners of  England  Tecommended  a  minimum 
allowance  of  si.x  hundred  cubic  feet  of  space  per 
man,  but  that  experiments  made  by  Dr.  gc  Chau- 
mont.  Professor  of  Hygiene  at  Netley  proved 
most  incontestably  that  even  this  comparatively 
large  allowance  is  inadequate  for  the  purposes  of 
ventilation.  The  author  admits,  however,  that 
even  so  small  a  limit  as  one  hundred  cubic  feet 
per  man  can  be  kept  sufficiently  pure,  provided 
the  most  approved  methods  of  artificial  ventila- 
tion be  carried  out. 

Having  thus  briefly  shown  the  defects  in  the 
present  method  of  ventilating  ocean  steamers,  let 
me  suggest  a  remedy. 

Happily  the  latter  is  as  simple  and  effective  as 
it  is  important.  For  although  any  increase  of 
cubic  space  for  passengers  and  sailors  would 
greatly  increase  the  cost  of  carriage,  the  number 
of  times  in  an  hour  that  the  air  in  that  space 
could  be  changed,  might  be  very  considerably 
increased  at  a  positively  trivial  cost. 

Dr.  W.  G.  Metcalf,  Medical  Superintendent  of 
the  Ontario  Lunatic  Asylum,  Kingston,  writes  t 


me  that  the  inmates  of  the  main  building  to  the 
number  of  three  hundred  and  ninety  are  actually 
supplied,  by  means  of  a  steam  fan,  with  three 
thousand  eight  hundred  and  forty  cubic  feet  of 
fresh  air,  each,  per  hour.  And  many  other 
])risons  and  insane  asylums  on  this  continent  are 
ventilated  in  the  same  way. 

Now,  I  would  ask,  why  could  not  a  similar 
method  be  adopted  on  board  ocean  steamships  ? 
Their  shape,  resembling  a  box,  completely  closed 
on  five  sides,  with  only  a  few  small  openings  in 
the  sixth,  precludes  them  from  any  possibility  of 
being  effectively  ventilated  by  ordinary  means. 
Why  not,  therefore,  provide  a  fan  blower  worked 
by  steam,  and  which  could,  no  matter  which  way 
the  wind  blew,  be  relied  upon  to  introduce  into 
every  part  of  the  ship  occupied  by  human  beings, 
at  least  that  amount  of  fresh  air  which  accurate 
experiments,  made  by  the  most  reliable  scientists, 
have  shown  to  be  absolutely  necessary  for  health. 

I  cannot  believe  that  the  question  of  cost 
would  be  any  objection  ;  for  the  same  passengers, 
or  the  cabin  ones,  at  least,  who  are  so  insufficient- 
ly supplied  with  air  are  most  lavishly  provided 
with  every  luxury  ;  thousands  of  dollars  being 
expended  on  decorations  alone  ;  and  a  surfeit  of 
food  being  given  every  few  hours  during  the 
day. 

With  the  present  system  of  ventilation  on  ocean 
steamships  under  the  most  favorable  circumstan- 
ces, the  steerage  passengers  are  not  allowed  more 
than  two  hundred  and  sixteen  cubic  feet  of  air  per 
hour ;  while  the  inmates  of  the  lunatic  asylums 
and  penitentiaries  never  receive  less  than  three 
thousand  eight  hundred  cubic  feet  of  fresh  air 
per  hour,  and  no  civilized  country  would  permit 
them  to  be  deprived  of  air  to  the  same  extent  as 
the  emigrants  are. 

The  only  objection  that  could  be  raised  against 
the  fan  ventilator  would  be  the  draught ;  but  that 
could  be  avoided  by  having  inlet  pipes  perforated 
with  a  large  number  of  small  holes,  and  the  speed 
and  pressure  so  regulated  that  only  the  proper 
amount  of  air  would  be  distributed  and  no 
more. 

Such  a  fan,  I  am  informed  by  a  practical 
engineer,  would  cost  the  small  sum  of  six  to 
eight  hundred  dollars.  It  could  be  driven  by  all 
of  the  numerous  small  auxiliary  engines  which 
have  to  be  kept  in  readiness  for  an  emergency, 
such  as  pumping ;  while  the  necessary  steam 
would  not  cost  as  much  as  one  cent  a  day  per 


244 


THE   CANADA   MEDICAL   RECOED. 


passenger  ;  and  if  the  distributing  pipes  were  put 
into  every  part  of  the  ship  while  it  was  being 
built,  the  cost  would  not  be  appreciable. 

Moreover,  such  a  fan  blower  would  almost 
save  its  cost  in  a  single  voyage,  for  it  could  be 
utilized  while  the  ship  was  loading  grain,  in  doing 
all  the  trimming,  which,  on  account  of  the  dust, 
is  a  very  unhealthy,  and,  consequently  expensive 
operation.  By  means  of  a  hose  pipe  attached  to 
the  fan  blower  the  grain  could  be  driven  with 
great  force  away  from  the  delivery  pipe  of  the 
elevator,  without  a  single  man  going  into  the 
hold. 

Owing  to  the  large  development  of  the  cattle 
trade  during  the  last  few  years,  the  necessity  for 
better  ventilation  is  more  than  ever  felt. 
Although  the  steamship  companies  do  all  in  their 
power  to  have  the  steerage  compartments 
thoroughly  cleansed,  still  with  the  present  system 
of  ventilation  it  is  impossible  to  completely  get 
rid  of  the  smell.  Many  emigrants  have  told  me 
that  the  smell  of  cattle  carried  on  the  previous 
trip,  added  to  that  of  the  closely  packed  and 
half  suffocated  passengers,  was  simply  horri- 
ble. 

In  view  of  the  immense  emigration  now  being 
directed  towards  our  shores,  and  the  responsibi- 
lity which  devolves  upon  us  of  seeing  that  the 
emigrants  are  provided  for  after  their  arrival ; 
and  considering  how  important  it  is  that  they 
should  arrive  here  in  a  healthy  instead  of  in  a 
sickly  condition,  and  in  view  of  the  light  which 
science  has  shed  upon  the  requirements  of  human 
life,  it  becomes  a  question  whether  the  time  has 
not  already  arrived  for  our  Government  to  make 
such  representations  to  the  Imperial  Board  of 
Trade  as  will  lead  to  a  change  being  made  in  the 
Merchant  Shipping  Act,  whereby  a  definite 
minimum  amount  of  fresh  air  would  be  provided 
for  every  statute  adult  on  board,  instead  of  that 
important  point  being  left  as  now  to  the  discre- 
tion of  the  emigration  officer  at  the  port  of 
embarkation. 

The  quantity  of  fresh  air  to  be  furnished  to  the 
occupants  of  the  cabin  and  staterooms  may 
safely  be  left  to  the  force  of  public  opinion,  but 
I  venture  to  predict  that  the  company  which 
would  make  a  decided  advance  in  this  regard, 
would  make  a  rich  return  for  the  small  amount  of 
money  so  invested.  The  travelling  public  would 
not  be  slow  to  appreciate  the  effort  to  supply 
them  with  a  sufficient  supply  of  the  first  necessary 
of  life. 


As  a  natural  sequence  to  the  first  portion  of 
my  paper,  I  wish  to  call  your  attention  very 
briefly  to  the  question  of  warming  and  cooling 
the  air  which  might  be  so  plentifully  provided 
by  the  above  mentioned  method. 

There  is  no  doubt  that  during  several  months 
in  the  year  a  great  deal  of  real  hardship  and  suf- 
fering is  experienced  by  the  emigrants  and 
seamen  who  cross  the  Atlantic,  owing  to  the 
absence  of  any  regular  system  of  heating. 

During  the  time  I  was  connected  professionally 
with  the  Marine  and  Emigrant  Hospital,  Quebec, 
and  other  institutions,  I  have  had  hundreds  of 
opportunities  for  observing  the  amount  of  sick- 
ness, suffering  and  death,  especially  among 
young  children,  directly  traceable  to  the  cold 
experienced  on  board  ship  during  a  Winter 
voyage. 

Indeed  any  system  of  ventilation  would  be 
incomplete,  unless  combined  with  means  of  heat- 
ing the  air  provided  by  it. 

For  the  average  emigrant  or  sailor  would  prefer 
to  breathe  the  foulest  of  foul  air,  partially  warmed, 
rather  than  the  purest  of  pure  air  freezing  cold. 
Indeed,  scarcely  a  Spring  passes  without  adding 
one  or  more  to  the  list  of  sailors  who  have  paid 
the  penalty  of  their  life  for  the  warmth  obtained 
from  a  charcoal  pan.  Nor  would  all  this  sickness 
and  death  be  either  difficult  or  costly  to  obviate 
if  the  method  of  ventilation  which  I  have  sug. 
gested  were  carried  out. 

"  In  the  Insane  Asylum  at  Kingston,"  Dr. 
Metcalf  writes  me,  "  the  air  passes  in  Winter 
over  steam  coils  and  becomes  hot,  the  amount 
of  heating  to  which  it  is  subjected  being  regula. 
ted  by  adjustable  valves."  On  steamers  a  zinc 
chamber  or  heater  might  be  constructed  around 
the  boilers,  through  which  the  air  could  pass 
before  being  forced  through  the  fan.  Only  in 
very  cold  weather  would  it  be  necessary  to  heat 
up  the  steam  coils. 

The  openings  for  the  admission  of  warm, 
fresh  air  should  be  near  the  ceiling,  and  the  foul 
air  openings  near  the  floor,  and  these  latter  should 
be  led  into  the  smoke-stack  or  furnaces. 

While  the  temperature  on  the  Atlantic  is 
generally  too  low,  there  are  other  voyages  where 
the  passenger  is  put  to  considerable  discomfort 
from  excessive  heat.  An  eastern  traveller  in  a 
recent  paper  states  that  average  midnight  tem- 
perature in  the  saloon  and  staterooms  was  one 
hundred  and  ten  degrees  F.,  most  of  the  passen- 
gers preferring  to  pass  the  night  on  deck. 


THE  CANADA   MEDICAL   RECORD. 


245 


And  yet  how  easy  to  remedy  this  state  of 
things.  By  working  the  fan  up  to  a  high  rate  of 
speed  so  as  to  comjiress  the  air,  and  then  letting 
it  suddenly  expand,  it  could  be  chilled  to  any 
degree  desired;  and  the  passengers,  instead  of 
being  nearly  roasted  alive  on  deck,  might  remain 
below  during  the  whole  voyage,  revelling  in  the 
delightful  coolness  of  the  temperate  zone,  while 
the  air  above  and  the  water  around  them  was 
simmering  at  one  hundred  and  twenty  degrees. 
To  show  that  such  a  plan  is  quite  practicable  is 
made  evident  from  the  statement  of  the  writer 
that  he  gathered  a  snow  ball  from  the  walls  of 
the  refrigerator,  which  was  kept  cold  in  that 
way. 

It  would,  I  think,  be  preferable  to  do  with  one 
dish  or  even  one  meal  less  each  day  for  the 
luxury  of  a  cool  and  well  aired  room  to  sleep  in 
at  night. 

I  have  placed  this  matter  very  briefly  before 
you,  but  I  trust  that  the  weight  of  the  influence 
of  such  a  learned  body  as  the  British  Association 
for  the  Advancement  of  Science,  which  we  are  all 
so  glad  to  welcome  to  this  country,  may  lead  to 
the  further  investigation  of  this  important  matter 
so  that  the  owners  and  architects  of  ocean 
steamships  may  recognize  the  evil,  and  device 
some  remedy  that  will  lead  to  some  improvement 
in  the  ventilation  of  ocean  steamships. 


SULPHONAL. 

ByH.  L.  Rf.ddy,  M.D.,  CM.,  L.R.C.S.E.,  L.R.C.P.L., 
Professor  Midwifery,  Bishops'  College. 

Or  as  it  is  known  chemically  disethylsulfondime. 
thylmetlian.  It  occurs  in  the  form  of  large,  flat 
colorless  crystals  which  are  tasteless  and  devoid  of 
smell.  Sulphonal  is  soluble  in  i8  to  20  parts  of 
boiling  water  and  i  to  100  in  tepid  water.  It 
dissob'es  more  rapidly  in  alcohol  or  alcohol  mixed 
with  ether.  Acids  and  alkalies  do  not  affect  the 
composition  of  the  body. 

Within  the  last  few  years  a  number  of  new 
remedies  have  been  introduced,  the  action  of 
which  we  have  been  told  was  unlike  opium,  chloral, 
cannabis,  or  the  bromides.  Most  of  these  drugs 
belong  to  the  aceial  group  of  compounds,  they 
include  methylse,  acetophenon  (known  as  hyp- 
non),  urethan,  paraedehyd,  and  hydrate  of  anylen. 
Although  some  of  these  have  found  favor  with  a 
few  of  the  profession  none  of  them  are  really  sat- 
isfactory. 

Sulphonal  was  first  prepared  by   Bauman,  who 


discovered  it  whilst  investigating  a  series  of  bodies 
known  as  disulphones,  to  which  it  belongs.  Its 
action  (according  to  German  authority)  appears 
to  consist  merely  in  the  intensification  of  those 
factors  that  lead  to  natural  sleep  in  the  physiolo- 
gical sense,  or  in  supplying  the  periodical  desire 
for  sleep  in  those  cases  where  it  is  wanting. 

Sulphonal  on  the  same  authority  is  said  to  have 
none  of  the  disadvantages  inherent  in  deadly 
narcotics,  and  is  more  reliable  than  the  Bromides. 
It  does  not  disturb  digestion,  is  not  constipating, 
no  unpleasant  after-effects,  is  not  likely  to  cause 
a  "  habit  "  even  when  employed  for  a  long  time. 
'  Schwalbe,  in  the  Deutsche  Med.  Woch,  concludes 
that : — 

1.  Sulphonal  is  an  agreeable  medicament, 
being  odorless  and  tasteless. 

2.  It  acts  as  a  hypnotic  in  cases  of  "  nervous" 
sleeplessness,  in  doses  of  fifteen  to  thirty  grains. 
When  the  insomnia  is  the  direct  result  of  organic 
disturbances  due  to  existing  disease  the  action  is 
more  or  less  uncertain. 

3.  Sulphonal  does  not  affect  temperature,  pulse 
or  respiration,  and  is  to  be  preferred  to  morphine 
and  chloral  when  heart  failure  is  to  be  feared.  It 
is  especially  to  be  commended  for  children. 

4.  The  subjective  manifestations,  immediate 
and  subsequent,  are  insignificant,  and  not  a  con- 
traindication for  the  use  of  the  drug. 

Dr.  Rabbas  has  used  it  at  the  Marsburg  lunatic 
asylum,  over  200  times  and  speaks  very  highly 
of  it. 

The  best  time  to  administer  it  would  appear  to 
be  the  late  afternoon  or  early  evening  hours,  when 
it  is  followed  by  8  to  lo  hours  of  natural  sleep. 
The  dose  is  from  15  to  60  grains.  The  hypnotic 
effect  is  observed  in  from  yi  hour  to  2  hours  after 
its  exhibition. 

Women  are  more  easily  affected  by  it  than  men. 
It  is  found  useful  in  febrile  wakefulness,  in  the 
restlessness  of  organic  heart  disease  and  even  in 
the  delerium  of  dementia. 

Mr.  T.  E.  Lovegrove  in  the  British  Medical 
Journul  says  that  his  experience  has  been  very 
discouraging.  For  several  hours  after  the  ex- 
hibition of  the  drug,  there  was  no  appreciable 
effect,  but  during  the  greater  part  of  the  following 
day  there  was  extreme  drowinessand  considerable 
cyanosis.  Mr.  Lovegrove  finds  the  best  vehicle 
for  its  administration  is  pulv.  tragacanth  co.  and 
water. 


246 


THE   CANADA  MEDICAL   RECORt>. 


ON  THE  REMOVAL  OF  OPACITIES  OFTHE 
CORNEA  BY  MEANS  OF  GALVANISM. 

To  the  Editor  of  The  Medical  Record. 

Sir  :  The  purpose  of  this  note  is  to  call,  or 
rather  recall,  the  attention  of  the  profession  to  the 
therapeutic  value  of  the  Galvanic  current  in  the 
treatment  of  opacities  of  the  cornea.  Some  cases 
I  have  now  under  observation  appear  to  show  that 
this  application  of  electricity  has  been  allowed  to 
fall  into  undeserved  desuetude.  I  cannot  offer  yet 
complete  results  of  treatment  to  support  this  claim, 
but  the  following  statement  may  serve  to  show 
that  it  is  worthy  of  some  attention.  In  February 
last  I  began  to  use  the  galvanic  current  for  the 
removal  of  an  opacity  of  the  cornea,  without 
knowledge  that  it  had  been  so  used  before.  The 
case  was  one  of  recent  macula  of  both  cornje 
visible  at  a  distance  of  several  feet.  It  has  now 
wholly  disappeared  from  one  eye,  and  is  barely 
discernible  in  the  other,  from  which  I  expect  con. 
tinned  use  of  the  remedy  to  remove  all  trace  of 
blemish  and  defect  of  vision.  Another  case,  taken 
up  a  few  days  later,  a  kidney-shaped  macula  about 
two  and  a  half  lines  in  length,  is  now  represented 
by  a  thin  speck-like  spot  which  the  patient  and  her 
friends  no  longer  see.  This,  too,  is  steadily 
melting  away.  Of  the  seven  other  cases  under 
treatment,  it  will  suffice  here  to  say  that  they  varied 
in  size  from  that  of  a  millet-seed  to  the  wliole 
circumference  of  the  cornea,  from  a  nebula  to  a 
dense  white  leucoma,  and  in  duration  from  forty 
days  to  forty-eight  years. 

All  of  these  cases  are  steadily  improving,  two  of 
the  most  extensive  macula;  being  merely  fragmen- 
tary remains  of  the  original,  while  the  cornese  else- 
where are  quite  clear.  The  rate  of  disappearance 
seems  to  depend  chiefly  upon  the  size  of  the  opacity, 
which,  like  a  heap  of  snow,  melts  away  from  the 
periphery  towards  the  centre,  the  oldest  but  little 
more  slowly  than  the  most  recent. 

The  method  I  have  employed  is  as  follows  : 
One  pole  of  the  battery  in  the  palm  of  the  hand, 
the  other  upon  the  closed  eyelids,  ordinary  sponge- 
covered  electrodes  being  used.  If  the  eye  is  or 
becomes  in  the  least  congested  on  the  seat  of 
pain,  the  anode  should  be  placed  there;  otherwise 
the  cathode  should  be  used  as  the  therapeutic 
pole,  its  action  being  more  rapid,  apparently.  The 
strength  of  the  current  should  not  exceed  three 
milliamp6res,  and  with  sensitive  eyes  a  strength  o^ 
two    milliamperes  is  better.     The   sitting    should 


not  extend  beyond  three  minutes,  unless  the  eye 
shows,  after  trial,  unusual  tolerance  of  the  current ; 
a  five  minutes'  sitting  sometimes  irritates  the  organ. 
An  application  was  made  daily  at  first,  but  this  was 
found  to  be  too  frequent — productive  of  irritation. 
Sittings  are  now  held  every  other  day  without 
discomfort  in  any  case. 

A  galvanometer  and  a  smoothly-working  gal- 
vanic battery  are  indispensable  in  this  treatment. 
I  am  using  Barrett's  milliampere-meter  and 
chloride-of-silver  battery. 

Very  respectfully, 

C.  H.  H.  Hall, 
Passed  Assistant  Surgeon. 

U.  S.  Naval  Hospital,  Yokohama,  Japan, 

NEW  YORK   ACADEMY  OF  MEDICINE— 
PEDIATRIC  SECTION. 


Meetiiig,  June  27,  1888. 


DIETETIC  management  OF  THE  SUMMER  DIARRHfEA 
iiF    INFANTS. 

With  much  pleasure  he  had  accepted  the  invita- 
tion of  the  Chairman  to  give  his  views  on  this 
question,  which  was  one  to  which  he  had  given 
much  attention,  having  had  a  large  experience  in 
the  treatment  of  the  disease  in  Philadelphia  hos- 
pitals and  private  practice.  When  called  to  treat 
a  case  of  this  nature,  his  first  question  was  :  what 
food  has  the  infant  been  taking?  As  yet  he  was 
quite  unable  to  believe  that  even  in  acute  cases  it 
was  necessary  to  take  away  the  milk  of  the  mother 
or  nurse.  They  continue  to  suckle  the  child,  but 
the  administration  of  water  is  very  useful,  as  the 
child  is  often  thirsty.  Stimulation  is  of  the  utmost 
importance.  Brandy  or  whisky,  a  teaspoonful 
three  or  four  times  a  day,  or  thirty  drops  in  sweet- 
ened water  every  two  hours.  As  to  other  food 
besides  mother's  milk,  if  the  milk  of  the  mother 
is  faulty,  the  nursing  must  stop  and  the  infant  be 
fed  artificially.  On  the  other  hand,  if  the  mother's 
milk  is  apt  to  be  good,  it  might  be  supplemented 
with  one-half  ounce  of  beef  juice  or  wine  whey. 
As  to  the  dietetic  treatment  of  the  summer  diarr- 
hcea  in  hand-fed  children,  the  first  thing  is  that  the 
food  be  carefully  investigated.  The  best  food  for 
hand-fed  infants  is  cows'  milk  ;  if  it  disagrees, 
put  the  infant  on  the  exclusive  use  of  beef  juice. 

Cows'  milk  contains  about  three  times  as  much 
casein  as  human  milk.  When  cows'  milk  is 
diluted,  the  amount  of  fatty  material  is  reduced, 
and  therefore  cream  and  sugar  should  be  added. 
To  undiluted  cows'  milk,  too,  sugar  must  be  added. 


tHfi   CANADA    MEDICAL    RECORD. 


247 


Lastly,  cows'  milk  is  acid,  luimaniiiilk  is  alkaline. 
Hence,  bicarbonate  of  sodium  or  lime  water  should 
be  added,  the  latter  being  the  best. 

In  the  dietetic  treatment  of  cholera  infantum 
he  depends  upon  milk  foods  mainly  ;  diluted  cows' 
milk  with  the  addition  of  lime  water  has  given  the 
best  results.  Not  more  than  two  to  four  ounces 
should  be  give  at  each  feeding,  and  we  should 
take  a  lesson  from  nature  in  this  respect.  The 
amount  of  food  should  not  be  increased  until  the 
child  is  about  a  year  old.  It  is  also  desirable  to 
vary  the  food.  It  may  be  diluted,  and  cream  and 
milk  sugar  added  ;  if  cane  sugar  be  used  instead, 
the  quantity  should  be  less.  The  addition  of  some 
starchy  material,  such  as  dextrin,  is  useful.  One 
of  the  best  is  arrowroot ;  and  barley  water,  as 
recommended  by  Or.  Jacobi,  is  very  good. 
Mellin's  Food  has  often  proved  most  useful.  In 
some  cases  excellent  results  are  obtained  from 
taking  away  all  milk  and  administering  beef  juice 
alone,  but  many  infants  will  vomit  the  soup  as  soon 
as  given. 

It  is  also  necessary  that  precise  directions  be 
given  how  the  infent  should  be  fed,  as  to  amount, 
frequency,  etc.  A  young  infant  should  be  fed 
every  two  or  three  hours ;  older  infants  four  to 
six  times  a  day.  Experience  had  brought  the 
author  to  the  conclusion  that  only  in  rare  and 
exceptional  cases  is  it  either  desirable  or  neces- 
sary to  feed  more  frequently  than  every  two  hours. 
It  collapse  seems  imminent,  stimulants  are  very 
good.  In  dealing  with  summer  diarrhoea,  the 
treatment  should  not  be  changed  before  Tvell 
ascertaining  the  result  of  the  first  measures. 
Often,  if  the  physician  had  waited  a  few  hours 
longer,  he  would  have  found  that  he  held  the  key 
to  the  situation.  Ripe  experience  of  the  physi- 
cian will  be  better  than  great  learning. 

As  to  micro-organisms  and  the  chemical  poisons 
in  the  milk,  it  is  a  fact  that  milk  and  food  pre- 
pared with  it  may  become  dangerous.  The 
existence  of  the  chemical  poison  in  milk  has  been 
demonstrated,  so  has  the  micro-organism.  But 
the  time  is  not  yet  ripe  for  the  acceptance  of  the 
theory.  The  arguments  are  strong  against  it. 
Infants  are  attacked  though  nursed,  directly  by  the 
mother,  in  whose  milk  no  mico  organism  can 
exist.  If  we  make  no  advance  in  our  treatment, 
put  the  infant  on  an  animal  diet.  The  use  of  an 
exclusively  animal  diet  is  not  new,  but  old. 
Certain  cases  will  yield  to  it,  in  exce|)tional  in- 
stances it  fails ;  then  we  must  return  to  milk.  If 
,  micro-organisms  were  the  only  cause,  no  child 
would  ever  recover,  and  yet  they  continue  to 
thrive  under  the  milk  treatment.  If  he  were  to 
accept  the  micro-organism  argument,  he  should 
have  to  abstain  from  giving  animal  food  ;  but  then 
the  difficulties  are  enormously  increased ;  this  no 
one  will  deny  who  has  tried  to  feed  on  an  exclu- 
sive meat  diet.  If  vomited,  we  must  try  a  mixed 
diet  of  milk  and  meat.  The  decision  of  the 
question  :  what  constitutes  cholera  infantum?  will 
often  be  very  difficult. 


If  infants  are  taken  from  the  breast,  often  they 
will  not  take  it  again.  Contintiing  the  assump- 
tion that  micro-organisms  are  the  sole  cause  of  the 
disease,  an  animal  diet  must  be  substituted.  It 
seems  strange  that  as  soon  as  an  infant  becomes 
ill,  wemust  take  from  it  that  food  which  is  best  for 
it. 

Dr.  S.  Baruch  read  a  paper  entitled 

A  CLINICAL  STUDY  OF  THE   ETIOLOGY    AND   TREAT- 
MENT  OF  SUMMER    DIARRHCEA   OF    INFANTS. 

He  said  the  season  for  cholera  infantum  was 
again  upon  us.  There  was  a  time  when  he  dread- 
ed the  approach  of  summer.  He  had  been  taught 
to  regard  the  disease  as  an  inflammation,  chiefly 
gastro-colitis,  and  to  give  minute  doses  of  mercury. 
The  inefficiency  of  this  treatment  showed  that 
something  must  be  erroneous,  .^s  long  as  he  con- 
tinued to  look  upon  the  disease  as  merely  inflam- 
matory, his  severe  cases  died.  He  believed  it  to  be 
chiefly  due  to  the  ingestion  of  micro-organisms. 
The  theories  hitherto  prevalent  were  faulty,  and 
have  led  to  false  methods  of  treatment. 

The  causes  were :  first,  insanitary  conditions, 
poverty,  overcrowding ;  second,  atmospheric  con- 
ditions ;  third,  bad  feeding.  The  first  causes 
prevail  not  only  in  cities,  but  under  different  con- 
ditions. He  had  observed  the  disease  in  rural 
towns,  etc.,  in  the  backwoods  of  South  Carolina, 
in  Washington  Heights  and  Audubon  Park,  and 
had  found  cases  just  as  severe  among  the  negroes 
of  the  South.  While  filth  increases  the  mortality, 
the  cause  is  due  to  micro-organisms. 

Artificial  feeding  has  long  been  accepted  by  the 
profession  as  a  cause.  Out  of  five  hundred  cases 
of  summer  diarrhcea,  only  a  few  occurred  among 
breast-fed  children.  That  had  been  ascribed  to 
the  difference  between  cows'  milk  and  woman's 
milk,  but  this  is  an  error.  The  chemical  composi- 
tion of  cows'  milk  had  been  investigated  again 
and  again,  and  the  difference  shown.  But  if  the 
artificial  food  was  changed  by  addition,  dilution, 
etc.,  we  still  find  great  difference  in  the  toleration 
of  the  infant's  stomach  in  summer  and  winter 
respectively.  The  researches  of  Esserich  have 
shown  that  the  great  cry  about  cows'  milk  has  no 
foundation.  He  had  given  casein  in  excess,  and 
found  it  well  digested.  Healthy  infants  are  cap- 
able of  assimilating  casein  far  in  excess  of  their 
requirements.  The  author  would  not  go  as  far  as 
Esserich,  for  practically  cows'  milk  is  not  so  well 
adapted  to  infants  as  has  been  accepted.  Yet  the 
cause  must  be  sought  in  another  direction  than  in 
the  difference  of  composition. 

That  high  temperature  exercises  a  powerful 
influence  is  true  ;  in  what  manner  does  tempera- 
ture change  the  prognosis  }  Its  depressing  effects 
are  pre-disposing  elements,  but  if  this  were  the  cor- 
rect interpretation,  it  would  not  affect  the  clinical 
obs.rvation  that  the  three  factors  act  in  unison,  but 
their  modus  operandi  has  not  been  correctly 
understood.  Why  does  cows'  milk  not  cause  dis- 
turbance in  winter?    The  development  of  bacteria 


248 


THE'  CANADA   MEDICAL   RECORD. 


is  the  cause  in  summer.  It  was  first  shown  by 
Pasteur  that  the  coagulation  is  due  to  the  bacteria. 
The  most  important  discovery  was  made  by  Lister, 
that  a  drop  of  sour  milk  added  to  urine  produced 
a  change,  and  that  a  drop  of  this  urine  again  caus- 
ed the  souring  of  the  milk.  Owing  to  the  piesence 
of  bacteria  the  proper  breaking  up  of  the  casein  is 
interfered  with,  the  intestinal  tract  becomes 
inflamed  and  thus  gives  rise  to  summer  diarrhoea. 
The  author  cited  different  writers  in  favor  of  this 
view. 

This  points  the  way  to  treatment :  bismuth, 
mercury,  etc.,  have  given  good  results,  while  opium 
has  failed. 

We  know  the  human  milk  is  aseptic  in  the 
gland  and  is  the  best  prophylactic.  The  best 
substitute  is  cows'  milk,  which  is  also  free  from 
bacteria  as  it  comes  from  the  udder.  Milking  is 
liable  to  introduce  impurities,  and  foam,  which  is 
air  with  germs,  is  especially  liable  to  catch  any 
floating  impurities.  We  had  learned  in  other 
departments  how  important  it  was  to  prevent  its 
access  to  the  uterus.  A  milking  tube  would  be 
useful,  but  it  is  not  generally  applicable,  and  the 
same  might  be  said  of  goats  recommended  as 
nurses. 

Next  to  preventing  the  access  of  noxious  germs, 
sterilization  of  cows'  milk  must  be  good.  Soxhlet's 
apparatus  comes  near  to  the  requirements,  and 
Caille  and  others  have  simplified  it.  These  gen- 
tlemen think,  because  milk  does  not  sour,  there- 
fore it  is  sterilized.  But  it  has  been  shown  that 
this  is  not  necessarily  true.  Continuous  exposure 
for  half  an  hour  at  ioo°  C.  is  not  suflicient  for 
sterilization.  Hence  Caille's  experiments  were 
not  quite  as  successful  as  Soxhlet's.  Boiling  the 
milk  has  been  recommended  by  Jacobi  as  long 
ago  as  1870.  By  this  the  casein  is  made  more 
soluble  and  digestible.  Various  authorities  corro- 
borate this  fact.  He  had  convinced  himself  that 
milk  could  be  certainly  sterilized  if  the  tempera- 
ture can  be  raised  to  266'^  F.,  under  pressure, and 
a  lower  temperature  will  suffice  if  continued  for  a 
longer  time. 

The  hygienic  management  of  the  infant  is  next  in 
importance.  This  remark  applies  to  all  diseases  due 
to  micro-organisms.  A  daily  bath  is  to  be  re- 
commended, and  a  proper  amount  of  undisturbed 
sleep  is  absolutely  necessary ;  hence,  fondling 
should  be  avoided.  Teething  no  longer  requires 
the  use  of  the  gum  lancet,  which  could  be  laid  on 
the  shelf  along  with  other  useless  instruments. 
Though  the  nervous  system  is  irritated,  the  process 
is  a  natural  one.  In  the  way  of  prophylaxis, 
attention  to  the  infant's  mouth  is  important.  In 
the  mouth,  germ-free  human  milk  undergoes  no 
change.  It  is  advisable  in  the  summer  months  to 
clean  the  infant's  mouth  with  a  weak  solution  of 
boracic  acid.  Sudden  changes  of  temperature  in 
August  are  best  guarded  against  by  a  flannel 
bandage  and  sacque. 

In  the  curative  treatment,  diminish  or  remove 
the  bacterial  supply.     A  wet-nurse  should  be  em- 


ployed where  possible.  The  artificial  food  must  be 
looked  after.  Barley  water  and  meat  broth  are  very 
excellent  substitutes  for  milk.  A  solution  of 
white  of  egg  in  water  is  also  a  valuable  nutriment. 
The  presence  of  the  b.acteria  must  be  neutralized, 
and  all  fermenting  material  removed  from  the 
stomach.  The  stomach  requires  absolute  rest. 
All  food  and  drink  must  be  withheld  for  five  or 
six  hours.  After  the  stomach  has  been  thoroughly 
cleansed — if  rest  does  not  bring  relief — pepper- 
mint, etc.,  may  be  tried.  A  dose  of  calomel  will 
generally  be  retained,  and  acts  not  as  a  parasiti- 
cide merely,  but  removes  the  bacteria  from  the 
canal.  Caslor  oil  will  sweep  them  out,  and  large 
draughts  of  warm  water  will  do  it.  A  rubber 
catheter  will  answer  if  attached  to  the  fountain 
syringe.  The  tube  is  anointed  with  vaseline,  and 
introduced  and  retained  until  a  quart  of  water  has 
passed,  the  child  being  laid  on  the  stomach. 
The  thorough  irrigation  of  the  large  intestines,  by 
the  physician  or  competent  nurse  produces  a  most 
soothing  effect  on  the  patient ;  almost  invariably 
quiet  slumber  ensues,  even  during  the  flow  of  the 
water.  He  cited  J.  Lewis  Smith  and  L.  Emmett 
Holt  in  corroboration  of  this  fact.  Local  troubles 
should  be  met  by  local  measures.  Though  he 
had  used  antiseptics,  he  did  not  think  them 
advisable  because  they  cannot  be  made  strong 
enough  ;  still  the  internal  administration  of  anti- 
septics, naphthalin,  etc.,  has  found  advocates. 
Bichloride  of  mercury  and  bismuth  might  be 
useful.  He  had  abstained  from  medicinal  treat- 
ment so  as  to  maintain  the  integrity  of  the 
stomach. 

Prostration  of  the  vital  powers  is  often  pro- 
nounced. Elevated  temperature  marks  generally 
a  necessity  for  its  reduction.  He  had  not  resor- 
ted to  medicinal  antipyretics.  Cold  baths  will 
often  change  the  aspect  of  the  case.  He  cited  a 
case  in  illustration  of  this  point.  Inanition, 
caused  by  diarrhcea,  must  be  met  by  careful  diet. 
Cows'  milk,  properly  sterilized,  will  be  useful,  and 
the  addition  of  dextrin  and  predigestion  will  be 
good.  Warn  mothers  not  to  add  milk  to  prepared 
food  containing  milk.  He  did  not  believe  in 
Mellin's  Food  because  it  requires  the  addition  of 
milk.  Stimulants  are  good  ;  whiskey  and  brandy 
are  the  best. 

Opium  was  the  only  drug  which  will  stop  peris- 
talsis of  the  bowels. 

Dr.  G.  B.  Fowler  spoke  on  the 

RELATIVE    DIGESTIVE    POWER    OF    THE    PEPSINS    IN 
COMMON  USE,  AND  THE  ACTION  OF  THE  DRUGS 
EMPLOYED    IN    THE    TREATMENT    OF    SUM- 
MER   DIARRHCEA    UPON    DIGESTION. 

He  gave  a  synopsis  of  the  results  of  some 
experiments  he  had  made  with  different  pepsins 
to  ascertain  their  digestive  value.  After  briefly 
dwelling  upon  the  mode  of  manufacture  of  the 
article,  he  stated  that  in  view  of  the  fact  that  each 
maker  claimed  that  his  product  was  the  best,  he 


THE  CANADA  MEDICAL   RECORD. 


249 


had  procured  thirteen  different  kinds  from  differ- 
ent houses.  He  had  put  one  grain  of  each  into  a 
bottle  and  had  added  to  each  ijottle  eiglit  ounces 
of  acidulated  water  (hydrochloric  acid  and 
water  of  one-half  per  cent,  strength).  Twelve 
hundred  grains  of  white  of  egg,  coagulated  by  boil- 
ing and  passed  through  a  sieve  and  very  finely 
comniiiiuled,  were  added  to  each  bottle.  For  com- 
parison the  first  bottle  had  received  only  a  charge 
of  acidulated  water  and  albumen  without  any  pep- 
sin. The  bottles  were  exhibited.  The  results 
were  very  different  from  what  might  have  been  e.\- 
pected.  Most  of  the  pepsin  seemed  entirely  inac- 
tive. He  was  very  much  surprised  with  the  result 
obtained  with  the  article  made  by  Parke,  Davis  & 
Co.,  one  grain  of  which  had  completely  digested 
twelve  hundred  grains  of  albumen.  Fairchild's  was 
second  best,  but  had  not  done  quite  as  well.  The 
rest  manifested  little  or  no  power.  It  is  claimed 
that  this  is  not  a  fair  test ;  that  a  more  bulky  pre- 
cipitate may  weigh  less  than  one  that  is  less  bulky. 
But  the  speaker  saw  no  difference  in  the  physical 
characters  of  the  respective  residues,  and  it  was 
very  evident  that  in  these  experiments  the  more 
bulky  invariably  were  the  heaviest.  He  had  used 
water  enough  for  all  the  albumen  to  go  into  solu- 
tion. Having  ascertained  the  time  required  for 
digesting  the  entire  amount  of  albumen,  he  had 
added  some  of  the  medicines  we  were  in  the  habit 
of  giving  in  summer  diarrha;a,to  see  whether  retard- 
ing effects  were  present  or  not. 

Salicylate  of  sodium  stops  it  absolutely.  Some- 
body says  it  does  so  by  fixing  the  hydrochloric 
acid  :  The  quantity  used  was  20  gr. ;  even  so  small 
a  quantity  as  3  gr.  retarded  the  process  about  two 
hours.  Salicylate  of  sodium  is  very  sparingly 
soluble  in  hydrochloric  acid. 

Quinine,  20  gr.,  there  was  no  digestion  ;  3  gr. 
ha.d  no  effect. 

Mariani  wine  stopped  the  digestion. 

Acetate  of  lead  does  not  retard  or  interfere  with 
the  action  of  the  pepsin. 

Tincture  of  chloride  of  iron,  30  drops,  hardens 
the  albumen  and  clumps  it  up,  and  retards  about 
two  hours;  5  drops  retard  about  15  minutes. 

Salol  retards  the  action  about  one  hour. 

Antifebrin  only  slightly  delays  the  action. 

Antipyrin  had  no  effect. 

Chalk  mixture  completely  arrested  the  action 
(quantity  added,  a  teaspoonful). 

Calomel,  no  effect. 

Bismuth  sub  carb,,  20  grs.,  no  effect. 

Tincture  of  kino,  copious  precipitate  of  the  pep- 
sin and  arrest  of  action. 

Tincture  of  catechu,  same  effect. 

Dr.  Caille  said  he  had  several  times  expressed 
his  opinion,  and  did  not  wish  to  take  up  the  time  of 
the  section.  He  was  well  aware  that  milk  is  not 
scientifically  sterilized  by  the  boiling  usually  prac- 
ticed. It  was  a  well  known  fact  that  one  child 
will  thrive  on  undiluted  milk,  another  on  diluted. 
In  view  of  the  intricacy  of  the  whole  subject,  he 
thought  collective  investigation  would  be  a  good 
way  to  solve  the  problem, 


Dr.  HuiciiisoN  thought  Dr.  Fowler  would  not 
get  the  same  results  if  he  were  to  repeat  the  same 
experiments.  He  had  made  si.x  experiments  with 
the  best  pepsins  in  almost  the  identical  way  Dr. 
]''owler  had  done,  but  his  results  had  been  very 
different  in  order  of  their  merits.  Parke,  Davis  & 
Co.'s  was  far  below  any  experimented  with.  Fair- 
child  Bros.  &  F'oster's  was  found  satisfactory. 
Peijsin  is  a  very  variable  product,  and  little  reliance 
should  be  placed  on  such  experiments.  No  two 
specimens  of  the  same  manufacturer  would  give 
the  same  results. 

He  expressed  his  appreciation  that  different  ob- 
servers could  come  to  similar  results,  referring  to 
Dr.  Baruch's  statement  as  to  the  chemical  analysis, 
showing  the  difference  between  human  and  cows' 
milk,  and  we  know  that  it  will  nourish  our  babies  in 
winter.  But  in  summer  our  milk  commences  to  fer- 
ment, and  trouble  begins.  The  boiled  milk  should 
be  filled  into  a  number  of  small  vials,  each  of 
which  is  to  contain  only  enough  for  one  feeding. 
His  experience  would  corroborate  all  that  Dr. 
Meigs  had  said  about  adding  cream  to  the  milk, 
and  he  had  carried  it  out  for  a  number  of  years. 

Dr.  Harwood  had  been  very  much  interested 
in  the  papers  read,  and  very  much  surprised  that 
in  reference  to  artificial  food  nothing  had  been 
said  about  condensed  milk.  It  was  his  experience 
and  belief  that  of  all  the  foods  procurable  none 
could  equal  condensed  milk,  for  the  reason  that 
it  had  been  heated  to  a  temperature  destroying 
any  bacteria.  Sugar  has  also  been  added.  It 
has  not  been  subjected  to  the  churning  process  on 
the  railroad  that  would  render  it  unfit  for  continu- 
ous and  regular  feeding.  In  all  his  practice, 
extending  over  a  number  of  years,  all  the  children 
he  had  become  responsible  for  had  been  nourished 
with  condensed  milk,  and  in  his  own  personal 
experience  and  family,  when  the  mother's  milk 
failed,  the  baby  was  brought  up  on  condensed  milk. 
He  had  never  failed  to  recognize  the  value  of  the 
addition  of  an  alkali  to  milk,  lime  water  being  the 
one  added,  and  the  quantity  used  for  diluting  one- 
third  that  of  the  milk,  and  boiled.  He  had  taken 
the  trouble  to  visit  Putnam  County  to  learn  the 
process  of  condensing  before  using  it. 

Dr.  Jacob:  said  he  would  strenuously  object  to 
condensed  milk.  Those  who  had  done  him  the 
honor  of  reading  his  writings  would  agree  with 
him. 

In  reference  to  the  pepsin  experiments  he 
thought  no  one  present  at  the  meeting  had  ever 
given  30  drops  of  tincture  of  iron.  Muriate  of 
iron  in  small  doses,  though  in  large  quantity  during 
the  day,  does  no  harm.  Whoever  had  given  it 
in  diphtheria  would  appieciate  that  fact. 

One  more  point  vv^as  of  the  greatest  possible 
importance.  Dr.  Fowler  had  stated  that  the 
digestive  process  was  interrupted  by  the  carbonate 
of  lime.  That  is  important  to  know,  though  it  is 
quite  natural  that  it  should  do  so  and  does  it  in 
the  stomach.  We  give  it  to  a  sick  child  which  does 
not  secrete  the  normal  amount  of  lactic  acid,  later 


250 


THE   CANADA   MEDICAL   RECORD. 


hydrochloric  acid,  and  if  you  pour  it  into  the 
stomach,  digestion  is  interfered  with.  AlkaHes 
ought  not  to  be  given  immediately  after  eating  ; 
they  will  neutralize  the  normal  acids  after  eating. 
Bicarbonate  of  sodium  has  different  properties. 
When  it  is  to  be  given  it  must  be  done  before  the 
administration  of  food.  In  an  abnormal  stomach 
there  is  an  amount  of  abnormal  fatty  acids, 
and  we  give  an  alkali  for  the  purpose  of  neutraliz- 
ing these  acids,  and  then  it  will  do  good.  Give 
alkalies  before  food  is  taken,  then  the  stomach  is 
free  from  the  fat  acids.  It  is  quite  possible  and 
physiological  to  give  an  alkali  before  meals,  and 
still  given  pepsin  afterward. 

Dr.  Meigs  said  he  was  somewhat  surprised  to 
learn  that  diarrhrea  was  rare  in  hand-fed  children 
in  winter.  In  a  foundling  institution  with  which 
he  is  connected,  one  of  the  worst  troubles  is 
diarrhcea.  Diarrhoea  is  not  at  all  uncommon  in 
winter,  especially  in  improperly  hand-fed  children. 
Past  clinical  experience  seems  to  be  tending  in  this 
direction,  that  cows'  milk  should  be  dilu;ed,  and, 
also  in  favor  of  the  addition  of  fat,  say  cream, 
which  adds  to  the  good  effects.  When  he  found 
that  analysis  of  human  milk  would  seem  to  show 
that  dilution  of  cream  to  cows'  milk  was  necessary, 
it  seemed  a  strong  argument,  backed  up  by  chem- 
istry and  clinical  experience. 

Dr.  Baruch  said  his  statement  as  to  the  non- 
occurrence of  diarrhcea  in  winter  referred  to  the 
serious  form  ;  that  occurring  in  winter  is  not  often 
fatal. 

Dr.  Meigs  :  A  good  many  cases  of  death  were 
from  diarrhoea.  They  were  children  of  the  poorest 
classes  of  society,  generally  in  bad  health  when 
first  seen;  they  have  diarrhcea  when  first  admitted, 
and  die. 

Dr.  Baruch  :  As  to  condensed  milk,  I  would 
like  to  ask  the  doctor  how  much  water  he  adds. 

Dr.  Harwood:  My  method  is,  three  teaspoon- 
fuls  of  the  condensed  milk  from  the  cans  to  a  half 
pint  of  water ;  one-third  of  that  water  is  lime 
water. 

Dr.  Baruch  :  Condensed  milk,  even  Borden's 
and  the  Swiss  brand,  would  have  to  be  diluted 
one-sixth  if  you  dilute  it  as  stated.  Where  would 
the  nourishment  come  in  ?  And  you  give  a  large 
amount  of  sugar  likewise.  I  think  condensed  milk 
is  the  most  pernicious  food. 

Dr.  Fowler  :  In  regard  to  the  value  of  these 
experiments.  Those  pepsins  were  bought  out 
of  the  shops,  and  if  they  cannot  digest  any  more 
albumen  than  appears  here,  they  must  be  very  weak. 
Saccharated  pepsins  would  be  still  weaker.  As  to 
Parke,  Davis  &  Co  's  pepsin,  it  was  ascertained 
that  it  had  been  prepared  by  a  new  process, 
and  had  been  only  recently  put  on  the  market.  The 
practical  application  of  the  results  I  leave  to  your- 
selves. It  is  well  not  to  give  these  remedies  dur- 
ing digestion.  The  curd  that  forms  may  set  up 
tonditions  which  may  give  you  trouble. — Dietetic 
Gazette. 


a 


/  Sm\ 


cmme. 


THE     DIAGNOSTIC    SIGNIFICANCE     OF 
HEMATURIA. 

Robert  Saundby,  M.  D.,  Edinburgh,  F.  R.  C.  P. 
(Lond.j,  in  the  British  Medicnl  Journal  writes: 
Hematuria  is  a  symptom  common  to  a  number  of 
pathological  conditions  which  differ  essentially 
in  their  seat,  nature,  and  relationships..  In  many 
of  these  it  is  a  prominent,  in  not  a  few  of  them  the 
sole  prominent  symptom,  while  its  differential 
diagnosis  is  beset  with  difficulties,  not  only  from 
the  multiplicity  of  causes,  but  from  the  fact  that 
there  are  a  ceitain  number  of  cases  which  can  only 
be  attributed  to  causes  still  unknown,  or  at  best 
very  obscure. 

Blood  may  appear  in  the  urine  in  a  corpuscu- 
lar or  non-corpuscular  form.  The  latter  is  called 
hemoglobinuria  to  distinguish  it  from  corpus- 
cular hematuria. 

Detection  of  blood  in  the  Vrinc. — The  diagnosis 
of  the  presence  of  blood  coloring  matter  in  the 
urine  may  be  made  by  (i)  the  eye,  (2)  the  mi- 
croscope, (3)  the  guaiacum  test,  (4)  the  spec- 
troscope ;  but  the  microscope  alone  is  capable  of 
differentiating     hematuria    from    hemoglobinuria. 

It  has  been  maintained  by  Dr.  Wickham 
Legg,  an  author  who  has  written  ably  on 
several  of  the  obscurer  problems  of  clinical 
medicine,  that  the  blood  corpuscles  get  broken 
up  after  the  urine  is  secreted.  He  maintains 
that  if  the  urine  is  examined  immediately  after 
leaving  the  body,  corpuscles  can  always  be  found. 
My  own  observations,  which  I  have  had  the 
opportunity  of  making  under  the  most  favorable 
conditions,  do  not  support  this  view.  Hayem  has 
found  free  hemoglobin  in  excess  in  the  blood 
serum,  while  in  the  well  known  icteroid  coloring 
of  the  skin  and  conjunctiva,  which  sometimes 
appears,  supports  the  view  that  the  hemoglobin 
IS  set  free  in  the  blood  before  it  appears  in  the 
urine.  I  shall  have  to  refer  to  this  matter  again, 
and  I  believe  I  shall  show  that  Dr.  Wickham 
Legg  is  so  far  right  that  hemoglobinuria,  as 
distinguished  from  hematuria,  is  not  always 
present  in  the  group  of  cases  where  chilling  of 
the  surface  appears  to  be  the  essential  factor  in  the 
production  of  attacks  of  bloody  urine. 

Having  premised  the  necessity  of  microscopic 
examination  for  the  differentiation  of  corpuscular 
from  non-corpuscular  hematuria,  it  may  be  broadly 
stated  that  blood  in  the  urine,  when  in  any 
quantity  and  chemically  unchanged,  presents  a 
very  characteristic  appearance  not  likely  to  be 
overlooked  or  mistaken  for  anything  else.  But 
when  the  urine  has  remained  some  time  in  the 
bladder,  the  bright  red  color  becomes  changed  to 
a  dirty  brown,  giving  to  the  urine  a  porter  color 
if  present  in  quantity  or  smoky  tinge  when  in 
less  amount.  This  change  is  due  to  a  chemical 
alteration    of  the    hemoglobin,    which    becomes 


TIIK   CANADA   MEDICAL   RECORD. 


251 


converted  into  methemoglobin  by  the  action  of 
the  acid  urine.  Such  dark  urine  may  be  con- 
founded with  that  caused  by  other  dark  pigments, 
such  as  indican  or  pyrocateciiin,  which  occasion- 
ally are  present. 

Unaltered  blood  in  small  quantity  is  not  very 
visible  ;  but  by  inspecting  the  urine  in  a  glass 
with  a  good  light  we  can  recognize,  not  only  its 
peculiar  color,  but  its  characteristic  dichromism, 
that  is,  by  reflected  light  it  appears  red,  while  by 
transmitted  light  it  is  green. 

The  microscopical  search  for  blood  is  so  well 
understood  now  by  all  practitioners  that  it  needs 
few  words.  If  traces  only  are  present,  the  lowest 
stratum  of  urine  should  be  examined  after  stand- 
ing some  time.  The  corpuscles  undergo  many 
changes  in  urine,  swelling  uj)  so  as  to  lose  their 
biconcave  form,  or  shedding  their  hemoglobin, 
by  which  they  alter  in  shape,  appear  vacuolated, 
and  ultimately  colorless.  Such  colorless  disks 
may  possibly  be  confounded  with  discoid  o.xalates 
and  torulae,  but  both  these  are  smaller,  the  latter 
containing  bright  nuclei  and  being  generally  oval. 

The  main  purpose  of  this  pa])er  is  to  deal  with 
renal  hematuria,  but  the  difficulties  of  differential 
diagnosis  are  so  great^  that  I  should  be  wanting 
in  honesty  if  I  dismissed  as  foreign  to  my  subject 
those  cases  which  dejjend  upon  other  causes.  I 
must,  therefore,  at  the  risk  of  trespassing  upon 
your  patience,  attempt  to  grapple  with  the  subject 
in  its  entirety. 

I  think  I  may  content  myself  with  the  bare 
statement  of  the  fact  that  llie  urine  of  women  is 
bloody  during  menstruation,  or  whenever  there  is 
vaginal  or  uterine  hemorrhage.  Hemorrhage 
from  the  urethra  may  be  caused  by  villous  growth, 
or  in  consequence  of  local  congestion  or  injury. 
The  blood  is  bright  red,  appears  independently 
of  micturition,  or  is  not  mi.\ed  with  the  stream, 
but  occurs  at  the  beginning  or  end  of  it,  and  is 
often  accompanied  by  local  pain  or  other  symp- 
toms. 

Hemorrhage  from  the  bladder  may  be  caused 
by  stone,  prostatic  disease,  villous  or  malignant 
growths,  cystitis,  ulcer,  parasites  (Bilharzia),  etc. 
In  stone,  prostatic  disease,  and  cystitis,  the 
diagnosis  is  not  difficult,  as  these  conditions  have 
well-marked  symptoms.  The  first  two  can  soon 
be  excluded  by  physical  examination,  while 
parasitic  ova  may  be  recognized  by  the  micros- 
cope. But  ulcer  and  growths  in  the  bladder 
present  peculiar  difficulties,  which  may  long  baffle 
diagnosis. 

We  may  commence  by  excluding  the  kidneys. 
Hemorrhage  from  the  renal  substance  reveals 
itself  by  blood  casts  of  the  urinary  tubules,  but 
hemorrhage  from  the  pelvis  has  no  such  constant 
sign,  though  casts  of  the  ureter  may  be  found. 
Renal  hemorrhage  is  usually  accompanied  by 
local  pain,  while  the  history  of  injury,  a  blow, 
passage  of  calculus,  etc.,  may  help.  Hemorrhage 
from  the  bladder  is  usually  associated  with  some 
degree  of  cystitis  and  local  pain,  frequency  of 


micturition,  etc.  By  passing  a  sound  or  lithotrite, 
fragments  of  growth  may  be  obtained  or  an 
irregular  ulcerated  surface  detected.  Washing 
out  the  bladder  may  afford  useful  aid  in  obtaining 
fragments  of  the  villous  growth. 

In  women  urethral  dilatation  and  digital  ex- 
ploration constitute  a  safe  and  easy  method  of 
examining  the  inside  of  the  bladder,  while  in 
males,  after  due  consideration,  an  exploratory 
cystotomy  may  be  performed.  Above  all,  in 
these  cases  medicine  must  seek  the  aid  of  surgery, 
and  surgery  of  medicine,  or  grave  errors  of 
diagnosis  and  treatment  will  be  made.  This  re- 
mark applies  to  many  other  forms  of  hematuria, 
as  we  shall  see. 

Rmal  Hematuria. — Sir  William  Roberts,  whose 
admirable  book  on  Urinary  and  Renal  diseases  is 
by  far  the  most  valuable  work  on  the  subject  in 
this  or  any  other  language,  divides  the  causes  of 
hematuria  into  three  groups:  (i)  local  lesions  ;  (2) 
symptomatic;  (3)  supplementary  ;  and  adds: 
"  Cases  also  occur  which  are  not  referable  to  any 
of  these  categories  of  which  the  origin  is  extremely 
obscure."  This  is  his  list: 

1.  Local  lesions.  External  injury,  violent  ex- 
ercise, calculous  concretions,  ulcers,  abscesses, 
cancer,  tubercle,  parasites,  active  or  passive 
congestion,  Bright's  disease. 

2.  SymjHomatic.  In  purpura,  scurvy,  eruptive 
and  continued  fevers,  intermittent  fever,  cholera, 
etc.,  mental  emotion. 

3.  Siipphmentary  or  vicarious.  To  menstrua- 
tion hemorrhoids,  asthma. 

In  one  or  two  instances  these  may  refer  to 
other  than  real  lesions,  but  the  list  is  a  useful 
one  to  modify  and  extend  for  our  purpose,  thus: 

1.  Local  lesions.  External  injury,  twisted  or 
movable  kidney,  calculus,  tubercle,  cancer,  syphi- 
lis, embolism,  parasites,  congestion,  Bright's 
disease. 

2.  Symptomatic.  Blood  diseases  (purpura, 
scurvy,  hemoglobinemia,  leucocythemia)  specific 
fevers,  malaria,  cholera. 

3.  Toric.     Turpentine,  cantharides. 

4.  Neurotic  or  viairious.  Hysteria,  insanity, 
asthma,  menstruation,  hemorrhoids. 

External  injury  causes  laceration  of  the  kidney 
substance,  which,  if  extensive,  may  call  for 
extirpation  of  the  organ  ;  in  most  cases  the  wound 
heals ,  and  recovery  takes  place.  The  diagnosis 
presents  few  difficulties,  and  the  treatment  must 
depend  upon  the  amount  of  hemorrhage,  which, 
if  great,  will  cause  a  tumor  in  the  flank  from 
effusion  into  the  neighboring  tissues.  The  treat- 
ment must  be  rest,  an  ice-bag  to  the  part,  ergotin 
subcutaneously,  and  in  the  last  resort  extirpation. 

Movable  kidney.  Closely  connected  with  the 
foregoing  are  cases  of  persistent  or  intermittent 
hematuria  dating  from  a  blow  or  fall.  It  is 
supposed  that  the  organ  is  partially  displaced 
and  rotated  on  its  horizontal  axis,  so  as  to  twist 
the  vessel  at  the  hilas,  thus  compressing  the  vein, 
and  causing  passive  congestion. 


252 


THE  CANADA  MEDICAL  tlECORD. 


The  employment  of  an  efficient  bandage  is  of 
the  utmost  importance  for  the  successful  treat- 
ment of  these  cases.  The  following  description 
of  a  suitable  appliance  is  from  a  paper  by  Dr. 
Apolant  (Deufschcs  Med.  Woch,  No.  41,  1886)  : 

"  The  bandage  used  to  reduce  the  kidney  was 
simply  a  belt  fitted  to  the  abdomen,  with  appen- 
dages of  India  rubber  webbing,  so  arranged  as  to 
grasp  the  hypochondrium.  To  prevent  its  slip- 
ping up,  two  covered  India-rubber  gas  tubes  secur- 
ed it  to  the  thighs.  Inside  the  bandage,  in  a 
position  somewhat  below  the  normal  position  of 
the  kidney,  a  firmly  padded  convex  leather 
cushion,  somewhat  larger  than  the  fist,  was  fixed, 
which  exercised  pressure  on  a  considerable  area 
of  the  abdomen  over  the  very  yielding  intestines. 
This  pressure,  while  being  pretty  strong  and  con- 
stant, must  be  of  such  a  nature  that  the  abdomen 
can  expand  and  contract  during  breathing.  This 
is  effected  by  the  India-rubber."' 

Calculus.  A  medical  friend  of  gouty  habit,  and 
a  great  sufferer  from  oxaluria,  was  getting  into  his 
brougham  one  day,  when  his  horse  started  and 
flung  him  on  the  back  seat  in  such  a  way  as  to 
bring  on  an  acute  pain  in  the  left  loin,  as  if  he  had 
strained  a  muscle.  Later  in  the  day  he  vomited, 
and  the  pain  was  so  great  at  night  that  he  took 
opium  to  relieve  it.  The  urine  became  bloody. 
In  the  course  of  twenty-four  hours  he  passed  a 
small  oxalate  of  lime  calculus,  and  his  trouble 
ceased.  This  case  shows  that  hematuria  after  a 
strain  or  blow  may  be  caused  by  the  displacement 
of  a  calculus,  which  had  formerly  occupied  some 
position  in  which  it  gave  rise  to  no  symptoms. 
Had  the  stone  not  passed,  the  cause  of  the  hemorr- 
hage would  have  remained  obscure,  or  it  might 
have  been  put  down  to  partial  displacement  of  the 
kidney.  The  symptoms  of  renal  colic  are  tolerably 
characteristic.  The  pain  shooting  down  towards 
the  groin,  with  vomiting,  and  retraction  of  the  tes- 
ticle, are  not  met  with  in  any  other  condition.  It 
is  noteworthy  that  the  pain  in  biliary  colic  does 
not  pass  downward  to  the  abdomen,  but  radiates 
round  the  thorax,  and  is  specially  localized  at  a 
spot  below  the  right  shoulder  blade.  A  medical 
friend,  whom  I  recently  attended  for  biliary  colic, 
tells  me  that  the  worst  pain  of  all  was  a  feeling  as 
if  three  or  four  vertel)ra3  were  being  gripped  by  a 
jjair  of  pincers.  Confusion  between  these  two  con- 
ditions is  impossible  if  hematuria  is  looked  for  and 
relied  upon,  as  I  believe  it  may  be,  as  a  constant 
symptom  of  renal  colic,  but  it  may  not  always  be 
present  in  quantity  sufficient  to  reveal  itself  to 
inspection  with  the  naked  eye.  Conversely  I  hold 
that  the  diagnosis  of  calculus  in  the  kidney  is 
incomplete  until  hematuria  has  occurred. 

It  may  be  contended  that  the  negative  results  of 
operation  do  not  absolutely  exclude  calculus.  In 
a  case,  treated  at  one  of  our  hospitals  I  believe,  a 
stone  was  passed ^jer  vias  naturales  after  an  explo- 
ratory incision  had  been  made  without  success,  so 
that  we  must  allow  that  even  surgeons  are  fallible, 
and  we  know  that  a  stone  of  small  size  may   give 


rise  to  marked  symptoms  without  getting  into  the 
infundibulum. 

Tulicrde.  Hematuria  in  tubercle  is  accompanied 
by  pus  and  shreds  of  renal  tissue.  Tubercle 
most  commonly  causes  pyelitis,  and  there  is  much 
more  pus  than  blood  in  the  urine.  The  diagnosis 
of  tubercle  depends  mainly  on  the  evidences  of 
tubercle  elsewhere  and  on  family  history. 

Cancer.  Hematuria  is  not  always  present  in 
cancer  ;  when  it  is,  it  is  very  profuse.  The  diagno- 
sis in  some  cases  is  easy,  as  a  tumor  may  be  felt, 
and  deposits  in  other  organs  can  be  made  out. 
Microscopic  examination  may  show  characteristic 
cells,  but  this  can  not  be  relied  upon.  In  some 
cases  the  differential  diagnosis  from  calculus  is 
very  difficult.  The  hemorrhage  is,  perhaps,  more 
profuse  and  persistent.  The  subjects  of  cancer 
may  last  a  long  time  in  fair  health  ;  one  patient  of 
mine  had  suffered  from  hematuria  for  four  years 
before  I  saw  him,  and  lived  quite  two  years  after- 
ward. Mr.  Chavasse  made  an  exploratory  incision, 
under  the  belief  (which  I  shared)  that  he  had  a 
calculus.  He  recovered  from  this  and  died  some 
time  afterwards,  the  post  mortem  examination, 
proving  that  calculus  was  not  present,  and  showing 
cancer  of  the  kidney  and  liver. 

Si/philis.  Gummatous  deposits  in  the  kidneys 
are  well  known  in  the  po.it  mortem  room,  but  their 
clinical  phenomena  have  not  been  fully  made  out. 
Embolism.  Embolism  of  the  kidney  is  not  an 
uncommon  accident  in  heart  disease,  especially  in 
vegetative  endocarditis,  also  in  pyemia.  Hema- 
turia occurring  under  these  conditions  may  safely 
be  attributed  to  embolism. 

Parasites.  Hydatid  cysts  in  the  kidney  cause 
hematuria,  and  can  only  be  recognized  by  the 
passage  of  fragments  of  hydatid  membrane  in  the 
urine.  Bilharzia  hematobia,  which  generally 
attacks  the  bladder,  may  occur  in  the  pelvis  or 
substance  of  the  kidney,  and  manifest  itself  by  the 
characteristic  ova  and  embryos  in  the  urine. 

Congestion.  Congestion  may  be  active  or  passive. 
Active  congestion  is  often  only  the  initial  stage  of 
acute  inflammation,  a  condition  which  very  rarely 
attacks  healthy  kidneys,  except  during  the  course 
of  acute  specific  diseases  ;  for  example,  scarlatina, 
diphtheria,  tonsilitis,  typhoid  fever,  etc.  But  such 
congestion  also  occurs  when  the  functions  of  the 
skin  are  seriously  interfered  with,  as  by  extensive 
burns,  or  more  commonly  by  chilling  of  the  sur- 
face, as  in  bathing,  exposure  to  cold,  etc. 

A  few  years  ago  a  young  man  consulted  me, 
saying  that  he  believed  he  was  passing  blood.  He 
had  been  to  a  swimming  bath,  and  after  returning 
home  noticed  his  urine  was  bloody.  This  was  on 
Saturday,  and  on  Monday,  when  I  saw  him,  the 
urine  contained  only  a  trace  of  blood.  By 
Wednesday  the  urine  was  normal.  This  patient 
told  me  that  his  brother  had  consulted  Dr.  A.  H. 
Carter  for  hematuria  following  exposure  to  wet 
after  playing  foot-ball. 

Passive  congestion.  Venous  engorgement,  con- 
sequent  upon    liver,  heart,  or   lung   disease,  may 


THE   CANADA  MEDICAL   RECORD. 


253 


cause  slight  hematuria.     The  condition  is   easily 
understood  and  readily  recognized. 

BrUjht's  Disease.  In  acute  nepliritis  more  or  less 
hemorrhage  occurs,  and  persists  throughout  the 
acute  stage.  The  diagnosis  depends  upon  the 
other  evidences  ol'  Brighl's  disease  ;  for  example, 
dropsy,  and  the  presence  of  epithelial  casts  in  the 
urine.  In  chronic  Bright's  disease  hemorrhage  is 
not  constant,  but  may  occur  at  any  time.  The 
amount  is  usually  moderate,  hut  in  rare  instances 
may  be  alarmingly  profuse  and  fatal.  The  recog- 
nition of  the  nature  of  the  case  depends  on  the 
l)resence  of  casts  in  the  urine  and  other  confirma- 
tory signs,  such  as  polyuria,  low  specific  gravity  of 
urine,  cardiac  hypertrophy,  high  arterial  tension, 
albuminuric  retinitis,  etc. 

Sijmplomatlc  Hematurin.  Hematuria  occurring 
in  connection  with  specific  diseases,  such  as  yellow 
fever,  malarial  fever,  and  cholera,  or  in  the  course 
of  blood  diseases,  such  as  purpura,  scurvy,  and 
leucocythemia,  depends  for  its  correct  diagnosis  on 
the  recognition  of  these  diseases,  each  of  which 
possesses  well-marked  sym])toms  and  definite 
clinical  relation.  But  this  is  not  the  case  with  hemo- 
globinemia,  which  demands  special  attention. 
This  condition  consists  essentially  in  the  dissolu- 
tion of  the  red  blood  corpuscles  in  the  body,  and 
the  presence  of  free  hemoglobin  in  the  liquor  san- 
guinis. Under  these  circumstances  the  hemoglo- 
bin escapes  through  the  Malpighian  tuft«,  and 
appears  in  the  urine.  The  determining  causes  of 
this  change  are  not  clearly  known.  Certain  poisons 
have  this  property  of  breaking  up  the  blood  cor- 
puscles by  direct  action  upon  them.  In  certain 
septic  condilions,- puerperal  fever,  pyemia,  etc., 
hemoglobinemia  occurs.  Physiologists  now  be- 
lieve, buc  it  is  not  formally  established,  that  the  red 
blood  corpuscles  are  broken  up  and  converted  in 
the  liver  into  bile  pigment.  It  is  supposed  that 
in  disease  this  process  is  interfered  with,  the 
destruction  taking  place  in  excess  of  the  power  of 
conversion,  or  the  process  stopping  short  at  the 
stage  of  destruction.  Paroxysmal  hemoglobinuria 
occurs  as  an  independent  disease. 

It  is  noteworthy  that  many  of  the  reported 
cases  of  hemoglobinuria  have  been  ascribed  in 
their  first  onset  to  a  fall  or  blow  on  the  back,  though 
a  chill  is  always  the  determining  cause  of  subsequent 
attacks.  The  disease  has  been  said  to  depend 
upon  syphilis,  but  in  what  way  is  not  explained. 
The  strongest  argument  in  favor  of  this  doctrine  is 
that  one  patient  lost  his  liability  to  attacks  on  anti- 
syphilitic  treatment.  But  the  force  of  this  is 
modified  by  the  knowledge  that  though  some 
cases  are  very  obstinate,  others  recover  of  them- 
selves. One  case  specially  is  known  to  me  in 
which  no  attack  has  occurred  for  several  years, 
though  no  special  treatment  has  been  followed, 
except  care  to  avoid  as  far  as  possible  exposure  to 
chills. 

It  is  worth  bearing  in  mind  that  albuminuria  is 
occasionally  persistent  in  these  cases,  and  Dr. 
Ralfe   believes    that    this  is  due  to   a   permanent 


inability  to  dispose  of  the  albuminous  material 
set  free  by  the  destruction  of  the  red  blood  cor- 
puscles. But  if  this  were  true  the  albumen  ex 
creted  should  be  globulin,  not  serum  albumen,  a 
suggestion  already  made  some  years  ago  by  .Sir 
William  Gull ;  and  I  have  endeavored  to  test  the 
truth  of  hypotliesis,  but  my  analysis  always  show- 
ed that  serum  albumen  was  jjresent  as  well  as 
globulin.  I  should  be  very  glad  to  see  this  point 
investigated  by  so  competent  a  chemist  as  Dr. 
Ralfe. 

Tiixic  Hcmntarui.  Hematuria  may  follow  the 
application  of  a  fly-blister,  or  the  internal  admin- 
istration of  cantharides.  The  latter  is  seldom 
practised,  but  the  drug  has  been  recommended  on 
quasi-homeopathic  ])rinciples  by  Dr.  Sidney  Rin- 
ger for  nephritis,  and  in  that  condition  I  have 
seen  it  even  in  one-minim  doses  cause  distinct 
hematuria.  When  given  for  criminal  purposes  the 
dose  is  usually  large,  and  the  hematuria  is  accom- 
panied by  strangury,  vomiting,  and  symptoms  of 
irritant  poisoning.  Turpentine  does  not  usually 
cause  heuiaturia,  though  the  readiness  with  which 
the  violet  odor  appears  in  the  urine  shows  that 
it  is  absorbed  and  excreted  by  the  kidney.  I 
have  had  one  very  interesting  example  of  hema- 
turia due  to  this  cause,  in  a  varnish  maker  who 
was  sent  to  be  examined  for  life  insurance.  He 
seemed  a  perfectly  healthy  man,  but  after  he  had 
gone  I  examined  his  urine,  and  found  it  contained 
a  little  albumen.  I  then  noticed  the  odor  of  vio- 
lets, and  closer  examination  showed  that  albumen 
was  due  to  the  pfgsence  of  blood.  There  were 
no  other  evidences  of  renal  disease,  but  there  was 
certainly  some  special  susceptibility  to  the  action 
of  turpentine,  as  this  gentlemen  informed  me  that 
he  was  not  personally  engaged  in  the  manufactur- 
ing process,  though  he  was  much  about  the  fac- 
tory. 1  tried  to  follow  up  the  case,  but  could  not, 
as  he  abandoned  the  proposal. 

Ndrcotic  and  vicarious  Hematuria.  I  have  no 
personal  experience  of  these  conditions.  Laycock 
(Nervous  Diseases  of  Women,  p.  229^  mentions 
hematuria  as  not  uncommon  in  hysteria,  but  I 
have  not  yet  recognized  a  case,  though  I  have 
certainly  met  with  one  or  two  cases  of  hematuria 
in  women  which  I  have  not  ventured  to  class  in 
this  paper.  Sir  W.  Roberts  mentions  menstrua- 
tion, hemorrhoids,  and  asthma  as  conditions  in 
which  vicarious  or  supplementary  hematuria 
occurs,  but  I  can  only  quote  him,  and  leave  the 
matter  without  further  comment,  as  I  have  never 
met  with  such  cases.  Dr.  G.  H.  .Savage  states  that 
hematuria  may  occur  spontaneously  in  acute  mania 
and  general  paralysis. 

Treatment  A  very  few  words  as  to  the  general 
treatment,  which  must  be  specially  regulated  in 
each  case  by  the  cause.  Undoubtedly  hematuria 
usually  passes  off  by  rest,  after  a  shorter  or  longer 
time,  independently  of  drugs.  But,  as  we  have 
seen,  there  are  persistent  cases  in  which  we  are 
bound  to  do  our  best,  and  ample  opportunity  is 
afforded  for  trying  all  known  remedies.     My   ex- 


254 


THE  CANADA  MEDICAL  REdOEO. 


perience  has  been  that  they  are  all  very  untrust- 
worthy, and  I  hesitate  to  give  the  preference  to 
any  one.  Acetate  of  lead,  ergot,  hamamelis,  gallic 
acid  and  perchloride  of  iron  should  have  a  fair  trial. 
In  hemoglobinuria  a  ten-grain  dose  of  quinine 
should  be  given  at  the  commencement  ot  the 
attack,  and  five  grains  three  times  a  day,  till  conval- 
escence is  established.  Chloride  of  ammonium, 
recommended  by  the  late  Dr.  Warburton  Begbie, 
has  never  been  followed  in  the  hands  of  others  by 
the  fortunate  results  he  obtained. — British  Medical 
Journal. 


REVIEW    OF   THE    RECENT    PROGRESS 
OF  ELECTRICITY. 

By    Charles    H.    Merz,    A.M.,    M.D.,    San- 
dusky, O. 

Columbus  Medical  Journal. 

The  object  in  writing  this  paper  is  to  give  a 
concise  outline  of  the  present  state  of  knowledge 
of  electro-therapeutics,  and  to  serve  as  an  article 
for  reference  on  the  subject. 

The  main  facts  concerning  the  application  of 
electricity  to  the  cure  of  disease  have  been  col- 
lected from  reliable  sources,  and  are  arranged  in 
alphabetical  order  without  any  unnecessary 
explanations. 

Particular  pains  have  been  taken  to  state  the 
strength  of  the  current  in  milli-amperes  whenever 
possible,  as  accurate  current  measurement  is 
absolutely  necessary  to  the  scientific  use  of 
electricity.  Many  writers  spealFof  using  twenty- 
five  and  thirty  cell  currents  about  the  brain, 
which  would  be  impossible  if  such  battery  were 
generating  the  current  it  should.  But  few 
patients  can  tolerate  a  current  of  more  than  two 
to  five  milli-amperes  about  the  head.  This  fact 
alone  would  make  it  desirable  that  a  definite 
strength  be  establi.shed  for  each  condition — thus 
making  the  dosage  of  electricity  uniform. 

The  strength  of  a  current  may  be  roughly 
estimated  without  a  milliampere  meter  by  placing 
the  needles  in  some  white  of  egg.  Robin  states 
that  a  current  of  45  milliamperes  causes  coagula- 
tion of  the  albumen  in  twenty  to  thirty  minutes. 
This  is  a  practical  test  that  can  be  made  under 
any  and  all  circumstances. 

Acne. — An  inflammatory,  usually  chronic, 
disease  of  the  sebaceous  glands,  characterized  by 
papules,  tubercles  or  pustules,  or  a  combination 
of  these  lesions,  occurring  for  the  most  part 
about  the  face  (Duhring). 

Bartholow  {Med.  Elec,  p.  228)  has  obtained 
good  results  from  the  use  of  galvanism  in  this 
and  many  other  affections  of  the  skin.  He 
stimulates  the  entire  surface  of  the  face,  paying 
little  attention  to  the  direction  of  the  current. 
A  current  of  2  to  3  m,illiamj)eres  is  found  most 
suitable.  After  the  immediate  effects,  which  are 
irritating,  have  passed  off,  the  skin  becomes 
pale   and    the   eruption    less   prominent.      One  J 


electrode  may  be  passed  over  the  face  while  the 
other  remains  on  the  nape  of  the  neck.  Fox 
uses  a  small  metal  button  applied  to  the  red 
blotches,  which  remain  after  evacuation  of  the 
contents  of  a  nodule.  In  acne  rosacea,  when 
dilated  blood  vessels  are  present,  treatment  with 
the  electrolytic  needle  has  given  good  results 
(Duhring  and  Stelwagen,  Am.  Si/s.  Med.,  page 
649).  The  positive  electrode  is  held  in  the  hand, 
and  a  fine  needle  attached  to  the  negative  is 
applied  to  the  small  vessels.  Two  to  six  milli- 
amperes  may  be  employed,  being  governed  by 
the  amount  of  pain  and  destruction  caused. 

Amauro.ns,  amblyopia,  anemia  of  the  optic 
disc,  and  other  diseases  arising  from  anesthesia 
of  the  retina,  have  yielded  excellent  results  under 
the  use  of  electricity.  Anemia  should  be  treated 
by  galvanism  and  hyperemia  by  faradism. 
Applications  should  be  made  directly  to  the 
eyes — the  anode  resting  on  the  closed  lids  and 
the  cathode  on  the  malar  bone  or  temple  (Bartho- 
low). A  current  of  two  milli-amperes  wil  lusually 
be  found  of  sufficient  strength.  It  may,  however, 
be  increased  until  faint  flashes  of  light  are  seen, 
but  should  not  be  continued  for  more  than  two 
or  three  minutes.  When  firadism  is  employed 
the  current  should  be  rapidly  interrupted  and  no 
stronger  than  is  comfortable. 

Amenorrhea. — May  be  either  an  interruption 
or  habitual  non-appearance  of  the  menstrual  dis- 
charge. May  occur  with  plethora,  from  distur- 
bance of  ovarian  or  uterine  function,  or  with 
anemia  and  debility.  The  greater  number  of 
cases  are  met  with  in  anemic  females. — {Harts- 
horn's Prac.  of  Med.')  Galvanism,  faradism  and 
franklinism  are  employed.  Electricity  is  espe- 
cially valuable  in  young  women,  where  the  men- 
strual function  is  not  fully  established,  on 
account  of  a  torpid  state  of  the  vaso-motor  nerves 
of  the  ovaries  and  uterus,  and  also  where  the 
catamenia  have  been  suppressed  after  labor,  or 
in  consequence  of  a  sudden  chill  or  emotion. — 
{Golding  Bird,  Quarterly  Epitome.) 

Antstliesiit. — May  arise  from  various  causes — 
lesions  of  the  brain  and  spinal  cord,  division  of 
a  nerve  supplying  a  certain  part,  the  results  of 
exhausting  diseases,  etc.  The  sense  of  touch 
may  remain,  and  the  sense  of  pain  be  lost,  or 
vice  versa.  When  sensory  functions  are  dimin- 
ished we  have  anesthesia  increased,  hyperesthesia. 
In  most  cases  removal  of  cause  is  the  principal 
element  in  the  cure.  The  faradic  current  is 
most  suitable.  Dry  the  skin,  and  dust  with  some 
drying  powder,  and  apply  the  current  by  means 
of  the  wire  brush  or  metal  electrode  for  about 
ten  minutes  daily.  The  stable  electrode,  well 
moistened,  should  be  applied  at  some  indifferent 
point.  A  strong  ascending  galvanic  current,  15 
to  25  milli-amperes,  may  do  good  where  there  is 
languid  circulation. 

Angioma. — Dr.  Alvarez  speaks  favorably  of 
electricity  in  the  treatment  of  angioma.  The 
positive    electrode  is    plunged   into    the  tumor, 


THE   CANADA   MEDICAL   RECORD. 


255 


whilst  the  negative  is  moved  about  over  the  mass 
externally,  or  as  near  to  it  as  possible.  He  gives 
good  results  in  a  large  number  of  cases.  The 
current  strength  may  vary  between  lo  and  40 
milli-amperes,  according  to  the  sensations  and 
effects  jiroduced. 

Aneurism. — In  the  treatment  by  electrolysis 
coagulation  is  the  end  sought.  For  aneurisms 
of  any  size,  both  poles  and  a  large  number 
of  needles  that  are  insulated  should  be  used. 
Strength  of  current,  about  45  milli-amperes. 
Current  should  be  allowed  to  How  for  some 
minutes. — {Bcfinl.)  The  advantage  in  using  two 
needles  is  that  a  double  clot  is  formed  and  the 
resistance  is  less.  Cisnicelli  records  37  cases  of 
aortic  aneurism  with  6  cures.  Petit  gives  114 
cases  of  thoracic  aorta,  with  96  benefitted,  38 
deaths  and  45  failures.  Robert  Abbe  uses  coils 
of  wire,  inserted  in  the  aneurism  after  Barwell's 
method.  The  galvanic  current  is  allowed  to 
flow  through  the  wire.  The  reason  there  are  so 
few  good  results  is  that  operative  procedures  are 
delayed  until  the  sac  is  almost  ready  to  burst. 
Coagulation  is  more  certainly  secured  by  this 
method  than  by  catgut  or  horsehair  alone.  No 
su]jpuration  or  embolism  ensues,  and  a  firm  clot 
is  formed. 

Asthma. — Probably  a  purely  functional  neu- 
rosis, as  the  organs  present  no  characteristic 
anatomical  changes.  In  cases  of  long  standing, 
the  evidences  of  chronic  catarrh  are  due  to  the 
secondary  affections.  Owing  to  its  neurotic 
origin,  Eade  {Brit.  Med.  Jour.)  recommends 
galvanization  of  the  neck.  One  pole  is  placed 
just  below  the  angle  of  each  jaw  and  in  front  of 
the  sterno-cleido-niastoid.  I  have  been  unable 
to  ascertain  the  exact  strength  of  current  em- 
ployed, but  he  uses  one  strong  enough  to  be  felt, 
probably  20  milli-amperes  would  be  sufficient. 
Bartholow  (vl/crf.  Elec.)  recommends  systematic 
galvanism  in  the  intervals  between  the  seizures. 
Ranney  recommends  drawing  of  sparks  from  the 
anterior  and  posterior  surfaces  of  the  chest  by 
means  of  the  static  machine  {Elec.  in  Medicine). 
The  induced  electrical  current  has  been  used  by 
Schaeffer  as  a  means  of  cutting  short  the  par- 
oxysms. Place  one  pole  at  the  angle  of  each  jaw 
in  front  of  the  sterno-mastoid,  so  as  to  cover  the 
course  of  the  pneumogastric  and  sympathetic  ; 
the  current  strong  enough  to  be  felt  passing 
through  the  neck.  Apply  15  minutes  twice  a 
day  for  six  days,  twelve  sittings  usually  affording 
relief.  At  first  there  may  be  dilatation  of  the 
pupils,  but  this  is  followed  by  contraction  as 
improvement  follows.  (^Geddiiigs,  Am.  Sys.  Mid., 
vol.  Hi.) 

Breast,  tumors  of — Under  this  head  are  classed 
such  growths  as  are  not  carcinomatous,  chronic 
mammary  tumor  (adenoma),  cysts,  fibromata, 
enchondromata,  osteomata.  Galvanism  is  the 
current  most  suited  tc5  the  treatment  of  these 
tumors.  It  is  essential  to  successful  treatment 
that  they  be  discovered  early,  while   yet  small. 


Surface  ajiplications  are  indicated.  Large,  soft, 
well  moistened  electrodes  should  l)e  applied  to 
both  sides  of  the  tumor,  and  so  ])iaced  as  to 
permeate  mainly  in  the  direction  of  the  axilla. 
A  current  ranging  from  10  to  50  milli-amperes 
may  be  used  at  each  seance.  No  exact  rule  can 
be  laid  down,  as  the  resistance  varies  greatly. 
Of  186  tumors  treated  after  this  manner  by  Dr. 
Garret,  of  Boston,  157  disappeared  entirely  and 
permanently. 

Bullets,  detection  of — Instruments  necessary, 
telephone,  suitable  shaped  metal  probes,  insu- 
lated nearly  to  the  tips,  and  a  small,  steel  ball 
with  necessary  connecting  cords.  In  the  appa- 
ratus as  jjerfected  by  Dr.  J.  H.  Girdner,  of 
Boston,  no  battery  is  used,  the  patient's  body 
being  made  to  furnish  the  current.  The  ear- 
phone is  flat  in  shape,  and  is  held  in  apposition 
to  the  surgeon's  ear  by  an  elastic  head  band  or 
metal  frame,  thus  leaving  both  hands  free  for 
work.  One  pole  of  the  magnet  in  the  receiver  is 
connected  with  a  small,  steel  ball,  which  the 
patient  holds  in  his  mouth  and  the  other  end  to  the 
probe.  The  probe  when  passed  into  sinuses  or 
bullet  tracks  gives  no  sound  unless  it  comes  in 
contact  with  some  metallic  substance,  when  the 
current  is  completed  and  a  decided  "  click"  is 
heard  in  the  instrument.  The  telephonic  probe 
is  destined  to  play  an  important  part  in  the 
department  of  surgery,  as  it  is  sensitive,  reliable, 
and  at  the  same  time  compact  and  inexpensive. 
Any  telephone  constructed  on  the  Bell  prin- 
ciple (electro-magnet  and  metallic  diaphragm) 
will  serve  to  transinit  the  sounds  to  the  ear. 
{Vide  Ganot's  Physics,  p.  884.) 

Cataract. — Recent  advances  in  electro-thera- 
peutics have  led  to  the  use  of  the  current  in  this 
affection.  The  action  of  electricity  is  three-fold 
— mechanical,  tonic  and  catalytic  ;  tonic  from 
its  action  on  the  sympathetic  and  pneumogastric, 
catalytic  from  its  electrolytic  action.  "  In  all 
cases  in  which  the  disease  is  progressive,  as 
indicated  by  the  fat  granules  and  nebulje,  where 
electricity  is  well  borne,  where  the  choroid  and 
retina  are  not  greatly  degenerated,  and  where 
there  is  no  complication  of  cirrhosis  of  the 
kidneys  or  liver,  diabetes  or  organic  disease  of 
heart  or  lungs,  improvement  may  be  expected." 
The  negative  electrode  should  be  placed  on  the 
eye,  and  the  positive  on  the  nape  of  the  neck, 
jaw  or  stomach.  A  current  of  two  milli-amperes 
will  be  sufficient  for  most  cases,  though  no  rule 
can  be  laid  down.  This  may  cause  vertigo.  A 
current  of  this  strength  may  be  applied  for  five 
or  six  minutes  daily.  Faradic  current,  negative 
to  the  nape  of  the  neck  or  in  the  hand  of  the 
patient,  and  positive  to  the  eye,  by  means  of  a 
moist  sponge  or  the  fingers.  Use  a  weak  current 
for  five  or  ten  minutes  daily. — {Kidder.) 

Cord,  Spinal. — Acute  inflammatory  conditions 
should  not  be  treated  with  electricity.  When 
the  disease  has  assumed  a  chronic  type,  galvanism 
is   of  more    service  than   the  faradic    or  static 


256 


THE   CANADA   MEDICAL   RECORD. 


currents,  probably  on  account  of  the  depth  of 
tissue  affected.  The  various  compHcations  of 
the  disease,  rectal  and  vesical  irritations,  inci- 
pient caries,  paralysis,  etc.,  may  often  be  greatly 
relieved  by  galvanism.  The  current  strength 
varies  from  five  to  eight  milli-amperes,  and  the 
applications  should  be  made  daily.  Occasion- 
ally a  current  of  twelve  milli-amperes  will  be 
found  necessary  in  chronic  cases.  Points  of 
tenderness  should  be  sought  and  galvanized 
separately. 

Fibroids. — From  July,  '82  to  July  '87,  Apostoli 
made  5,201  applications  of  the  continuous 
galvanic  current  for  the  following  affections : 
Fibroids  of  the  uterus,  polypi,  entire  or  partial 
hypertrophy  of  the  uterus,  subinvolution,  acute 
and  chronic  endometritis,  ulceration  of  cervix, 
periuterine  inflammation,  ovaralgia,  ovaritis, 
salpingitis,  tubular  cysts,  atresia,  and  hematocele. 
The  5,201  applications  were  made  on  403 
patients.  Of  these  he  lost  two,  and  had  ten 
phlegmons,  which  he  excited  or  aggravated. 

FisHdit.  A7utL — Ciniselli  reports  a  case  in 
which  all  manner  of  cauterization  had  been 
employed.  An  elliptical  ulcer  was  found  on  the 
right  margin  of  the  anus  one  and  one-half  inches 
square.  He  cauterized  it  superficially  with  a 
current  of  fifteen  milli-amperes  for  fifteen  min- 
utes, with  the  result  that  in  one  week  there  was 
less  pain  and  tenderness,  and  cicatrization  had 
commenced.  One  week  later  cicatrization  was 
complete  and  all  pain  gone.  Numerous  cases  of 
a  similar  nature  have  been  reported,  establishing 
the  value  of  electricity  in  this  condition. 

Galvanization.' — Central. — Dr.  Beard  recom- 
mends that  the  cathode  be  placed  over  the  epi- 
gastrium. The  anode  is  to  be  stroked  over  the 
forehead,  with  a  current  of  about  two  milli- 
amperes,  for  two  minutes ;  then  to  the  cranium 
for  two  minutes  ;  afterward  moved  up  and  down 
the  neck  for  a  like  length  of  time. and  finally  applied 
up  and  down  the  spine  for  about  ten  minutes. 
This  method  gives  excellent  results  in  the  various 
forms  of  nervous  dyspepsia,  gastralgia,  hysteria, 
hypochondriasis,  etc.  When  the  current  is  trans- 
ferred from  the  brain  to  the  spine  it  may  be 
increased  somewhat — running  up  to  five  and 
eight  milli-amperes. 

Hematocele  of  tunica  i^aginalis — Apostoli  re- 
commends galvano  puncture  as  being  quick  and 
exerting  a  surgical  and  medical  effect. 

Hemorrhage — Post-partum.  —  It  is  possible  by 
means  of  the  faradic  current  to  keep  up  contrac- 
tions of  the  uterus  for  hours.  One  electrode  may 
be  applied  at  the  symphisis  pubis  and  the  other 
moved  about  over  the  abdomen. 

Hernia. — But  few  cases  of  the  application  of 
electricity  to  this  condition  are  recorded.  Dr. 
Craft,  of  Cleveland,  reports  a  case  in  which  a 
needle,  properly  insulated  except  at  the  point  and 
attached  to  the  positive  pole,  was  introduced 
subcutaneously  between  the  external  and  internal 
rings  and  a  current  sufficient  to  e.xcite  adhesive 


inflammation  allowed  to  pass.  Care  must  be 
taken  to  keep  the  needle  external  to  the  peri- 
toneum and  not  to  injure  the  cord.  The  operation 
resulted  in  a  cicatricial  sealing  of  the  inguinal 
canal. 

Hydrocele. — Excellent  results  have  been  ob- 
tained by  electrolysis  by  Rodolfi,  Erhardt,  Frank, 
and  Bartholow.  Two  insulated  needles  are  intro- 
duced into  the  sac  and  brought  within  half  an 
inch  of  each  other,  when  the  current  is  turned  on. 
Signer  Macario  (6'ck.  Med.  Ital.  Lombard  No.  36) 
reports  two  cases  cured  by  the  single  application 
of  a  current  one  minute.  In  both  cases  the  fluid 
disappeared  entirely  in  24  hours,  though  no  fluid 
escaped  from  the  needle  puncture.  A  current  of 
20  to  30  milli-amperes  may  be  used,  being  guided 
largely  by  the  sensations  experienced  by  the 
patient. 

Hypertrichosis. — Place  patient  in  a  suitable 
position  and  light.  Have  a  suitable  galvanic 
battery.  Moistened  sponge  electrode  attached  to 
the  positive  pole  and  a  platino-iridium  needle  or 
jeweler's  brooch  attached  to  the  negative  by 
means  of  a  suitable  handle.  The  needle  is 
inserted  as  near  as  possible  into  the  hair  follicle 
and  the  circuit  completed.  After  a  sufficient 
length  of  time  the  circuit  is  opened  and  the  needle 
withdrawn.  The  hair  is  permanently  destroyed. 
Hays  (iSV.  Louis  Med.  and  Surg.  Journal)  uses  5 
to  10  zinc-carbon  cells  and  a  cambric  needle, 
allowing  the  current  to  flow  1510  seconds.  Hard- 
away  (  Phil.  Med.  Times)  used  8  cells  and  a  No. 
13  cainbric  needle.  Fox  {N'.Y.  Med.  Record) 
prefers  10  to  16  cells  of  zinc  carbon  battery  and 
fine  flexible  steel  needle.  Amory  {Boston  Med. 
and  Surg  Journal)  thinks  a  fine  gold  needle  the 
best  and  20  seconds  sufficient  as  to  current 
strength.  Lusgartin  (Wein.  Meiz.  Wochensehi/t.) 
uses  yi  to  I  milli-amperes  from  20  to  30  seconds. 
Michelson  (Xiertel  Jahrschri/t.  fuer  Dcrmatolgie) 
used  3  milli-amperes.  Baratoux  required  5  to  8 
milli-amperes,  and  Brocq  needed  from  10  to  25 
milli-amperes.  I  have  found,  after  a  large  num- 
ber of  experiments,  that  a  jeweler's  fine  brooch  is 
the  most  suitable  needle,  and  that  a  current  of  3 
milli-amperes  for  30  seconds  is  sufficient  to  des- 
troy the  coarsest  hair,  while  one  rarely  needs  a 
current  greater  than  2  milli-amperes  if  continued 
long  enough. 

Lidiiction  Balance. — Principle  first  applied  by 
Babbage,  Hershell  and  Dove.  The  instrument 
devised  by  Prof  Hughes  ( FiVZe  Ganot's  Physics, 
p.  848.)  is  the  most  complete,  and  offers  to  the 
physicist,  or  physician,  a  powerful  instrument  of 
search.  The  apparatus  consists  of  two  primary 
coils,  each  containing  200  meters  of  No.  32  .«ilk- 
covered  copper  wire,  and  two  secondary  coils,  all 
four  being  exactly  alike.  The  two  primary  ( oils 
are  joined  in  series  with  a  battery  of  three  or  four 
Daniell's  cells,  in  which  a  microphone  is  also 
inserted  ;  the  current  being  broken  by  the  ticking 
of  a  small  clock.  The  secondary  coils  are  con- 
nected with  a  telephone  in  such  a  manner  that 


int   CANADA  MEDICAL   RECORD. 


25? 


their  action  upon  it  is  opposed.  In  winding  the 
coils  it  is  found  ahnost  impossible  to  get  an  exact 
balance.  Adjustment  between  the  secondary 
and  primary  coil  is  made  by  a  micrometer  screw. 
When  this  is  accomplished  there  is  silence  in  the 
telephone,  but  if  any  metal  is  introduced  in  one  of 
the  secondary  coils  a  sound  is  heard  at  once. 
This  princi])le  has  been  made  use  of  in  the  detec- 
tion of  metallic  substances  buried  in  tiie  body; 
but  while  the  substance  is  always  detected,  it  is 
not  accurately  located,  and  the  resiilts  from  the 
use  of  the  instrument  have  not  been  of  the  most 
satisfactory  nature. 

Intestlwd  Obstruction. — In  invagination,  faradic 
currents  have  effected  cures.  Cases  are  reported 
by  Bucquoy  {Jaur.  de  Therapeutique)  and  by 
Ballouhey  {These  de  Paris)  of  cures  by  the 
galvanic  or  faradic  currents.  In  the  use  of  the 
galvanic  current  peristalsis  is  probably  started 
from  the  point  of  application,  while  faradism 
probably  acts  by  forcibly  contracting  that  part  of 
the  canal  reached  by  the  current,  and  the  con- 
sequent traction  exerted  upon  the  invaginated 
portion  {Bartliolw),  One  pole  should  be  placed 
in  the  rectum  and  the  other  passed  over  the 
abdomen.  Direction  of  the  current  is  unimpor- 
tant. 

Lactation. — The  faradic  current  has  given  good 
results  in  undeveloped  glands  after  parturition. 
In  one  case  reported  by  Aubert  (^London  Med. 
Record)  two  applications  gave  a  free  supply.  The 
static  spark  is  recommended  as  being  more 
reliable,  but  faradism  will  do  well.  Both  breasts 
should  be  included,  and  the  treatment  should  be 
instituted  promptly  to  be  successful.  Becquerel 
relates  a  case  of  a  young  woman  who,  after  eight 
days  suppression,  was  able  to  nurse  her  baby, 
and  in  whom  the  quality  of  milk  was  improved. 
Pierron  relates  a  large  number  of  cases  in  his 
practice  in  which  electricity  either  re-established 
the  function  after  suppression,  or  induced  it  when 
absent  after  normal  labor.  In  my  own  practice 
I  have  found  galvanism,  a  current  strength  of 
four  to  six  milli  amperes,  and  faradism  alternately 
to  be  a  very  satisfactory  method  of  treatment. 
The  anesthesia  usually  present  rapidly  decreases 

Larynx,  Papilloma  of — May  be  successfully 
removed  by  means  of  the  galvano-cautery.  It 
is  well  to  produce  local  anesthesia  by  means  of  a 
strong  solution  of  cocaine.  The  cautery  point 
should  be  at  a  white  heat,  and  placed  in  situ 
before  the  current  is  turned  on.  The  amount  of 
battery  power  required  for  any  particular  elec- 
trode may  be  ascertained  beforehand.  Leave 
electrode  in  contact  with  the  growth  for  a  few 
seconds  only.  In  a  few  days  the  growth  will 
drop  off  if  properly  cauterized. 

Livtr,  hydatid  cysts  of. — Capillary  electrolysis 
is  recommended  as  one  of  the  new  methods  of 
treatment.  In  this  method,  the  needle  is  repla- 
ced by  a  canula  which  remains  free.  There  is 
no  pain.  By  the  partial  coagulation  of  the  fluid, 
a  more  efticient    chemical    action  takes  place. 


During  the  passage  of  the  current,  it  permits  of 
the  escape  of  the  gaseous  froth.  It  destroys 
the  hydatids  and  changes  the  living  into  an 
indifferent  substance  which  solidifies  and 
retracts.  Finally  it  obtains  the  cure  of  the  cyst 
without  subjecting  the  patient  to  a  serious 
ojjeration.  (M.  H.  Heurot,  Jour,  de  Med.  de 
Paris,  Oct.  II,  '82.) 

Lupus  vulgaris. — The  ulcer  and  surrounding 
integmnent  should  be  washed  carefully  with  soap 
and  water.  The  application  may  be  made  by 
means  of  a  flat  silver  plate,  set  in  a  rubber  ring 
to  prevent  action  on  the  healthy  tissues.  This 
is  attached  to  the  negative  pole.  A  current  of 
from  5  to  10  milli-amp6res  is  employed  for  ten 
or  fifteen  minutes.  In  this  manner  the  electro- 
lytic action  is  confined  to  the  diseased  parts. 
Under  the  influence  of  the  current,  the  lupus 
nodules  become  excoriated  and  swollen,  and  give 
vent  to  a  clear,  watery,  sticky  fluid.  After  a  few 
hours  they  sink  out  of  sight.  They  may  be 
dressed  in  iodoform  for  eight  or  ten  days.  The 
result  is  a  pigmented  cicatrix.  This  method  of 
treatment  is  applicable  to  the  ulcerating  and  non- 
ulcerating  forms.  {Vide  Weiner  Med.  Wochen- 
schrift,  Nos.  27,  28.) 

Metritis  and  Endometritis. — Metritis,  hyperpla- 
sia of  the  connective  tissue  of  the  uterus  combi- 
ned with  increased  sensibility.  In  a  paper  by 
Apostoli  (Jour.  Am.  Med.  Assoc,  Vol.  8,  No.  19), 
the  application  of  electricity  in  these  conditions 
is  fully  treated.  A  medical  galvanometer  for 
intensity  divided  into  milli-amperes  should  be 
included  in  the  circuit.  Of  permanent  batteries, 
the  Leclanche  cell  is  recommended.  The  intra- 
uterine electrode  should  be  large  enough  to  reach 
all  parts  of  the  uterine  cavity  and  have  a  glass 
muff  to  i)rotect  the  vagina.  The  electrode  should 
be  of  ijlatinum.  A  neutral  or  insensible  electrode, 
which  is  applied  to  the  abdomen,  allows  of  the 
use  of  the  intense  current  without  pain  or  heat. 
The  cords  should  be  of  good  conducting  material. 
Precede  the  applications  with  a  vaginal  antiseptic 
injection.  "  Singe  and  disinfect  "  the  electrode 
and  introduce  it  carefully  with  the  current  turned 
on.  Cauterize  the  cavity  thoroughly  in  all 
hemorrhagic  cases,  less  thoroughly  in  others, 
.^fter  two  or  three  applications  the  intensity  must 
be  increased,  reaching  100  to  200  milli-amperes. 
Apply  for  five  or  ten  minutes.  These  applica- 
tions should  be  made  every  week,  and  every 
second  day  if  necessary,  and  should  be  followed 
by  a  rest  of  several  hours  in  bed.  This  treat- 
ment, it  is  claimed,  induces  a  new  form  of  intra- 
uterine mucous  membrane  and  forms  an  intra- 
uterine exudation. 

Myoma. — Martin,  in  a  paper  read  before  the 
Ninth  International  Congress,  speaks  of  the 
treatment  of  myoma  by  electricity.  Local  effects 
of  the  poles  should  be  borne  in  mind.  I.e.,  that 
acids  collect  at  the  positive  and  alkalies  at  the 
negative.  A  current  possessing  intensity  rather 
than  volume  is  desired.     The   current  exercises 


258 


THE  CANADA  MEDICAL  RECORD. 


an  atrophic  effect — not  electrolytic  action  alone, 
that  produces  the  desired  end.  The  elements 
being  separated  an  electrolytic  action  takes  place 
and  absorption  follows.  Caustic  effects  are  not 
desired  and  there  is  no  galvano-puncture  as  in 
Apostoli's  treatment.  A  current  of  more  than 
loo  milli-amp6res  is  never  used.  This  method 
of  treatment  is  claimed  to  be  devoid  of  danger, 
painless,  checks  hemorrhage,  reduces  the  size  of 
the  tumor  and  admits  of  accurate  dosage.  (3Ied. 
News,  Vol.  51,  No.  2.) 

(To  he  continued.^ 


THE    THERAPEUTICAL  VALUE   OF  BIS- 
MUTH  SALICYLATE. 

Dr.  Hale  (Polyclinic)  says  : 

In  an  experience  extending  over  two  years, 
with  its  use  in  treatment  of  inflammatory  affec- 
tions of  the  gastro-intestinal  tract,  seldom  has  it 
failed  to  accomplish  the  desired  result  and  per- 
manently cure  the  disease.  In  severe  cases  of 
diarrhea  occurring  in  phthisical  patients,  I  have 
effected  diminution  in  the  number  of  stools  by 
half  dram  doses  of  the  drug  at  intervals  of  two 
hours,  reducing  the  amount  of  the  dose  on  the 
amelioration  of  the  symptoms.  In  cholera 
morbus,  after  the  cause  has  been  removed,  this 
agent  will  reduce  the  existing  inflammation  and 
induce  a  cessation  of  the  morbid  action. 

In  dysentery,  acute  in  character  and  of  the 
sporadic  variety,  it  has  proved  efficacious  when 
full  medicinal  doses  have  been  administered, 
allaying  the  disorder  with  great  rapidity. 

The  diarrhea  accompanying  enteric  fever, 
especially  in  children,  I  have  been  able  to  con- 
trol by  its  use,  when  other  well  known  remedies 
for  this  disorder  had  failed.  If  impossible  to 
administer  by  the  mouth,  an  enema  may  be  em- 
ployed, but  in  that  case,  the  amount  should  be 
double  that  given  by  the  month  ;  and  it  should 
always  have  a  small  amount  of  opium  adminis- 
tered with  it. 

In  dyspepsia,  with  acid  eructations  and  pyro- 
sis, with  a  feeling  of  heaviness  at  the  stomach 
after  the  ingestion  of  food,  bismuth  salicylate,  in 
combination  with  simple  bitters,  soon  tones  up 
the  organ  and  relieves  the-  disorders.  Recently, 
Dr.  James  Ware,  of  Lake  Charles,  La.,  commu- 
nicated to  me  the  following  cases  in  which  he 
had  found  the  preparation  useful  : 

ist.  Female,  set.  forty-five,  dysentery.  At  the 
end  of  five  days  of  treatment  with  opium  and 
so  on,  I  gave  :  R. — Bismuth  salicyl.,  gr.  c;  bismu- 
thi  subnit.,  gr.  c.  M.  Ft.  pulv.  No.  vj.  div. 

Gave  one  powder  every  three  hours.  The 
woman  was  entirely  relieved  in  twelve  hours. 

2nd.     Female,    st.    twenty-three,    dysentery. 


Gave  salicylate  as  above,  also  by  enema,  thus  : 
R. — Bismuthi  salicyl.,  gr.  cc;  glyceriuEe,  f  3  j  ; 
aquK,  f  3  vj.  M.  Big. — f  3  i,  in  three  ounces  of 
tepid  water,  after  each  stool. 

Woman  was  well  in  forty-eight  hours. 

3rd.  Child,  ffit.  three ;  never  fully  recovered 
from  an  attack  of  cholera  infantum  last  summer. 
Relieved  by  salicylate  in  eight  grain  doses. 

4th.  Male,  jet.  twenty-five  ;  periodical  fermen- 
tation of  contents  of  bowels  every  ten  or  twelve 
days  for  a  year.  Relieved  now  at  the  beginning 
of  every  attack,  by  fifteen  grains  each  of  the 
bismuth  salicylate  and  subnitrate. 

5th.  Female,  jet.  twenty ;  pruritus  vulvae. 
Suffered  terribly  for  several  days.  Used  corro- 
sive sublimate,  carbolic  acid,  and  other  remedies 
with  no  benefit ;  then  employed  :  R. — Bismuthi 
salicyl.,  gr.  c;  aquse,  f  f  iv. 

As  a  vaginal  injection  ;  relief  instantly. 

6th.  Female,  aet.  fifty-six.  Fermentation  of 
contents  of  stomach  and  bowels  every  ten, 
twenty  or  thirty  days  for  twenty  years,  accom- 
panied with  violent  pain  and  frequent  discharges 
of  acid  mucus.  Relief  generally  came  in  from 
thirty  to  seventy-two  hours.  In  the  midst  of  an 
attack  I  gave  ten  grains  of  salicylate,  and  subni- 
trate, with  immediate  relief.  She  has  taken  this 
amount  night  and  morning  for  thirty  days,  with 
no  return  of  the  disease. 

The  preparation  of  this  drug  I  have  used  is  a 
pure  white,  very  flocculent  and  light  material. 
In  beginning  the  treatment  of  any  inflammatory 
affection  of  the  alimentary  canal,  full  and  decided 
doses  should  be  administered,  and  subsequently, 
when  decrease  in  the  severity  of  the  symptoms 
takes  place,  the  amount  may  be  lessened.  It 
severe  cases  occurring  in  children,  I  never 
commence  treatment  with  a  dose  less  than  five 
to  eight  grains. 

The  formula  I  prefer  in  cholera  infantum  and 
many  other  diarrheal  disorders  in  children  is  the 
following  :  R. — Bismuthi  salicyl.,  3  ij-;  tr.  capsici., 
gtt.  xij.;  spts.  amnion,  aromat.,  f  3  iss.:  pulv. 
acacias,  3  ij.;  aq.  cinnamoni,  q.  s.  ad.,  f  3  ij.  M. 
Sig — Teaspoonful  every  two  hours,  for  a  child 
from  three  months  to  one  year  of  age. 

In  the  adult  I  prefer  to  use  the  preparation  in 
powder,  or  combined  with  some  other  astringents, 
as  tannic  acid,  acetate  of  lead,  etc.  With  the 
bismuth  salicylate  it  is  possible  in  many  instances 
to  entirely  dispense  with  an  opiate,  and  this  I 
always  endeavor  to  do  if  possible. 

The  beneficial  action  of  this  drug  is  undoubt- 
edly due  to  the  antiseptic  power  of  the  salicylic 
acid  as  much  as  the  astringent  properties  of  the 
bismuth.  In  many  cases  of  vomiting  it  will  con- 
trol it  if  given  in  five  grain  doses,  also  in  preg- 
nant women  the  vomiting  in  many  instances 
may  soon  yield  to  the  action  of  this  preparation, 
and  its  return  to  any  great  extent  will  be  preven- 
ted by  its  continuance  in  small  and  frequently 
repeated  doses. 


TilE  CANADA   MEDICAL   RECORD, 


259 


PEPPERMINT   WATER    IN    PRURITUS 

PUDENDI. 
Dr.  Amand  Routh  calls  attention  to  the    value 
of  pepiJermint  water  in  pruritus  pudendi.     Injiru- 
rilus,  due  to  i)ediculi,  ascaridcs,  an  irritable  urethral 
caruncle,  an  endocervical  polypus,  early  cancer  of 
the   cervix,   distension   of    Eartholini's    ducts    or 
glands,  the  leucorrhcea  of  vaginitis,  endocervicitis, 
and  metritis,  or  the  irritating  discharges  of  advan- 
ced carcinoma  uteri,  or  to  a  gouty  or  diabetic  dia- 
thesis, peppermint  water  excels  all  others,  cocaine 
inclusive,  in  affording  relief,  whilst  endeavors   are 
l)eing  made  to  remove  the  cause.     The  agent  here 
alluded   to  is  peppermint  water   used  as   a  lotion. 
The    B.  P.  preparation  answers  well,  but  is    bulky 
for  carrying  about,  and  is  incapable  of  concentra- 
tion unless  rendered  alkaline.     This  is  best  done 
by  borax,  as  being  in  itself  soothing  and  antisep- 
tic.    Patients  can  easily  make  their  own  lotion,  as 
required  for  use,  by  putting  a  teaspoonful  of  borax 
into   a  pint  bottle  of  hot  water,  and  addmg  to  it  5 
drops   of  oleum  menthse    piperita;,  and    shaking 
well ;  the  parts  affected  to  be  freely  bathed  with  a 
soft  sponge.     If  no  cracks  or  sores  are  ]3resent,  this 
lotion  will  remove  the  itching;  but  if  there  be  eczema 
or   a   rawness  from    scratching,  it  is    inapplicable. 
Olive  oil,  with  5.  grs.  of  iodoform  to  the  ounce,  is 
then  more  useful.     The  greatest  and  most  perma- 
nent relief  is  afforded  in  the  neurosal  form,  especi- 
ally in  the   pruritus     which     often    accompanies 
pregnancy.     It  is  also   very  useful  in   the  pruritus 
which    occurs    at    the  climacteric,  or    in  elderly 
women,    in    whom  it   may    be  only    part    of    a 
general  pruritus,  and  also  in  those  cases  of  women 
of  all  ages,  where  the  urine  simultaneously  becomes 
of  very  low  specific  gravity  without  any   evidence 
of  having  a  gouty  or  granular  kidney  as  a   remote 
cause. — Brit.  Med.  Jour.,  April  14,  iS88. 


ELECTRICITY  IN  THE  TREATMENT  OF 
FIBROIDS  OF  THE  UTERUS. 

(By  Maria  B.  Werner,  M.D.,  Philadelphia,  Pa.) 
The  use  of  electricity  in  the  treatment  of  fibroids 
has,  until  within  later  years,  been  more  or  less  in 
the  hands  of  charlatans,  their  accidental  good 
results  induced  many  inquiring  and  scientific 
minds  to  investigate  its  therapeutical  value,  and 
endeavor  to  place  it  before  the  profession  as  an 
agent  whose  known  quantities  produce  definite 
results.  While  this  latter  still  presents  many 
sides  for  improvements,  all  will  agree  that  a 
steady  advance  has  been  made  in  this  study. 

About  1870,  Dr.  Cutter  began  to  use  the 
galvanic  current  for  uterine  fibroids.  The  patient 
was  placed  under  the  influence  of  an  anes- 
thetic, and  the  electrodes  were  introduced 
through  the  abdomen,  deeply  into  the  growth 
(three  to  four  inches),  but  not  allowed  to 
approach  each  other.  The  application  lasted 
from  three  to  fifteen  minutes,  the  operator  being 
guided  by  the  systemic  symptoms.  The  inter- 
vals were  usually  from  one  week  to  a  fortnight, 
IjUt  it  has  been  repeated  everyday  for  one  week. 


In  the  February  number  of  the  American  Journal 
of  Ohstetrics  for  1887,  Dr.  Cutter  has  given  a 
statistical  re])ort  of  fifty  cases ;  eleven  cured, 
three  relieved,  twenty-five  arrested,  seven  not 
relieved,  and  four  fatal.  These  results  may  seem 
encouraging,  but  the  method  seems  not  entirely 
free  from  danger,  almost  the  first  thought  being 
a  possible  wounding  of  the  intestines  or  bladder  . 
and  while  this  might  be  avoided  by  careful  per' 
cussion,  the  chances  for  a  sharp  attack  of  peri- 
tonitis seem  to  require  courage  as  an  indispens- 
able factor. 

In  1S78,  Dr.  Semeleder  modified  Mr.  Cutter's 
treatment  by  using  one  puncture  through  the 
abdomen,  the  other  being  thrust  either  through 
the  vagina  or  rectum  into  the  tumor.  The 
treatments  lasted  five  minutes,  and  were  repeated 
from  every  seven  to  fifteen  days.  There  were 
reported  at  that  time  fifty  cases,  thirty-four  of 
these  Avere  ameliorated  ;  in  a  certain  number  the 
tumor  disappeared  completely.  In  sixteen,  pro- 
gress was  not  arrested,  while  four  cases  proved 
fatal  from  peritonitis. 

In  1879,  Drs.  Martin  and  Cheron  reported 
four  cases  in  which  they  had  used  the  continuous 
current.  One  pole  on  the  neck  of  the  uterus,  the 
other  placed  upon  the  abdominal  wall.  They 
claimed  that  an  uninterrupted  continuous  current 
rapidly  diminished  the  size  of  a  fibroid  tumor, 
but  would  not  make  it  disappear  entirely  in  less 
than  two  and  a  half  years.  They  also  noted 
that  the  hemorrhages  were  much  diminished. 

In  1881,  M.  Gallard,  with  his  pupil,  Dr. 
Pegoud,  studied  the  action  of  the  continuous 
current  on  fibroid  uteri,  using  an  instrument 
resembling  a  sound  with  an  olive-shaped  tip  of 
platinum.  This  was  introduced,  if  possible,  into 
the  cervical  canal ;  otherwise  it  was  simply  placed 
upon  the  neck,  the  tip  being  protected  by  a 
sponge.  The  other  pole  was  connected  with 
copper  plates,  covered  with  chamois  skin  dipped 
into  a  saline  solution,  these  were  placed  upon 
the  abdomen. 

Their  observations  differed  from  all  the  pre- 
vious ones,  in  that  the  hemorrhages  were  not 
arrested  or  diminished,  that  the  menstrual  period 
always  appeared  a  few  days  too  soon  ;  the  other 
results  were  also  negative.  This  was  discussed 
by  Dr.  Onimus,  who  thought  it  due  to  the  use  of 
too  many  (elements)  cells — fifteen  having  been 
used  by  the  operator — anji  suggested  that  never 
more  than  ten  should  be  used.  The  error  was, 
however,  on  the  wrong  side  ;  when  we  come  to 
look  at  Dr.  Apostoli's  work  on  the  subject,  we 
find  he  has  used  as  many  as  seventy-two  cells  on 
patients,  who  had  borne  them  well,  and  produced 
good  results.  The  mere  mention  of  cells,  how- 
ever, gives  no  definite  idea  of  strength,  since  two 
cells  composed  of  the  same  elements  vary  in 
strength  in  direct  ratio  with  the  amount  of  usage 
and  age  of  exciting  liquid,  not  considering  the 
eff"ect  generally  produced  on  electricity  by  the 
state  of  the  weather. 


260 


THE   CANADA    MEDICAL   RECORD. 


In  the  report  brought  before  the  notice  of  the 
profession  by  Dr.  Lucien  Carlet  in  1884,  we  find 
full  particulars  of  Dr.  Apostoli's  treatment  and 
its  results.  The  important  points  in  its  favor 
are:  if  followed  carefully  there  is  little  or  not 
danger  of  shock  or  peritonitis,  and  the  patient  is 
always  more  or  less  benefited.  His  careful 
observations  and  studies  have  done  much  to 
simplify  its  use,  as  wejl  as  furnish  us  with  careful 
directions  regarding  the  length  of  treatment, 
strength  of  current,  and  application  of  the  poles. 
The  advantages  are,  that  it  can  be  done  without 
an  anesthetic,  in  the  office,  is  not  apt  to  produce 
shock,  and  the  danger  of  the  wound  made  is 
reduced  to  a  minimum.  The  needle  is  used 
exclusively  through  the  vaginal  portion  of  the 
tumor. 

A  little  more  than  two  years  ago,  I  had  the 
pleasure  of  seeing  Dr.  Apostoli  at  his  clinic,  his 
work  was  conscientiously  done,  and  the  patients, 
without  exception,  expressed  themselves  much 
improved  by  the  treatment. 

The  active  electrodes  used  were  of  two  kinds, 
usually  combined  in  one  instrument,  a  long, 
moderately  thick  probe,  finished  on  one  end 
like  a  uterine  sound  ;  the  other  straight,  with  its 
extremity  shaped  like  a  spear  with  cutting  edges. 
The  one  end  would  be  sheathed  in  the  handle 
while  the  other  was  being  used,  or  vice  versa. 
This  was  either  of  platinum  or  gold,  the  two 
metals  least  affected  by  the  current.  A  rubber  or 
glass  tube  was  used  as  an  insulator. 

The  passive  electrode  consisted  of  a  pad  of 
clay  to  cover  the  abdomen,  the  current  connected 
with  a  copper  or  leaden  plate  was  placed  on  the 
pad.  This  made  resistance  stronger,  and  dis- 
tributed the  current  more  evenly. 

The  internal  electrode  was  usually  negative, 
unless  hemorrhage  was  a  troublesome  symptom, 
when  the  positive  became  the  active  electrode  ; 
this,  being  the  acid  pole,  produces  a  caustic 
effect,  and  at  the  same  time  a  contraction  and 
condensation  of  the  tumor.  The  sound  is  used 
more  often  than  the  spear  ;  the  latter  is  used  in 
two  particular  instances  with  advantage. 

ist.  When  a  fibroid  is  within  easy  reach 
through  the  vagina. 

2d.  In  a  large  intramural  fibroid,  when  the 
instrument  is  passed  along  the  uterine  canal  and 
plunged  a  short  distance  into  the  fibrous 
tissue. 

It  is  needless  to  say,  in  our  enlightened  age, 
that  complete  and  careful  antisepsis  of  both 
vagina  and  instruments  is  of  absolute  importance. 
The  instruments  are  made  antiseptic  by  heat 
(alcohol  lamp),  and  the  vagina  cleansed  with  an 
antiseptic  solution.  A  railliamperemeter  is  also 
an  indispensable  aid  to  the  careful  physician. 

For  nearly  two  years  I  have  had  an  opportunity 
to  watch  six  cases,  for  a  space  of  time  suflicient 
to  give  an  account  which  may  prove  interesting. 

Case  i. — Mrs.  K.  W.,  white,  set.  58,  four, 
children,  two  miscarriages  ;   seen  ist  of  March, 


1886.  Histroy  :  Prolonged,  profuse  and  painful 
menstruation,  steadily  increasing  for  the  last  six 
years,  together  with  a  feeing  of  weight  and  drag- 
ging pain  in  the  lower  part  of  the  abdomen,  also 
an  inability  to  sit  down  without  pain.  Examina- 
tion revealed  an  enlarged  and  irregularly  nodula- 
ted uterus,  occupying  almost  the  entire  pelvic 
cavity.  Uterine  cavity,  four  and  a  half  inches. 
To  the  right  of  the  uterus,  a  small  flattened  body 
was  felt,  which  could  be  separated  in  its  lower 
half  from  the  uterine  body.  There  was  no  nausea 
or  exaggerated  pain  on  pressure.  Faradic  elec 
tricily  was  used  (negative  pole  in  the  uterus- 
positive  on  the  abdomen)  thrice  weekly  for  four 
weeks,  after  which  the  galvanic  current  was  used 
exclusively.  All  the  treatments  were  intra-ute- 
rine,  with  two  exceptions,  when  the  puncture  was 
used.  The  uterus  began  to  diminish  slowly  but 
steadily  in  bulk,  after  the  first  six  weeks,  until, 
in  the  early  part  of  August,  it  measured  three 
inches.  The  body  smooth,  almost  normal  to 
touch  ;  the  flattened  mass  on  the  right  gradually 
became  more  rounded,  and  was  now  about  the 
size  of  an  English  walnut,  separate  from  the 
uterus,  pressure  giving  some  pain  and  nausea. 
About  this  time  treatment  was  suspended.  In 
November,  nearly  three  months  later,  presented 
herself  at  my  office.  Uterus  retroflexed  and 
turned  to  the  left;  cavity,  two  and  three-quarter 
inches  ;  right  and  posterior  half  of  pelvis  occu- 
pied by  a  painless  cystic  tumor,  about  as  large 
as  a  medium-sized  orange.  An  operation  was 
advised.  March,  1887,  I  made  an  abdominal 
section,  removed  a  parovarian  cyst.  The  uterus 
was  seen  to  be  perfectly  normal  in  size  and  appear- 
ance.— Am.  Jour  0/  Ohstet. 

FLOODING. 

(Montgomery.) 

A  woman  of  twenty-eight  complains  of 
flooding  for  three  weeks.  Examination  shows 
that  uterus  is  about  as  large  as  that  of  a 
three  months'  pregnancy  ;  but  ic  does  not  feel  like 
a  pregnant  uterus,  nor  do  the  other  conditions 
•favor  this  view.  The  probabilities  are  that  we 
have  here  soft  growth  in  the  cavity  of  the  uterus. 
Although  she  says  that  she  has  not  had  a  chance 
to  become  pregnant  since  last  November,  we  will 
not  take  the  risk  of  inserting  a  sound  into  the 
uterus  till  we  have  had  the  woman  under  farther 
observation.  Meanwhile  she  will  be  given  this 
prescription  for  the  flooding. 

R     Ext.  cannabis  indicffi gr- viij 

Ext.  ergotffi  fluidi    3j 

Ext.  hamamelis  fluidi 3   ss 

Tinct.  cinnamomi 3  ss 

M.     Sig. — Teaspoonful  three  times  a  day. 

Ergot  would  not  b.  contra-indicated  even  if  we 
knew  her  to  be  pregnant.  Injection  of  hot  water 
will  also  be  given.  As  soon  as  we  are  quite  sure 
that  there  is  no  pregnancy,  the  os  will  be  dilated 
with  a  tent  wide  enough  to  introduce  a  finger ; 
and  then  a  positive  diagnosis  can  be  made. 


THE   CANADA    MEDICAL   KECORD. 


2G1 


HOW  TO  TREAT  CRAMPS  IN  THE  LEGS. 

Many  persons  of  lioth  sexes  are  greatly  troubled 
with  cramps  in  one  or  both  their  legs.  It  conies 
on  suddenly,  and  is  very  severe.  Most  people 
jump  out  of  bed  (it  nearly  always  comes  on  either 
just  after  going  to  bed,  or  while  undressing)  and 
ask  some  one  to  rub  the  leg.  I  have  known  it  to 
last  for  hours,  till,  in  despair,  they  would  send  for 
the  family  physician ;  and  even  then  it  would  be 
hours  before  the  spasms  would  let  up. 

There  is  nothing  easier  than  to  make  the  spasm 
let  go  its  hold,  and  it  can  be  accomplished  without 
sending  for  a  doctor,  who  may  be  tired  and  in  need 
of  a  good  night's  rest.  When  I  have  a  patient  who 
is  subject  to  cramps,  I  always  advise  him  to  pro- 
vide himself  with  a  good,  strong  cord.  A  long  gar- 
ter will  do  if  nothing  else  is  handy.  When  the 
cramp  conies  on,  take  the  cord,  wind  it  around 
the  leg  over  the  place  that  is  cramped,  and  take 
an  end  in  each  hand  and  give  it  a  sharp  pull — one 
that  will  hurt  a  little.  Instantly  the  cramp  will 
let  up,  and  the  sufferer  can  go  to  bed  assured  that 
it  will  not  come  on  again  that  night.  For  the  per- 
manent cure,  give  about  six  or  eight  cells  of  galva- 
nic battery,  with  the  negative  pole  applied  over 
the  spot  that  cramps,  and  the  positive  pole  over 
the  thigh.  Give  it  for  ten  minutes,  and  repeat 
every  week  for  one  month. 

I  have  saved  myself  many  a  good  night's  rest, 
simply  by  posting  my  patients,  subject  to  spasm 
of  the  legs,  how  to  use  the  cord  as  above.  I  have 
never  known  it  to  fail,  and  I  have  tried  it  after 
they  had  worked  half  the  night,  and  the  patient 
was  in  the  most  intense  agony.  Even  in  such 
cases,  at  the  first  jirk  of  the  cord,  all  pain  left. — R. 


W.  St.  Clair,  M.  D., 


PNEUMONIA  IN  CHILDREN. 

Child  of  twenty-two  months  ;  admitted  May  ist; 
has  had  persistent  cough ;  temperature  ranging 
from  100  °  to  103  °  ;  dullness,  but  not  very  mark- 
ed, at  base  of  right  lung  ;  mucous  rdlts  at  the 
same  spot.  Diagnosis,  catarrhal  pneumonia.  Dr. 
Stryker  said  that  this  case  illustrated  the  fact  that 
very  young  children  rarely  have  the  symptoms  cf 
pneumonia  so  well  marked  as  they  are  in  adults. 
Instead  of  complete  dullness  at  the  affected  spot, 
there  is  merely  a  modified  dullness,  and  ausculta- 
tion shows  that  some  air  is  entering  the  vesicles  at 
this  point. 

Before  being  admitted  the  child  had  suffered 
from  bronchitis.  This  has  extended  to  the  air  cells, 
and  now  the  child  has  both  bronchitis  and  pneumo- 
nia. As  for  treatment,  generally  the  simpler  the 
better. 

You  might  try  a  mild  mustard  plaster,  but  do 
not  leave  it  on  until  there  is  any  possible  irritation. 
Turpentine  stupes  are  also  good. 

He  is  not  in  favour  of  [joultices  on  account  of 
their  sogginess,  and  the  sudden  changes  of  tempe- 
rature to  which  the  child  is  subjected  through  the 
changing  of  the  poultices.  He  prefers  a  thick 
packet  of  cotton  around  the  chest. 


The  treatment  given  was  a  mixture  of  mistura 
glycyrrhiza;  comp.,  ammonii  chloridum,  syr. 
senega;,  and  syr.  ipecac. 

.\  little  paregoric  was  added  to  a  dose  when 
thought  necessary,  on  account  of  the  cough. — 
I'h'daddphln  Mediail   Times. 


ANTIPYRIN  IN  MIGRAINE. 

During  the  last  two  months  I  have  treated 
twenty  cases  of  migraine;  several  of  the  patients 
having  suffered  for  over  ten  years,  and,  finding 
all  drugs  useless,  had  become  reconciled  to  being 
periodically  prostrated  for  one  or  two  days.  In 
every  case  I  ordered  eight  grains  of  antipyrin, 
dissolved  in  water  or  lemonade,  to  be  repeated 
each  half  hour  until  cured,  the  patient  to  remain 
lying  down.  Most  of  the  cases  were  quite 
cured  by  two  jjowders,  but  the  most  obstinate 
yielded  to  three,  and  in  no  case  did  the  antipy- 
rin fail.  A  cup  of  warm  tea  sometimes  seemed 
to  help,  and  the  only  inconvenience  due  to  the 
treatment  was,  in  a  few  of  the  cases,  considerable 
sweating. 

Many  of  the  patients  can  hardly  credit  that, 
instead  of  being  utterly  helpless  for  twenty-four 
hours,  they  can  now  cut  short  an  attack  in  one 
hour. 

There  is  another  great  advantage  in  using  anti- 
pyrin, and  that  is  that  it  prevents  as  well  as  cures 
these  attacks.  One  lady,  who  cannot  remember 
]  having  fewer  attacks  than  three  a  month,  each 
lasting  about  thirty-six  hours,  has  been  quite  free 
for  about  eight  weeks,  and  this  she  attributes 
solely  to  the  occasional  use  of  an  antipyrin  pow- 
der.— Med.  Revieio . 


WEAK  THROAT. 

He  advised  a  woman  who  had  a  weak  throat, 
that  is,  the  mucous  membrane  was  relaxed,  and 
caused  sensations  of  a  sore  throat  without  its 
actually  being  sore,  to  pursue  this  treatment :  On 
one  sumac  top,  as  fresh  as  possible,  she  was  to 
pour  a  pint  of  boihng  water  ;  and  into  this  put  a 
teaspoonful  of  common  salt.  Keeping  the  water 
warm,  she  was  to  gargle  her  throat  thoroughly 
every  three  hours.  Atkinson  has  seen  this  treat- 
ment have  a  remarkably  beneficial  effect. 


Hypodermic  or  other  syringes,  when  clogged 
so  that  a  fine  wire  cannot  be  forced  through 
them,  may  be  cleaned  by  holding  them  over  a 
spirit  flame  for  a  moment,  and  the  foreign  matter 
will  be  quickly  expelled  or  destroyed,  so  that 
liquids  may  be  used  immediately.  When  a  wire 
has  rusted  in  a  needle,  dip  the  point  in  oil,  then 
hold  it  over  a  flame,  and  it  can  be  removed.  It 
is  well  to  draw  oil  through  the  point,  then  heat 
it,  and  rust  will  be  removed  from  the  interior  ; 
afterwards  wash  with  alcohol,  and  it  is  ready  for 
use. — Memphis  Medical  Monthly. 


2  62 


THE   CANADA    MEDICAL   RECORD. 


BORIC  ACID  A  REMEDY  FOR  STYE. 

Dr.  Geo.  Reuling  says  :  I  have  found  a  simple 
and  effective  remedy  for  stye  to  be  a  solution  of 
fifteen  grains  of  boric  acid  to  an  ounce  of  water. 
By  applying  this  solution  three  times  a  day  to 
the  inflamed  part  of  the  eyelid,  by  means  of  a 
camel's  hair  brush,  this  painful  and  annoying 
affection  will  be  conquered  very  rapidly — Vir- 
ginia Med.  MontMy,  October,  1887. 


The  Canada  Medical  Record 

A  Monthly  Journal  of  Medicine  and  burgerv- 


EDITORS  : 
FKANCIS    W.  CAMPBELL,  M.A.,  M.D.,  L.K.C.P.  LOND 

Editor  and  Proprietor. 

ASSISTANT   EDITOR: 

A.  L4PTH0RN  SMITH,  B.A.,  M.D.,  M.R.C  S.  Eng.,   F.Q.S. 

LONDON. 

SUBSCRIPTION    TWO    DOLLARS    PER   ANNUM. 

All  communications  and  Exchanges  must  be  addressed  to 
the  Editors, Orawer35G,  Post  Office,  Montreal. 


MONTREAL,  AOGUST,  1888. 

CONTAGIOUSNESS  OF  PHTHISIS. 

We  had  the  pleasure  the  other  day  of  a  con- 
versation with  an  esteemed  confrere,  Dr.  Osier,  now 
Professor  of  Clinical  Medicine  in  the  University  of 
Pennsylvania,  on  the  above  subject.  It  has  long 
been  our  opinion,  based  on  clinical  facts,  that 
Phthisis  is  rather  a  contagious  than  a  hereditary  dis- 
ease. That  is  to  say,  that  a  man  dying  of  phthisis 
leaving  only  one  child  born  after  his  death,  and 
-n  another  house,  free  from  the  germs  of  tubercle, 
and  from  a  mother  who  had  not  been  infected 
with  the  disease,  such  a  man,  we  say,  would  not 
transmit  tubercle  to  his  child.  Such  a  case  rarely 
happens,  but  on  the  contrary,  the  children  of 
tubercular  parents  almost  invariably  have  their 
lungs  saturated  with  tubercle  bacilli  immediately 
after  their  birth.  But  we  maintain  that  if  such 
children  were  removed  immediately  to  healthy 
surroundings,  they  would  start  in  life  with  an  in- 
herited weak  constitution,  it  is  true,  but  witli  no 
specific  tendency  to  phthisis.  They  would  be 
more  liable  to  contract  phthisis  on  exposure  to  the 
germs,  just  the  same  as  but  not  more  than  any 
other  jierson  of  weak  constitution.  There  is  a 
general  law  to  be  seen  in  nature,  in  virtue  of  which 
lower  organisms  prey  upon  the  weaker    members 


of  the  higher  area.  For  instance,  as  long  as  the 
green  leaf  is  strong  and  well  nourished,  fungi 
do  not  touch  it.  But  the  moment  that  from  any 
cause  the  vitality  of  the  leaf  is  materially  affected, 
;hen  the  fungi  seize  upon  it  and  soon  consume 
it,  leaving  nothing  but  a  fibrous  skeleton.  Now 
just  in  the  same  way  when  a  case  of  phthisis  is 
imported  into  a  house  occupied  by  a  family,  in 
which  for  a  hundred  years  back  no  one  had  died 
of  phthisis,  the  weakest  organized  inmates  of 
that  house  will  contract  the  disease  one  after  the 
other.  The  fact  that  certain  members  of  the 
family  escape  only  proves  that  their  vitality  was 
strong  enough  to  resist  it.  Do  we  not  see  the 
same  thing  during  an  epidemic  of  typhoid .'  We 
know  that  the  period  of  incubation  of  typhoid  is 
only  a  week  or  two,  and  yet  it  is  a  common  thing 
to  find  that  the  patient  had  not  been  feeling  well 
for  some  months ;  he  had  been  below  par,  as  they 
often  say. 

An  argument  sometimes  used  against  the  conta- 
giousness of  phthisis  is  the  apparent  immunity 
of  nurses  in  consumptive  hospitals.  But  this  can 
be  easily  ^explained  ;  only  the  strongest  constitu- 
tions are  engaged  in  such  institutions  ;  and  if  any 
of  them  should  show  signs  of  failing  health,  she 
would  be  immediately  ordered  away. 

On  submitting  the  above  argument  to  Dr. 
Osier,  he  expressed  himself  at  being  thoroughly 
convinced  of  the  contagiousness  of  phthisis,  and 
he  informed  me  that  he  had  seen  the  advance 
sheets  of  a  work  about  to  be  brought  out  in  Phil- 
adelphia on  this  very  question.  The  importance 
of  this  subject  cannot  be  over-estimated,  more 
people  die  of  consumption  than  of  any  otiier 
known  disease,  and  while  many  other  formerly 
very  fatal  diseases  are  rapidly  disappearing  under 
the  direction  of  sanitary  science,  the  death  rate 
from  phthisis  remains  almost  as  great  as  ever. 
And  yet  we  feel  convinced  that  it,  too,  might  be 
made  to  disappear  completely  from  off  the  face 
of  the  earth,  under  a  proper  system  of  isolation. 
This  of  course  is  out  of  the  question  at 
present;  public  opinion  must  first  be  pre- 
pared for  it,  through  the  profession.  It  is  with 
the  object  of  calling  the  latter's  attention  to  it  that 
we  have  made  the  above  remarks.  Let  medical 
men,  when  taking  the  family  history  and  previous 
history  of  a  consumptive  patient,  no  longer  rack 
his  and  the  patient's  brain  to  find  a  remote  ancestor 
who  had  the  disease,  but  let  him  rather  enquire 
as  to  the  surroundings  of  the  patient  during  the 


THE  CANADA   MEDICAL   RECORD. 


263 


last  few  years.  In  some  cases  he  will  find  that 
the  disease  was  imjiorted  by  a  pretty,  blue  eyed, 
white-skinned  nurse  girl,  who  before  coming  to 
them  had  been  nursing  her  sister  who  died  of  con- 
sumption ;  in  other  cases  it  will  be  found  to  have 
been  caught  from  a  consumptive  husband  or  wife  i 
in  some  cases  even  it  has  been  contracted  from  a 
fellow  lodger,  whose  name  jjcrliaps  the  patient  does 
not  know.  Many  examples  of  the  above  means  of 
contagion  have  come  to  our  knowledge,  and  we 
believe  that  it  is  the  duty  of  the  profession  to 
put  those  who  look  to  us  for  guidance  on  their 
guard  against  contracting  this  terrible  disease. 


CANADIAN  MEDICAL  ASSOCIATION. 

The  following  papers  have  been  promised  for 
the  meeting  of  the  Canadian  Medical  Association, 
which  will  be  held  in  Ottawa,  on  the  12th,  13th 
and  14th  of  September  : 

1.  Face  Presentations — Dr.  \V.  M.  MacKay, 
Woodstock. 

2.  The  Mortality  of  Pneumonia — Dr.  Wm.  Oslen 
Philadelphia. 

3.  The  Duty  of  the  Medical  Profession  under 
the  Pubhc  Health  Act  of  Ontario — Dr.  Wm. 
Canniff,  Toronto. 

4.  On  some  Minute  but  important  Details  in 
the  Management  of  the  Continuous  Current  in  the 
Treatment  of  Fibroid  and  other  Diseases  of  the 
Uterus — Dr.  A.  L.  Smith,  Montreal. 

5.  A  Case  of  Resilient  Stricture  of  the  Urethra 
Cured  by  Electricity — Dr.  A.  L.  Smith,  Montreal. 

6.  On  the  Treatment  of  Varicocele  and  Orchitis 
by  the  Electrical  Current — Dr.  A.  L.  Smith; 
Montreal. 

Papers  have  also  been  promised^by  Drs.  Fen- 
wick,  Shepherd,  AUoway,  Blackader,  and  Bell,  of 
Montreal,  and  many  others. 


THE  CODE  OF  ETHICS  OF  THE  AMERI- 
CAN MEDICAL  ASSOCIATION. 

Art.  IV. — Of  the  duties  of  physicians  in  regard 
to  consultations. 

1.  A  regular  medical  education  furnishes  the 
only  presumptive  evidence  of  professional  abilities 
and  acquirements,  and  ought  to  be  the  only  ac- 
knowledged right  of  an  individual  to  the  exercise 
and  honors  of  his  profession.  Nevertheless,  as  in 
consultations  the  good  of  the  patient  is  the  sole 
object  in  view,  and  this  is  often  dependent  on  per- 
sonal confidence,  no  intelligent  regular  practi- 
tioner, who  has  a  license  to  practice  from  some 
medical  board  of  known  and  acknowledged  respect- 


ability, recognized  by  this  Association,  and  who  is 
in  good  moral  and  professional  standing  in  the 
])lace  in  which  he  resides,  should  be  fastidiously 
excluded  from  fellowship,  or  his  aid  refused  in 
consultation,  when  it  is  requested  by  the  patient. 
But  no  one  can  be  considered  as  a  regular  practi- 
tioner or  a  fit  associate  in  consultation,  whose 
practice  is  based  on  an  exclusive  dogma,  to  the 
rejection  of  the  accumulated  experience  of  the 
profession,  and  of  the  aids  actually  furnished  by 
anatomy,  physiology,  pathology  and  organic  chem- 
istry. 

2.  In  consultations,  no  rivalship  or  jealousy 
should  be  indulged ;  candor,  probity  and  all  due 
respect  should  be  exercised  toward  the  physician 
having  charge  of  the  case. 

3.  In  consultations,  the  attending  physician 
should  be  the  first  to  propose  the  necessary  ques- 
tions to  the  sick ;  after  which  the  consulting  phy- 
sician should  have  the  opportunity  to  make  such 
further  inquiries  of  the  patient  as  may  be  necessary 
to  satisfy  him  of  the  true  character  of  the  case 
Both  ])hysicians  should  then  retire  to  a  private, 
place  for  deliberation  ;  and  the  one  first  in  atten- 
dance should  communicate  the  directions  agreed 
upon  to  the  patient  or  his  friends,  as  well  as  any 
opinions  which  it  may  be  thought  proper  to  ex- 
press. But  no  statement  or  discussion  of  it 
should  take  place  before  the  patient  or  his  friends, 
except  in  the  presence  of  all  the  faculty  attending, 
and  by  their  common  consent  ;  and  no  opinions  or 
prognostications  should  be  delivered  which  are  not 
the  result  of  previous  deliberation  and  concur- 
rence. 

4.  In  consultations,  the  physician  in  attend- 
ance should  deliver  his  opinion  first ;  and  when 
there  are  several  consulting,  they  should  deliver 
their  opinions  in  the  order  in  which  they  have  been 
called  in.  No  decision,  however,  should  restrain 
the  attending  physician  from  making  such  varia- 
tions in  the  mode  of  treatment,  as  any  subsequent 
unexpected  change  in  the  character  of  the  case 
may  demand.  But  such  variation,  and  the  rea- 
sons for  it,  ought  to  be  carefully  detailed  at  the 
next  meeting  in  consultation.  The  same  privilege 
belongs  also  to  the  consulting  physician  if  he  is 
sent  for  in  an  emergency,  when  the  regular  atten- 
dant is  out  of  the  way,  and  similar  explanations 
must  be  made  by  him  at  the  next  consultation. 

5.  The  utmost  punctuality  should  be  observed 
in  the  visits  of  physicians  when  they  are  to  hold 
consultations  together,  and  this  is  generally  prac- 
ticable, for  society  has  been  considerate  enough  to 
allow  the  plea  of  a  professional  engagement  to 
take  precedence  of  all  others,  and  to  be  an  ample 
reason  for  the  relinquishment  of  any  present 
occupation.  But  as  professional  engagements  may 
sometimes  interfere,  and  delay  one  of  the  parties, 
the  physician  who  first  arrives  should  wait 
for  his  associate  a  reasonable  period,  after 
which  the  consultation  should  be  considered  as 
postponed  to  a  new  appointment.  If  it  be  the 
attending   physician  who   is   present,    he  will,  of 


264 


THE   CANADA   MEDICAL   RECORD. 


course,  see  the  patient  and  prescribe  ;  but  if  it  be 
the  consulting  one,  he  should  retire,  except  in  case 
of  emergency,  or  when  he  has  been  called  from  a 
considerable  distance,  in  which  latter  case  he  may 
examine  the  patient,  and  give  his  opinion  in  writing 
and  under  seal,  to  be  delivered  to  his  associate. 

6.  In  consultations,  theoretical  discussions 
should  be  avoided,  as  occasioning  perplexity  and 
loss  of  time.  For  there  may  be  much  diversity  of 
opinion  concerning  speculative  points,  with  perfect 
agreement  in  those  modes  of  practice  which  are 
founded,  not  on  hypothesis,  but  on  experience  and 
observation. 

7.  All  discussion  in  consultation  should  be 
held  as  secret  and  confidential.  Neither  by  words 
nor  manner  should  any  of  the  parties  to  a  consul- 
tation assert  or  insinuate  that  any  part  of  the 
treatment  pursued  did  not  receive  his  assent.  The 
responsibility  must  be  equally  divided  between  the 
medical  attendants — they  must  equally  share 
the  credit  of  success  as  well  as  the  blame  of 
failure. 

8.  Should  an  irreconcilable  diversity  of  opinion 
occur  when  several  physicians  are  called  upon 
to  consult  together,  the  opinion  of  the  majority 
should  be  considered  as  decisive  ;  but  if  the  num- 
bers be  equal  on  each  side,  then  the  decision 
should  rest  with  the  attending  physician.  It  may, 
moreover,  sometimes  happen  that  two  physicians 
cannot  agree  in  their  views  of  the  nature  of  a  case 
and  the  treatment  to  be  pursued  ;  this  is  a  cir- 
cumstance much  to  be  deplored,  and  should 
always  be  avoided,  if  possible,  by  mutual  conces- 
sions, as  far  as  they  can  be  justified  by  a  conscien- 
tious regard  for  the  dictates  of  judgment.  But  in 
the  event  of  its  occurrence,  a  third  physician  should, 
if  practicable,  be  called  to  act  as  umpire  ;  and,  if 
circumstances  prevent  the  adoption  of  this  course, 
it  must  be  left  to  the  patient  to  select  the  physi- 
cian in  whom  he  is  most  willing  to  confide.  But, 
as  every  physician  relies  upon  the  rectitude  of  his 
judgment,  he  should,  when  left  in  the  minority, 
politely  and  consistently  retire  from  any  further 
deliberation  in  the  consultation,  or  participation 
in  the  management  of  the  case. 

9.  As  circumstances  sometimes  occur  to  ren- 
der a  special  consultation  desirable,  when  the  con- 
tinued attendance  of  two  physicians  might  be 
objectionable  to  the  patient,  the  member  of  the 
faculty  whose  assistance  is  required  in  such  cases 
should  sedulously  guard  against  all  future  unsoli- 
cited attendance.  As  such  consultations  require 
an  extraordinary  portion  of  both  time  and  atten- 
tion, at  least  a  double  honorarium  may  be  reason- 
ably expected. 

10.  A  physician  who  is  called  upon  to  consult 
should  observe  the  most  honorable  and  scrupulous 
regard  for  the  character  and  standing  of  the 
practitioner  in  attendance  ;  the  practice  of  the 
latter,  if  necessary,  should  be  justified,  as  far  as  it 
can  be,  consistently  with  a  conscientious  regard 
for  truth,  and  no  hint  or  insinuation  should  be 
thrown  out  which  could  impair  the    confidence 


reposed  in  him,  or  affect  his  reputation.  The  con- 
sulting physician  should  also  carefully  refrain  from 
any  of  those  extraordinary  attentions  or  assidui- 
ties which  are  too  often  practiced  by  the  dishonest 
for  the  base  purpose  of  gaining  applause,  or 
ingratiating  themselves  into  the  favor  of  families 
and  individuals. 


PERSONALS. 

We  had  the  pleasure  of  a  visit  from  our  confrere 
and  former  pupil.  Dr.  W.  E.  Fairfield,  Gold  Med- 
alist of  Bishop's  College,  who  has  been  established 
for  some  little  time  at  Wequiock,  Wisconsin,  and 
where,  we  are  glad  to  learn,  he  is  proving  no  excep- 
tion to  the  rule  that  Bishop's  College  men  are 
never  very  long  in  making  a  reputation  for  them- 
selves wherever  they  may  cast  their  lot.  He  is  on 
a   pleasure  trip  to  New  York. 

Drs.  Ross,  Roddick,  Shepherd,  Bell  and  Lap- 
thorn  Smith,  the  last  of  whom  has  been  invited  to 
read  a  paper  before  the  Association  of  Gynecolo- 
gists and  Obstetricians,  intend  to  leave  for  Wash- 
ington on  the  1 6th  of  Sept.  The  first  four  gentle- 
men will  attend  the  meetings  of  the  American 
Association  of  Surgeons  and  Physicians.  They 
will  be  absent  about  a  week. 


REVIEW. 
^-1  treatise  on  Diphtheria,  historically  and  practi- 
cally considered,  including  Croup,  Tracheotomy 
and  Intubation,  by  A.  SAUv:6,Docteur  en  Mede- 
cine,  ancien  des  Hopitaux  de  Paris,  etc.,  etc.; 
translated,  annotated  and  the  surgical  anatomy 
added ;  illustrated  with  a  full  page  colored 
lithograph  and  many  wood  engravings,  by 
Henry  Z.  Gill,  A.M.,  M.D.,  LL.D.,  etc.,  pub- 
lished by  J.  H.  Chambers  &  Co.,  St.  Louis, 
Mo. 

The  translator,  Dr.  Gill,  must  thoroughly 
understand  French  idiotinatically,  and  we  com- 
pliment him  on  the  success  of  his  translation  and 
on  the  many  practical  additions  made  by  him, 
including  intubation.  We  can  highly  recom- 
mend this  book  to  any  medical  man,  who,  having 
to  deal  much  with  this  so  often  fatal  disease, 
desires  to  keep  himself  abreast  of  the  times,  not 
only  in  treatment,  but  with  every  aspect  of  it. 
It  is  the  most  exhaustive  treatise  we  have  seen 
dealing  alone  with  this  subject,  and  when  we 
consider  that  over  600  authors  have  been  con- 
sulted including  those  of  every  nation,  some  idea 
may  be  formed  of  the  amount  of  labor  expended 
by  the  author  in  its  production. 


THE  CANADA  MEDICAL  RECORD, 


Vol.  XVI. 


MONIREAL,    SEPTEMBER,    1888. 


No.   12. 


CODSTTEIiTTS. 


ORIGINAL  COMMUNICATIONS. 

Elcctrifji!  Nre.i8ureineiit9 2Gr- 

Tasiiia,  K;irity  o£,  iii  the  Country 2GH 

SOCIETY   PROCEEDINGS. 

Twenty  First   Annual  Meeting    of  the 
Canadian  Medical  Association 270 


PROGRESS  OF  SCIENCE. 

On  the  Treatment  of  Ilaliitual  Constipa- 
tion in  Infants  277 

I)ysnienorrliea 271* 

For  Headache  270 

Notes  on  Antipyrin 280 

The  Specific  Treatments  of  TyiAoId  Fe- 
ver  282 

Lactic  -Vcid  and  Diet  In  Infantile  Diar- 
rhoja 284 


The  use  of  Antipyrin  daring  Labor.. ...  2*6 

Treatment  of  Carbuncle 280 

Vomiting  in  Pregnancy  a  sign  of  the 
sex  of  the  child 2>7 

EDITORIAL. 

Co  Je  of  Ethics  of  the  American  Medical 

Association 287 

Reviews 288 


f)i46inal  QommunicaUoni. 


ELECTRICAL  MEASUREMENTS. 
By  a.  Lapthorn  Smith,  B.A.,  M.D. 

Read  before  the  Canadian  Electrical  Society 
of  Montreal,  Sept.  ^rd,  i8S8. 

Mr.  Chairman  and  Gentle.men. — It  is  with  feel- 
ings of  considerable  diffidence  that  I  accede  to 
your  request  to  read  a  paper  before  this  Society. 
My  object  in  wishing  to  belong  to  it  was  ratiier  to 
learn  than  to  teach  ;  so  that  I  feel  I  must  throw 
myself  wholly  on  your  indulgence  in  offering  you 
the  following  considerations  on  electrical  measure- 
ments. The  reason  why  I  choose  this,  for  me, 
somewhat  difficult  subject,  was  that  during  the 
succeeding  meetings  we  will  probably  have  the 
pleasure  of  listening  to  some  very  deep  but  inter- 
esting papers  from  some  of  the  more  learned 
members,  in  the  course  of  which  continual  refer- 
ence will  be  made  to  terms  which  to  them  are  as 
plain  as  the  alphabet,  but  which  may  be  beyond  the 
grasp  of  those  of  us  who  received  our  scientific  edu- 
cation before  the  days  of  electricity;  But  first  I  must 
apologise  to  those  wlio  are  thoroughly  uj)  in  this 
modern  .science  if  during  the  course  of  this  paper 
I  take  up  a  little  of  their  time  in  explaining  care- 
fully things  which  they  already  know  ;  my  excuse 
must  be  found  in  the  maxim  that  in  addressing  an 
audience,  we  should  keep  in  our  mind's  eye,  not 
the  person  present  who  knows  most  about  the 
subject  of  which  we  are  speaking,  but  the  one 
whom  we  suppose  to  know  least  about  it.  I  shall 
therefore  hope   that  before   I   have   finished   my 


address  this  evening  I  shall  have  been  able  to 
make  the  terms,  vol,  ohm,  ampere  and  coulombe 
familiar  to  every  one  to  whom  they  are  not  as 
yet  very  clear. 

If  we  pick  up  any  work  on  electricity,  whether 
applied  to  medicine,  surgery,  or  the  arts,  we  cannot 
read  a  page  hardly  without  meeting  with  some  of 
these  words.  And  when,  in  a  few  years,  electri- 
city shall  have  completely  taken  the  place  of  gas, 
and  when  motive  power  will  be  furnished  from 
electrical  stations,  it  will  become  more  and  more 
important  to  know  the  meaning  of  these  words. 
Before  long  such  terms  as  volt,  ohm,  ampere  will 
be  as  common  standards  as  gallons,  pounds  and 
inches. 

As  the  electrical  current  is  an  imponderable 
fluid,  we  can  best  acquire  a  clear  idea  of  its  mea- 
surable characteristics  by  comparing  it  with  water. 
Now  you  know  that  when  you  have  a  reservoir  of 
water  at  a  certain  height  above  the  ground,  and 
you  make  an  opening  at  the  bottom  of  it,  the  water 
will  run  out,  and  it  does  not  matter  whether  the 
reservoir  holds  one  gallon  or  one  million  gallons, 
the  pressure  with  which  the  water  is  forced  out  of 
the   opening  at  the  bottom  is  just  the  same. 

As  any  one  who  has  not  thought  of  this  might- 
not  agree  with  me,  I  will  just  demonstrate  this 
fact  by  means  of  these  two  reservoirs,  both  the 
same  height,  the  one  of  which  contains  exactly 
three  times  the  amount  of  the  other.  I  place 
them  side  by  side  and  open  the  tubes  at  their  bot- 
toms simultaneously,  and  you  will  perceive  that 
the  pressure  or  force  with  which  the  water  escapes 
is  just  the  same  in  one  and  in  the  other  at  the 
beginning,  and  as  long  as  the  two  liquids  are  at  the 


26G 


THE   CANADA   MEDICAL    RECORD. 


same  height,  as  evidenced  by  the  distance  to 
which  the  stream  is  thrown.  But  you  will  also 
remark  that  the  flow  will  last  three  times  longer 
from  the  large  reservoir  than  from  the  small  one. 

When  speaking  of  the  energy  with  which  water 
rushes  from  its  reservoir,  we  call  it  pressure,  and  the 
pressure  varies  with  the  height  of  the  reservoir. 
When  the  topof  the  water  in  the  reservoir  is  33  feet 
above  the  opening  at  tlie  outlet ,  we  say  that  there  is 
pressure  of  an  atmosphere,  or  in  other  words  15 
pounds  to  the  square  inch.  The  pressure  depends 
not  at  all  on  the  size  of  the  reservoir,  but  on  the 
height  of  the  liquid  above  its  outflow.  Allow  me 
to  illustrate  this  by  putting  side  by  side  two  reser- 
voirs, one  of  which,  as  in  the  last  experiment,  con- 
tains three  times  as  much  water  as  the  other,  but 
in  this  case  arranged  differently,  viz.,  each  quan- 
tity on  top  of  the  other.  If  I  now  open  the  out. 
let  tubes,  you  will  see  that  the  pressure  is  three 
times  greater,  as  evidenced  by  the  distance  to  which 
the  stream  is  projected,  or  the  rapidity  with  which 
it  could  be  made  to  turn  a  wheel. 

You  will  also  remember  that  if  we  were  to  con- 
nect the  outflow  tube  with  another  reservoir,  the 
current  will  continue  only  so  long  as  there  is  a 
difference  in  level  between  the  surfaces  of  the 
two  liquids. 

There  is  just  one  other  point  which  I  must  ask 
you  to  remember,  and  that  is  that  given  two 
reservoirs  of  the  same  height,  or  endowed  with  the 
same  energy  or  pressure,  the  outflow  will  be  in 
proportion  to  the  resistance  offered  by  the  narrow- 
ness of  the  tube. 

This  can  be  shown  by  the  following  experiment : 
Here  are  two  reservoirs  of  the  same  capacity  and 
with  the  same  pressure.  To  one  is  attached  a 
tube  of  a  certain  length,  and  to  the  other  one  a 
much  longer  tube  of,  however,  the  same  diameter. 

The  pressure  is  the  same  in  the  two  reservoirs, 
but  the  friction  or  resistance  offered  by  the  outlet 
tube  is  greater  in  the  one  than  in  the  other.  The 
resistance  of  water  in  the  tube  varies  with  the 
diameter  and  the  length  of  the  pipe. 

I,et  us  take  again  two  reservoirs  each  contain, 
ing  the  same  quantity  of  liquid.  The  outflow 
from  these  vessels  will  vary  according  to  the  pres- 
sure and  the  resistance  of  the  tubes.  In  other 
words,  the  outflow  per  minute  will  be  the  pressure 
divided  by  the  resistance. 

When  water  is  travelling  along  a  pipe  of  large 
calibre,  and  suddenly  comes  to  a  much  smaller 
one,  the  resistance  is  greatly  increased. 


All  of  these  principles  are  exactly  applicable  to 
electricity  :  only  some  of  the  words  are  changed. 
For  pressure  substitute  electromotive  force ;  resis- 
tance remains  the  same  ;  and  for  outflow  substitute 
quantity  or  volume. 

As  I  have  already  said,  electromotive  force  in 
electricity  corresponds  with  head  or  pressure  in 
speaking  of  water.  When  we  place  an  easily 
attacked  metal  such  as  zinc  in  an  active  liquid  such 
as  sulphuric  or  hydrochloric  acid  and  water,  the 
latter  is  decomposed  into  its  constituents — hydro- 
gen and  oxygen.  The  oxygen  combines  with  the 
zinc  to  lorm  with  the  sulphuric  acid  sulphate  of 
zinc,  and  the  hydrogen  is  set  free.  A  new  form 
of  energy  called  electromotive  force  is  then  created, 
or  rather  the  energy  put  into  the  zinc  when  it  was 
smelted  by  heat  is  converted  into  electromotive 
force.  In  order  to  collect  this  force  and  lead  it 
out  of  the  bottle  in  which  it  is  formed,  it  is  neces- 
sary to  introduce  therein  a  non-attackable  conduct- 
ing body  such  as  carbon  or  copper. 

The  liberated  hydrogen  follows  the  direction  of 
the  current  which  is  from  the  attacked  to  the  non- 
attacked  substance  ;  but  arriving  at  the  carbon  it 
deposits  itself  there  in  the  form  of  small  bubbles, 
which  after  a  time  completely  cover  it.  And 
as  gas  is  a  very  bad  conductor  of  electricity,  the 
current  is  mechanically  hindered  by  it. 

Not  only  that,  but  the  hydrogen,  being  itself  an 
element,  is  capable  of  setting  up  with  the  newly 
formed  oxygen  a  secondary  gas  battery  current, 
called  a  current  of  polarization  of  opposite  direc- 
tion to  the  principal  current,  which  it  rapidly 
weakens.  As  this  hydrogen  must  be  got  rid  of, 
this  is  accomplished  in  the  following  manner:  An 
easily  decomposable  substance  is  introduced  into 
the  circuit,  which  readily  gives  up  its  oxygen  to  the 
nascent  hydrogen,  with  which  it  forms  water. 

In  the  Daniell  cell,  sulphate  of  copper  is  thus 
used. 

In  the  Marie  Davy  cell,  sulphate  of  mercury  is 
used. 

In  the  Leclanche  cell,  peroxyde  of  manganese  is 
used. 

In  the  Bunsen,  nitric  acid. 

IntheGrenet  battery,  bichromate  of  potash. 

In  the  Leclanche  cell  for  the  attacking  fluid  no 
acid  is  used  as  acid,  but  the  acid  is  supplied  gra- 
dually by  the  decomposition  of  hvdrochlorate  of 
ammonia,  a  conipound  which  is  easily  decomposed 
by  the  current  into  aunnonia  and  hydrochloric 
acid,  which  latter  attacks  the  zinc,  and  the  ammo- 


THE   CANADA   MEDICAL   RECORD. 


267 


nia  escapes  into  the  air.  The  great  advantage  of 
this  battery  is  that  the  attacking  Hquid  is  formed 
only  when  the  circuit  is  completed,  and  the  bat. 
lery  only  burns  itself  up  during  the  time  it  is  actu. 
ally  in  use.  At  the  same  time  its  electromotive 
force  is  high,  namely,  onv.  and  a  half  volts.  The 
Smee  cell  gives  |^  a  volt  ;  the  bichrornate  2  volts  ; 
the  Bunsen  nearly  2  volts. 

Now  just  as  we  measure  steam  or  water  power 
in  pounds  per  square  inch,  and  heat  by  thermome- 
tric  degrees,  electromotive  force  is  measured  by 
volts.  A  volt  is  the  pressure  yielded  by  a  galva- 
nic cell,  the  Daniel  cell  being  taken  as  the  stan- 
dard unit.  The  size  of  the  cell  has  nothing  to  do 
with  its  electromotive  force  ;  a  cell  the  size  of  a 
percussion  cap  will  give  an  electromotive  force  as 
high  as  a  cell  a  yard  in  diameter. 

Electromotive  force  depends  on  difference  of 
potential. 

The  difference  of  potential  exists  in  all  dissimi- 
lar electrified  bodies,  whether  Ihey  are  large  or 
small  makes  no  matter;  just  as  the  fact  that  pres- 
sure of  water  due  to  its  flow  from  a  reservoir  to  a 
plain  beneath  is  not  influenced  at  all  by  the  area 
of  the  receiver,  but  by  the  height  of  the  water  level 
above  the  plain. 

As  I  have  shown,  water  pressure  is  the  same 
per  vertical  foot  of  height,  whether  the  column  at 
its  base  is  a  square  foot  or  a  square  mile  in  area. 
The  two  bodies  in  the  cell  are  at  different  poten- 
tial, therefore  the  current  flows  from  one  to  the 
other  from  the  attacked  to  the  unattacked,  through 
the  liquid  which  surrounds  them,  and  then  back  to 
the  attacked  body  through  the  wire. 

The  galvanic  cell  converts  chemical  action  into 
electricity  by  burning  the  zinc,  Just  as  the  steam 
boiler  converts  coal  into  energy  by  the  chemical 
action  of  combustion.  If  in  the  galvanic  cell  we 
burn  twice  as  much  zinc  in  a  given  time,  we  shall 
have  a  current  twice  as  strong,  but  not  twice  as 
intense ;  we  can  do  this  by  making  the  surface  of 
the  zinc  twice  as  large. 

Thus  you  see  that  while  the  size  of  the  bodies 
in  the  cell  has  no  bearing  on  the  pressure  of  the 
current,  it  has  a  material  bearing  on  the  strength 
of  it. 

So  that  when  we  want  high  (iressure  electricity, 
we  put  into  the  cell  bodies  which  are,  or  will  be 
when  attacked,  of  highly  different  potential.  When 
we  want  great  strength  of  current  we  look  to  their 


dimensions.  All  Leclanchc  cells  have  the  same 
pressure,  whether  big  or  small.  If  we  take  two 
Leclanche  cells,  different  sizes,  the  tensions  or 
pressures  of  the  two  currents  are  precisely  the 
same  ;  but  if  we  harness  these  two  currents  to  some 
work,  mechanical  or  chemical,  such  as  the  decom- 
position of  water,  the  result  will  vary  according  to 
the  volume  of  the  cell.  In  practice,  however,  we 
do  not  make  large  cells  chiefly  because  they 
are  cumbersome  and  difficult  to  handle.  We  can  in- 
crease either  the  electromotive  force  or  the  strength 
of  the  current  by  using  several  cells  of  the  same 
size  and  connecting  them  together  differently.  If 
we  conn  ;ct  them  in  a  series  of  tension,  that  is  the 
attacked  element  of  one  to  the  unattacked 
element  of  the  other,  and  so  on,  we  shall  add  to- 
gether the  electromotive  force  of  each,  while  the 
strength  of  the  current  will  remain  the  same  as 
that  of  one  cell,  if  however  we  connect  all  the 
attacked  elements  of  the  four  cells,  say,  to  one 
wire,  and  all  the  unattacked  ones  to  the  other,  we 
shall  have  quadrupled  the  size  of  the  element, 
and  we  shall  have  a  current  four  times  as  strong, 
while  its  pressure  will  remain  at  one  volt. 

RESISTANCE. 

When  the  current  in  a  cell  travels  from  the  at- 
tacked to  the  non-attacked  eletnent,  through  the 
liquid  in  the  cell,  it  meets  with  resistance  ;  and  so 
also  when  the  current  travels  around  from  the  non 
attacked  element  to  the  attacked  element,  by  the 
wire  outside  of  the  cell,  it  meets  with  resistance 
still  further.  There  are  then  two  places  where 
the  current  meets  obstacles, — one  inside  the  cell 
and  one  outside  of  it.  The  resistance  offered  by 
the  liquid  inside  the  cell  is  known  as  the  internal 
resistance,  while  the  other  is  known  as  the  exter- 
nal resistance.  The  internal  resistance  is  so  much 
lost  energy,  so  that  we  should  endeavor  to  make  it 
as  sniall  as  possible,  by  bringing  the  solid  elements 
in  the  cell  as  near  together  as  possible. 

For  this  reason  the  conglomerate  battery  is  an 
improvement  over  the  one  with  porous  pot. 

The  external  resistance  we  can  control,  it  may 
be  due  to  many  miles  of  telegraph  wire,  the  coils 
of  an  electromotor,  or  the  filament  of  an  electric 
lamp,  the  human  body,  or  to  any  other  path  we 
provide  for  the  current,  in  traversing  which  it  does 
the  work  we  desire. 

The  unit  of  resistance  is  called  an  ohm,  in 
honor  of  George  Simon  Ohm,  who  was  born  at  Er- 
langen  in  1781. 


268 


THE    CANADA    MEDICAL   RECOED. 


The  standard  ohm  is  the  resistance  offered  by 
a  column  of  mercury,  io6  centimeters  long  and  one 
millimeter  in  cross  section,  but  there  are  many 
other  ways  of  getting  an  ohm  of  resistance.  For 
instance,  440  feet  of  telegraph  wire  made  of  gal- 
vanized iron  offers  a  resistance  of  i  ohm. 

On  the  other  hand,  less  than  five  feet  of  No.  TiT, 
pure  copper  wire  gives  a  resistance  of  i  ohm.  I 
can  demonstrate  this  with  the  amperemeter.  I 
have  here  19  feet  of  33  wire,  which  should  give  a 
resistance  of  4  ohms.  I  have  also  a  Leclanche  cell 
which  has  been  weakened  down  by  hard  work  to 
an  electromotive  force  of  i  volt,  the  nor- 
mal electromotive  force  being  nearly  one  and  a  half. 
Now  I  volt  through  i  ohm  should  give  one  amperei 
or  I  volt  through  4  ohms  should  give  one-fourth  of 
an  ampere,  and  this  is  precisely  what  it  gives  by  ex- 
periment. 

No.  40  wire  being  much  finer,  the  resistance 
which  it  offers  is  much  greater  ;  in  fact,  less  than  i 
foot  of  it  offers  a  resistance  of  an  ohm.  Or  to  put 
it  to  the  test,  less  than  4  feet  should  give  4  ohms 
Or  allow  ^  of  an  ampere  to  pass  through.  And 
this  you  see  it  does. 

I  volt,  through  i  ohm,  gives  i  ampere  ;  60  volts 
through   60  ohms  gives  i   ampere. 

The  human  body  gives  a  resistance  of  50  to 
200  ohrns. 

A  16  candle  power  incandescent  lamp  gives  a 
resistance  of  50  or  60  ohms. 

Resistance  depends  on  two  things :  on  the 
nature  of  the  conducting  body  interposed  between 
the  poles,  being  greatest  in  glass  and  least  in 
copper ;  and  secondly,  resistance  depends  on  the 
length  and  calibre  of  the  conductor;  the  longer 
and  smaller  it  is  the  greater  will  be  the  resistance, 
the  shorter  and  thicker  it  is  the  smaller  will  be  the 
resistance.  Thus  while  it  only  takes  less  than  a 
foot  of  the  smallest  size  wire  No.  40  to  give  an  ohm, 
it  would  take  over  20  thousand  feet  of  the  largest 
size  No.  loco  to  offer  the  same  resistance. 

On  the  resistance  of  different  conductors  is 
based  ohms  law,  viz.,  that  the  intensity  of  a  current 
is  equal  to  the  electromotive  force  divided  by  the 
resistance. 

The  ohm  meter  consists  of  a  series  of  resistance 
coils  of  fine  wire,  of  varying  length  and  fineness, 
arrang;ed  with  binding  posts,  so  that  the  current 
can  be  thrown  into  a  10,  20,  100,  1000,  or 
10,000  coil  and  of  different  metals  (such  as  Ger-  ; 
man  silver). 


QUANTITY. 

Ohm's  law,  as  I  have  said,  is  that  the  electromo- 
tive force  divided  by  the  resistance  equals  the 
quantity.  The  quantity  of  current  furnished 
by  I  volt  of  pressure  through  one  ohm  of  resis- 
tance is  called  an  ampere. 

An  ampere  is  too  large  a  current  to  be  used  i" 
medicine,  so  it  has  been  divided  into  milli -amperes 
or  thousandths  of  an  ampere.  According  to 
ohm's  law,  I  volt,  through  10  ohms  would  give  j'j 
of  an  ampere  or  100  milli-amperes,  or  20  volts 
through  100  ohms  would  give  20-100  or  i  ampere 
or  200  milli-amperes.  The  resistance  of  the  body 
is  sometimes  as  high  as  200  ohms,  and  as  each 
Leclanche  cell  has  an  E.  M.  F.  of  i  ^  volts,  it 
would  take  a  little  less  than  28  cells  or  40  volts  to 
give  y  of  an  ampere  through  the  body. 

A  coulombe  is  an  ampere  flowing  during  the 
period  of  one  second,  but  it  is  a  term  which  is  only 
beginning  to  come  into  general    use. 


RARITY  OF  TAENIA  IN  THE  COUNTRY. 

Read  at  the  July  (188S)  meeting  of  the  District   of  Bedford 
Medical  Association 

By  A.D.  Stevens,  M.D., 
Dunham,  Que. 

Mr.  President  and  Gentlemen  : — I  was 
yesterday  reminded  by  a  confrere  that  my  name 
was  mentioned,  among  others,  by  the  Chairman 
at  the  last  meeting,  to  read  a  paper  on  this  occa- 
sion. We  now  and  again  see  it  stated  by  Jour- 
nalists, when  soliciting  contributions,  that  the 
daily  life  of  almost  every  active  medical  man  fur- 
nishes material  for  a  subject  which  may  be 
made  interesting  to  readers  or  listeners.  What- 
ever truths  you  may  have  found  in  this  statement 
I  cannot  say  ;  but,  with  ample  notice  and  a  more 
or  less  active  jiractice,  I  confess  I  am  quite  at  a 
loss  to  decide  upon  a  subject  worthy  of  your  at- 
tention. Nothing  has  occurred  in  my  field  of  ob- 
servation, for  some  time  past,  that  possesses  suffi- 
cient novelty  or  significance  to  relate  within  your 
hearing,  unless  it  be,  perhaps,  a  case  of  tape-worm 
or  taenia. 

I  do  not  pretend  to  know  the  range    of  e.xjieri- 
ence  of  the  gentlemen   who    are   with    us   to-day, 
but  I  may  say  that  so  far  as  my  own  work  is  con- 
cerned, tape-worm  has  been  found  e.\ceedingly  rare^  ■ 
— so  rare,  in  fact,  that  the  one  I  am  about  to  refer 


TIIK   CANADA   MEDICAL   RECORD. 


269 


to  is  the  first  and  only  one  I  have  h,ul  tlie  nKin- 
agement  of  during  my  now  soniewiiat  lengtliened 
professional  career  ;  and  even  tliis  could  hardly 
prove  its  origin  to  have  been  in  the  Townships, 
as  the  man  (the  owner  of  it)  had  only  recently 
put  foot  on  Canadian  soil  after  a  prolonged  re- 
sidence in  the  Town  of  Milton,  Vermont.  Hence 
I  conclude  this  species  of  parasite  is  not  of  such 
frequent  occurrence  in  the  Townships  as  it  is  in 
some  other  portions  of  the  world,  and  I  choose 
the  case. 

I  am  not  aware  that  there  has  been  of  late  any 
additions  made  to  previously  existing  literature 
upon  this  feature  of  the  subject  of  Helminthics 
and  shall  not  mention  any  point,  in  connection 
with  it,  not  believed  to  be  necessary  to  an  intelli- 
gent recital  of  the  treatment  of  the  case,  as  well  as 
the  results  obtained. 

About    a  couple    of  months  ago,  a  man,  aged 
about  sixty  years,  and  of  fairly  healthy  appearance 
consulted  me  with  reference  to  a  supposed  diges- 
tive trouble  manifesting  itself  by  frequent  colicy 
pains    in    the    intestines,    of  a    severe  character. 
Otherwise,    he    said,   the    functions  of   the   body 
were  being  carried  on  as  well  as  he  could  desire. 
Without    in    any    degree    suspecting    that,    after 
these  long  years  of  waiting,  I  had  been  suffered 
to   contend   with  a  case  of  genuine    tape-worm, 
I    gave  him  a  full  dose   of  compound   cathartic 
pills,    and    told    him  to   return   in    two   or  three 
days.     When  he    came    back,  however,    he    was 
the  bearer  of  a  vial  that  contained  several  fleshy- 
looking  substances  that  he  had  voided,  and  which, 
unenlightened    as  was,    I,  your   humble    servant, 
I  had  no  difficulty  in  recognizing  as  zooids  or  liiii's 
of  a  tape-worm.     The  good  man  seemed   a  little 
frightened   at  first  on  seeing   what  had   escaped 
from  him  (or  rather  what  he  had  escaped  from) ; 
but  after  a  full  explanation   that  it  was   neither  a 
serpent  nor   a  flattened  cord,   he  became   more 
hopeful   (and  asked    for    a    little     nourishment). 
With  the  exception   of  some    of  the  remedies  of 
doubtful    reputation,    it   may  well  be   sus]:)ected, 
from  what  1  have  said  Before,  that  I  had  nothing 
to  give  him.     But  I  was  equal    to    the    occasion 
(as     I     am    sometimes).     In     order      to     gain 
time    to    get    a  prescription   from   the    druggist, 
I  gave  him  a  very  highly  colored  liquid  in  a  very 
high.ly  ornamented  vial,  told  him  to  follow  direc- 
tions minutely,  and  put  in  an   appearance  in  four 
or  five  days  again.     The  record  of  the  Male  Fern 
seemed  to  me  to  be  the  best.  In  fact,  pumpkin  seeds 


were  not  to  be  thought  (.f.  They  were  out  of  sea- 
son, and  too  democratic.  Filix  Mas  sounded  well, 
and  besides  it  had  the  advantage  of  being  of  purely 
British  origin,  and  it  did  the  work  well,  as  you  will 
presently  see.  I'o  be  more  serious,  however,  I 
caused  to  be  put  up  ihree  doses  of  the  follow- 
ing: 

5       Fl.  Ext.  Filicis  Jjs 

.SjJts.  Terebinth  z  js 

Ovi  vitelli  T  Misce 

et  adde  aqua;  et  syrupi  q.  s  ad  3  ij — I'"iat  haustus, 
mane  sumcndus.  He  was  directed  to  take  a  full 
dose  of  castor  oil  on  retiring  at  night,  and,  in  the 
morning,  after  a  thorough  evacuation  of  the  bowels 
had  been  secured,  to  take  one  of  the  three  doses 
as  above,  and  carefully  preserve  every  thing  sus- 
picious that  passed  until  I  came  and  examined 
them. 

From  all  I  had  heard  and  read  of  taj  e-worm,  I 
had  been  led  to  believe  that  it  was  only  after 
specially  skilled,  professional  search  that  the  head 
could  be  found,  if  expelled  at  all;  and  as  I  knew 
its  discovery  was  a  sine  qua  nan  to  success,  I  kept 
my  eyes  wide  open. 

Whether  my  case  was  an  exceptionally  easy 
one  to  conduct  or  not,  my  previous  experimental 
acquirements  do  not  warrant  me  in  giving  an 
opinion,  or,  whether  I  even  obtained  the  prize 
at  all,  it  must  be  admitted  is  of  doubtful  accuracv. 

But  whatever  may  have  been  my  doubts  and 
fears  as  to  getting  that  part  of  the  worm,  which 
should  contain  whatever  brain  material  he  possess- 
ed, they  proved,  I  fancy,  like  so  many  other  things 
mundane,  to  be  without  foundation  and  illusory. 
Tlie  good  natured  man's  fourteen  years  old  grand- 
daughter, to  whom  I  had  previously  parted  with 
a  large  amount  of  my  own  knowledge,  was  possess- 
ed of  the  peccant  intruder,  brains  and  all,  before 
the  man  at  the  helm  reached  the  field  of  conflict. 
Tliere  did  not  seem  to  be  much  doubt  of  it,  but  it 
must  be  remembered  that  neither  the  young  lady 
nor  myself  were  put  under  oath. 

These  Entozoa  are  said  to  have  grown  sometimes 
to  enormous  lengths — even  as  much  as  one 
hundred  yards  having  been  reported  in  one  case  ; 
but  in  the  instance  under  consideration,  although 
I  did  not  arrange  the  joints  or  zooids  in  line,  so  as 
to  measure  or  count  them,  I  am  not  disposed  to 
place  the  length  beyond  four  or  five  yards.  Then 
again,  we  have  good  authority  for  urging  the 
necessity  of  providing  against  the  possibility  of 
there  being  several   such   organisins  in  the  same 


270 


THE   CANADA    MEDICAL   RECOtlt>. 


subject.  To  make  sure  that  my  work  was 
complete— that  I  had  secured  the  whole— I  told 
the  patient  to  take  the  second  dose,  in  the  same 
manner,  on  the  following  day,  while,  at  the  end 
of  a  week,  he  was  directed  to  take  the  third  and 
last  dose,  carefully  guarding  everything  that  came 
away  after  each  effort. 

As,  by  this  time,  our  friend  had  become  toler- 
ably well  familiarized  with  his  interesting  fellow- 
traveller,  which  had  for  so  long  and  so  affection- 
ately adhered  to  him  closer  than  the  proverbial 
brother,  I  did  not  think  it  worth  while  to  return 
to  the  scene  of  action,  and  instructed  him  to 
report  himself  at  my  quarters,  bearing  anytliing 
of  an  unfriendly  look  that  might  be  expelled.  He 
has  tiot.  however,  put  foot  into  my  sanctum  up  to 
this  date,  and  it  is  only  reasonable  to  conclude 
there  were  nj  more. 

And  now.  Gentlemen,  having  thus  briefly  told 
the  story  of  my  own  experience  in  tape-worm,  no 
matter  how  triflingly  I  may  have  treated  the 
subject  myself,  I  would  like  to  hear  your  own 
especially  whether,  as  I  fancy  is  the  case,  the  worm 
has  been  met  with  as  seldom  by  you  as  my  own 
observation  would  lead  one  to  believe, — I  would 
also  be  pleased  to  know  your  treatment  and 
success,  should  you  have  happened  to  meet  with 
the  parasite  at  any  time  in  your  fields  of  labor. 


Sodeiij'  J^H^aceedings. 


TWENTY-FIRST  ANNUAL  MEETING 

OB'  THE 

CANADIAN  MEDICAL  ASSOCIATION. 

Parliament  Building,  Ottawa,  Ontario. 
September  12th  &  13th,  18S8. 
Dr.  J.  E.  Graham,  Toronto,  President,  took  the 
chair  at  10  o'clock,  and  formally  opened  the  twenty- 
first  annual  meeting  of  the  Canadian  Medical  As- 
sociation. In  introducing  Dr.  George  Ross,  as 
President  elect  of  the  .Association,  he  expressed  the 
great  pleasure  it  afforded  him  in  doing  so,  and 
said  : — "I  think  we  can  congratulate  ourselves  upon 
the  prospects  of  having  a  very  pleasant  and  profi- 
table meeting,  and  upon  the  fact  that  we  have 
selected  as  PresiJent  for  this  year  a  gentleman  who 
js  in  every  way  capable  of  falfiUing  the  duties  of 
that  office.     Dr.  Ross  is  one  of  the  leaders  of  the 


profession  in  the  largest  city  of  the  Dominion,  and 
his  reputation  is  not  alone  confined  to  that  city  but 
to  the  Dominion  at  large." 

Dr.  George  Ross,  (xMontreal)  then  took  the 
chair. 

The  Secretary,  Dr.  James  Bell  (Montreal),  read 
the  minutes  of  the  last  meeting  of  the  Association 
which  were  approved  of 

election  ok  members. 

The  following  gentlemen  having  been  duly  pro- 
posed and  seconded,  w^re.  unanimously  elected 
members  of  the  Association  : 

Dr.  Allen  Baines,  Toronto,  Ont.  ;  Dr.  \V.  I'An- 
son,  Ottawa  ;  Dr.  M.  C.  McGannon,  Brockville  ; 
Dr.  Thos.  Potter,  Ottawa  ;  Dr.  \V.  C.  Cousens, 
Ottawa;  Dr.  B.  F.  Hurdman,  Ottawa;  Dr.  S. Wright, 
Ottawa;  Dr.  C.  J.  H.  Chipman,  Ottawa;  Dr.  A. 
H.  Horsey,  Ottawa  ;  Dr.  J.  W.  Shillington,  Ottawa  ; 
Dr.  W.  F.  Graham,  Ottawa;  Dr.  C.  P.  Dewar, 
Ottawa  ;  Dr.  W.  H.  Klock,  Ottawa ;  Dr.  T.  L. 
Brown,  Melbourne,  Que. 

NOMINA!  ING    COMMIT'JEE. 

The  following  gentlemen  were  selected  as  mem- 
bers of  the  nominating  committee  : 

Drs.  F.  W.  Campbell,  T.  G.  Roddick,  Montreal ; 
J.  E.  Graham,  Wm.  Caniff,  Toronto  ;  Dr.  Bray, 
Chatham;  Drs.  Sweetland  and  Church,  Ottawa; 
Drs.  Griftin  and  Mullin,  Hamilton;  Dr.  Eccles, 
London ;  Dr.  Fenwick,  Kingston ;  Dr.  Baird, 
Pakenhatn  ;  Dr.  Smith,  Seaforth  ;  the  President  and 
Secretary. 

selection  of  officers  for  SECTIONS. 

The  following  gentlemen  were  selected  : — 
Chairman  of  Medical  Section. .Dr.  Bray,    Chatham 
"  Surgical  Section. ..Dr.  Cameron,  Toron- 

to. 
"  Obstetrical  and  Gynecological 

Section.. .Dr.  Trenholme,  Montreal. 

_       GENERAL    business. 

Dr.  Graham  pointed  out  that,  last  year,  a  com- 
mittee was  appointed,  the  object  being  to  endeavor 
to  further  the  interests  of  this  Association,  and  to 
present  a  report  of  this  meeting,  but  that  owing  to 
the  absence  of  Dr.  Stewart,  ex  secretary,  in  Europe 
this  summer,  nothing  has  been  done  by  that  com- 
mittee. He  said  that  it  was  felt  that  this  Associa- 
tion was  not  in  such  a  flourishing  condition  as  it 
ought  to  be,  and  that  it  did  not  hold  the  sympathy 
of  the  profession  throughout  the  Dominion;  also, 


TUE   CANADA   MEDICAL   RECORD. 


271 


that  the  By-Laws  are  found  to  be  very  deficient. 
He  therefore  suggested  that  another  committee 
be  appointed  witii  the  view  ofbringing  in  a  report 
at  the  next  annual  meeting  tliat  would  be  of  ad. 
vantage  to  the  Association 

Dr.  Roddick  moved,  seconded  by  Dr.  13ray, 
that  Dr.  Graham,  Dr.  Ross  (President)  the  Pre- 
sident elect,  the  Secretary  and  Treasurer,  form 
the  committee. — Carried. 

RECIPROCnV    OK    REGISTRATION. 

Moved  by  Dr  (Jirdwood,  seconded  by  Dr. 
Roger,  that  a  committee  be  appointed,  consisting 
of  Drs.  Wright,  Cami)bcll,  Sullivan,  Bray,  Eccles, 
Milne  and  himself,  to  ascertain  the  feeling  of  the 
different  Medical  Councils  of  the  Dominion,  upon 
what  terms  reciprocity  of  registration  may  be 
obtained  between  the  different  provinces,  and 
the  mother  country  and  other  colonies. 

He  stated  that  on  making  enquiry  in  regard  to 
reciprocity  of  registration  with  Great  Britain,  he 
was  informed  that  before  registration  could  take 
place,  it  would  be  necessary  to  have  an  Order-in 
Council  passed  making  a  new  law  of  reciprocity 
of  registration  applicable  to  Canada.  Recipro- 
city takes  place  between  Great  Britain  and  Aus" 
tralia,  and  he  thought  that  we  might  very  fair- 
ly have  reciprocity  of  registration  between  Great 
Britain  and  this  colony.  He  also  remarked  upon 
the  want  of  harmony  existing  between  the  Medi- 
cal Councils  of  the  different  provinces  in  not 
allowing  members  to  practice  in  any  province  in 
the  Dominion. 

Drs.  Bray,  Mullin,  Campbell,  Sheard  and 
Cousens  spoke  in  discussion. 

Motion  carried. 

The  President  read  his  address. 

A  vote  of  thanks  for  his  able  address  was 
moved  by  Dr.  Workman,  seconded  by  Dr  Camp- 
bell, and  carried. 

Sir  James  Grant  spoke  in  suppjort  of  the  mo- 
tion. 

The  meeting  adjourned  until  2  o'clock. 

J.\MES  Bell,  M.D., 

Secretari/. 
Approved. 
Geo.  Ross. 

nominating  committee. 

The  meeting  of  the  nominating  committee  toijk 
place  immediately  after  the  adjournment  of  the 
general  .meeting. 


On  motion  of  Dr.  Bray,  seconded  by  Dr. 
Sweetland,    Dr.    F.    W.    Campbell   was   elected 

chairman. 

The  following  members  of  the  commitee  were 
present : 

Dr.  Roddick,  Dr.  Graham,  Dr.  Bray,  Dr. 
Sweetland,  Dr.  Church,  Dr.  Mullin,  Dr.  Smith, 
Dr.  Ross,  president;  Dr.  James  Bell,  secretary. 

Election  of  oeficers. 

President  of  the  Association. — 

The  committee   recommend  that    Dr.    H.  P. 
Wright,  Ottawa,  be  re-elected  President  for  the 
ensuing  year. 
Secretary. — 

That  Dr.  James  Bell,  Montreal  be  re-elected 
Secretary. 

Treasurer. — 

A  letter  of  resignation  from  Dr.  Sheard  was 
read  by  the  Secretary. 

That  Dr.  W.  H.  B.  Aikins,  Toronto,  be  ap- 
pointed Treasurer. 

The  committee  recommend  that  the  resignation 
of  Dr.  Sheard  as  Treasurer  be  accepted,  and 
that  a  hearty  vote  of  thanks  be  passed  to  him 
for  his  services  during  the  past  seven  years  in 
that  capacity. 
Local  Vice-Presidents. — 

The  committee  recommend  that  the  following 
be  elected  : — 

Ontario,  Dr.  Chas.  Sheard,  Toronto  ;  Quebec, 
Dr.  F.  W.  Campbell,  Montreal ;  New  Brunswick, 
Dr.  Graham,  Bathurst ;  Nova  Scotia,  Dr.  Ed. 
Farrell,  Halifax ;  Manitoba,  Dr.  Lynch,  Winnipeg  ; 
British  Columbia,  Dr.  J.  M.  Lefevre,  Vancouver  ; 
N.  W.  Territories,  Dr.  Jukes,  Regina;  P.  E. 
Island,  Dr.  Jenkins,  Charlottetown. 
Local  Secretaries. — 

Ontario,  Dr.  Griffin,  Hamilton;  Quebec,  Dr.  A. 
N.  Worthington,  Sherbrooke ;  New  Brunswick, 
Dr.  Kellar,  Fredericton  ;  Nova  Scotia,  Dr.  Web- 
ster, Wolfville  ;  Manitoba,  Dr.  A.  H.  Ferguson, 
Winnipeg;  British  Columbia,  Dr.  Milne,  Victoria; 
N.  W.  Territories,  Dr.  Oliver  C.  Edwards  ;  P.  E. 
Island,  Dr.  McLaren,  Georgetown. 

The  committee  recommend  that  the  next  annual 
meeting  be  held  at  Banff,  N.  W.  T.,  in  the  early 
part  of  August,  1889. 

That  $100  be  granted  to  the  general  secretary. 
F.  W.  Campbell, 

Chairman. 


272 


THE  CANADA  MEDICAL  RECORD. 


MEDICAL   SECTION. 

Ottawa,  September   12,  1888. 

Dr.  Bray,  Cliatham,  in  the  Chair. 

It  was  moved,  seconded  and  carried,  that  Dr. 
.Sheard,  Toronto,  be  appointed  Recording  Secre- 
tary. 

Dr.  H.  P.  Wright,  Ottawa,  was  then  called  upon 
to  read  his  Address  in  Medicine— but  being 
abseat,  Dr.  Caniff,  Toronto,  was  asked  to  read  his 
paper  upon  "  The  duty  of  the  Medical  profession 
under  the  Public  Health  Act  of  Ontario."  A 
telegram  was  received  from  him  stating  his  inabi- 
lity to  be  present,  and  Dr.  Mills,  Montreal,  was 
called  upon  to  read  his  jiaper  on  "  The  influence 
of  the  nervous  system  on  the  nutritive  processes." 
He  b;gan  his  subject  by  referring  to  a  synopsis  of 
a  paper  read  by  him  last  year  on  a  new  basis  of 
improved  Cardiac  Pathology,  which  develo]>ed  the 
theory  that  all  the  nutritive  processes  were  con- 
stantly under  the  influence  of  the  nervous  system. 
He  explained  metabolism  as  the  molecular  life  of 
protoplasm,  and  regarded  the  organic  action  of 
the  nervous  system,  or  nerve  with  the  tissue  ele- 
ment, as  regulating  these  processes.  He  proved 
that  nerves  going  to  bone,  on  being  divided,  caused 
atrophic  changes  in  the  bone,  a  change  called  by 
Charcot,  Acute  Necrobiosis.  He  also  referred  to 
certain  affections  of  the  skin  following  nerves  which 
he  traced  to  similar  nervous  lesions.  He  spoke 
of  the  cause  of  death  in  animals,  after  section  of 
the  vagi  nerves,  as  being  due  to  pneumonia,  which 
was  an  inflammatory  process  due  to  the  severance 
of  the  nerve  connection.  On  birds,  section  of 
nerves  in  connection  with  tlie  heart  was  followed 
by  its  fatly  degeneration.  He  discussed  the 
influence  ot  the  Trigeminus  nerve,  also  the  inhibi- 
tory fibres,  and  sympathetic  fibres,  due  wholly  to 
inteifcrence  with  nutrition.  He  referred  to  the 
emotions,  and  their  influence  on  vital  processes 
as  being  such,  and  also  dwelt  upon  the  training 
of  athletes,  stating  that  over  exertion  called  into 
play,  and  used  up,  the  residual  nerve  force. 

Dr.  Mills'  paper  was  discussed  by  Dr  Playter, 
of  Ottawa,  and  Drs.  Sheard  and  Graham,  Toronto. 
Dr.  Graham  asked  Dr.  Mills  to  explain  the  influ- 
ences to  the  cause  which  accelerated  heart's  action. 
Dr.  Mills  promised  to  do  so  after  he  heard  Dr_ 
Grahain's  ]>aper  on  ''A  case  of  extreme  rapidity 
of  the  heart's  action.''  Dr.  Small,  Ottawa,  also 
.'poke  in  referei'.ce  to  the  nervous  influence  on  the 


movements  of  the  Amoeba,  and  Dr.  Campbell  and 
others  took  part  in  the  discussion,  to  all  of  which 
Dr.  Mills  replied  satisfactorily. 

Dr.  Wright,  Ottawa,  then  explained  the  absence 
of  any  special  Medical  Address,  as  he  did  not 
clearly  understand  what  the  meeting  expected  of 
him. 

The  Section  then  adjourned  to  meet  at  10.30 
a.m.  Thursday. 

Charles  Sheard,  M.D., 

Secretary. 
SURGICAL     SECTION. 

Ottawa,  September  12th,  1888. 

Dr.  Clarence  Church,  Chairman. 

Dr.  Proudfoot,  Montreal,  read  notes  of  a  case 
of  "  Excessive  hemorrhage  after  cataract  extrac- 
tion, into  the  anterior  chamber  of  the  eye."  No 
Anajstheti:  was  used,  and  no  iridectomy  made. 
Pressure  was  made  over  the  globe  by  compress 
and  bandage,  which  were  removed  next  morning, 
owing  to  great  pain,  and  an  atropine  solution 
dropped  into  it.  Hemorrhage  continuing,  i^res- 
sure  was  re  applied  with  boracic  lotion,  and  mor- 
phia given  for  the  pain,  which  was  very  severe. 
Hemorrhage  continuing  on  the  eleventh  day, 
enucleation  was  performed,  and  on  dividing  the 
globe,  the  point  from  which  the  hemorrhage  came 
was  found  to  be  in  the  Retina.  No  reason  could 
be  given  for  the  troublesome  hemorrhage,  except- 
ing that  the  patient  was  very  plethoric  and  a 
drunkard.  No  discussion  followed  the  reading  of 
this  paper  and  the  Section  adjourned  to  meet  at 
10.30  a.m.  Thursday. 

A.  H.  Horsey,  M.D., 

Secretary. 
obstetrical  and  gvn/ecoi.ogical  section. 
Ottawa,  September  12th,  1888. 
Dr.  Trenholme  in  the  Chair. 
Dr.  .Alloway,  Montreal,  read  a  paper  on  "The 
indications  for,  and  comparative  merits  of  Emmet's 
and  Schroeder's    methods  of  operating  upon  the 
Cervix  Uteri."     This  jjaper  gave  rise  to  an  inter- 
esting discussion  upon  the  subject.     Dr.  Gardner 
spoke  in   favor  of  Schroeder's  operation    as  com- 
pared with  Emmet's  in  cases  of  extreme  hypertro- 
phy of  the  neck,  and  inflammation  of  the  mucous 
membrane.      It  enables    disease  to   be    removed 
where    Emmet's  fails    on  account  of  the  stitches 


TUE   CANADA   MEDICAL   RECORD. 


273 


being  unable  lo  approximate  the  edges  together 
after  an  operation.  Dr.  Trenholme  favored 
Emmet's  operation  in  all  cases,  except  in  very  ex- 
treme ones  of  hypertrophy  and  inflammation  ac- 
companied by  glandular  disease  of  the  follicles 
where  Emmet's  operation  was  not  available,  but 
thought  that  in  very  few  cases  would  this  be  found 
necessary,  if  the  tissue  was  pared  away  well  towards 
the  cervical  canal,  leaving  a  narrow  border  by 
which  tissue  could  be  obtained.  Pressure  upon 
the  hypertrophied  parts  afterwards  would  lead  to 
the  formation  of  the  natural  Cervix.  In  no  case 
were  we  warranted  in  amputating  the  Cervix,  if  it 
could  be  avoided. 

The  general  sense  of  the  meeting  was  that  it 
was  much  indebted  to  Dr.  Alloway  for  bringing 
the  subject  up,  and  that  the  operation  of  Schroe- 
der  should  be  resorted  to  only  in  extreme  cases. 
Thursday,  September  13,  1S88. 
The  meeting  opened  at  10  o'clock.  Dr.  Ros.s, 
President,  in  the  Chair. 

Dr.  G.  H.  Oliver,  Delegate  to  the  Association 
from  the  Medical  Society  of  the  State  of  New 
York ;  Dr.  Wallis  Clark,  of  Utica,  N.  Y.,  and  Dr. 
Imrie,  of  Detroit,  Mich.,  were  introduced  by  the 
President,  who,  on  behalf  of  the  Canadian  Medi- 
cal Association,  welcomed  them. 

Dr.  Henderson,  Kingston,  President  of  the 
Ontario  Medical  Society,  was  invited  to  a  seat  upon 
the  platform.  He  expressed  the  pleasure  it  affor- 
ded him  to  be  present  at  this  meeting,  and  said 
that  as  the  representative  of  the  Ontario  Medical 
Association  he  felt  sure  that  any  friendly  senti- 
ments conveyed  to  that  Association  through  him 
would  be  heartily  reciprocated.  It  will  always  be 
his  duty  to  promote  that  unity  and  concord  which 
should  exist  between  the  Ontario"  Medical  Society, 
the  local  societies  and  chis  Dominion  Association. 
He  referred  to  the  re-formation  in  Kingston,  a 
short  time  ago,  of  the  Cataraqui  Medical  Society, 
which  is  now  affiliated  with  the  Ontario  Medical 
Society,  and  which  has  sent  two  delegates  to  this 
meeting,  and  hoped  that  such  a  society  will  be 
formed  in  Ottawa,  and  elsewhere,  with  the  view  of 
forming  a  connecting  link  between  the  local  society 
and  this  Association. 
The  following  gentlemen  were  elected  members 
of  the  Association  : — 

Dr.  W.  J.  Burns,  Caledonia  ;  Dr.  Wallace, 
Metcalfe;  Dr.  Preston,  Carleton  Place;  Dr.  Lynch, 
Almonte;  Dr.  Munro,  Perth;  Dr.  Sutherland, 
Valleyfield,    Que. ;  Dr.    Burns,    Almonte  ;     Dr. 


Milne,    Victoria,  B.  C,  and  Mr.  Davis,  Chelsea, 
Que. 

The  President  referred  to  the  great  pleasure  of 
seeing  present  a  representative  from  such  a  dis- 
tant province,  and  iipon  the  suggestion  of  Dr. 
Proudfoot,  invited  Dr.  Milne  to  a  seat  upon  the 

platform. 

REPORT   OF    NOMINATING   COMMITTEE. 

On  motion  the  ReiJort  of  the  Nominating  Com- 
mittee was  received  and  considered  clause  by 
clause,  and  was  unanimously   adopted. 

The  thanks  of  the  Association  were  tendered 
to  Dr.  Sheard  for  the  long  and  valuable  services 
rendered  to  the  Association  as  Treasurer. 

Dr  Mullin  having  called  attention  to  the  fact 
that  no  allowance  was  made  to  the  Treasurer  for 
travelling  expenses,  etc.,  it  was  moved  that  the 
travelling  and  other  expenses  of  the  Treasurer, 
Dr.  .jheard,  for  this  year,  and  that  of  1887,  be 
defrayed  by  the  Association. — Carried. 

On  the  suggestion  of  the  Committee,  that  the 
next  annual  meeting  beheld  at  Banff,  N.  W.  T.,  a 
general  discussion  ensued. 

Invitations  were  extended  to  the  Association 
to  hold  its  next  annual  meeting  at  London,  Ont., 
by  Dr.  Eccles  ;  at  Toronto,  Ont.,  by  Drs.  Sheard 
and  Graham,  and  at  Victoria,  B.  C,  by  Dr. 
Milne,  and  a  letter  received  by  Dr.  Ross  from 
Lucius  Tuttle,  Passenger  Traffic  Manager  of  Cana- 
dian Pacific  Railway  Company  at  Montreal, 
dated  September  nth,  1888,  was  read,  stating 
that  if  the  Association  desire  to  meet  at  Banff,  a 
trip  will  be  given  from  Montreal,  or  from  other 
Stations  in  Ontario  or  Quebec  on  the  line  of  the 
Canadian  Pacific  Railway  to  Banff  and  return, 
first-class,  including  a  double  berth  in  the  sleep- 
ing car  for  each  person,  meals  in  the  dining  cars 
on  the  way  west  of  Montreal  and  back,  and  four 
days  living  at  the  Banff  hotel,  for  a  round  sum  of 
$95,  and  that  similarly  low  rates  will  be  made 
from  other  points  in  Canada,  and  as  far  as  pos- 
sible from  cities  in  the  United  States. 

Dr.  Walker,  Dundas,  moved  in  amendment  to 
the  Report  of  the  committee  that  the  Association 
meet  next  year  at  Toronto  to  receive  the  Presi- 
dent's Address,  and  then  adjourn  to  meet  at 
Banff  for  the  transaction  of  other  business.  Dr. 
Horsey,  Ottawa,  seconded  the  amendment. 

Dr.  Mullin,  Hamilton,  moved  in  amendment 
to  the  amendment,  seconded  by  Sir  James  Grant, 


274 


THE   CANADA    MEDICAL   RECOED. 


that  the  next  meeting  of  the  Association  be  held 
at  Toronto  on  such  date  as  may  be  deemed  advi- 
sable by  the  officers  of  the  Association,  and  that, 
in  addition,  an  excursion  to  Banff  be  organized 
by  them  to  take  place  immediately  after  the 
meeting. 

The  amendment  to  the  amendment,  and  the 
amendment  to  the  Report  of  the  Committee  were 
lost  on  division,  and  the  recommendation  of  the 
committee  carried  that  the  next  annual  meeting 
be  held  at  Banff  in  the  early  part  of  x\ugust,  1889. 

Dr.  Bray,  Chatham,  moved,  seconded  by  Dr. 
Trenholme,  Montreal,  that  the  Executive  make 
satisfactory  arrangements  with  the  railway  author- 
ities for  members  to  go  to  the  end  of  the  line.- 
Carried. 

Dr.  H.  P.  Wright,  Ottawa,  thanked  the  Asso- 
ciation for  the  honor  conferred  upon  him  in  elec- 
ting him  President  for  the  coming  year. 

The  meeting  then  adjourned  to  meet  in  Sections. 
James  Bell,  M.D., 

Stcretary. 

MEDICAL  SECTION. 

Thursday,  September  13th,  1888. 
Morning  Session. 

Dr.  Bray  in  the  Chair. 

Dr.  Graham,  Toronto,  was  called  upon  to  read 
his  paper  on  a  case  of  extreme  rapidity  of  the 
heart's  action.  He  reported  two  cases,  one  of 
which  was  characterised  by  a  rapid  beating  of  the 
heart,  the  beats  numbering  over  140,  and  being 
uncountable.  His  illness  lasted  three  weeks,  and 
the  peculiar  features  in  the  clinical  history  were 
the  absence  of  dyspncEa,  the  absence  of  renal 
changes,  discoverable  on  examination  of  the  urine, 
and  any  physical  signs  directly  referable  to  the 
lungs.  The  case  was  treated  by  rest,  regulation 
of  diet  and  the  administration  of  digitalis,  and 
after  a  comparatively  short  treatment,  the  patient 
recovered  his  accustomed  health.  The  second 
case  was  more  prolonged  and  peculiar  in  the  fact 
that  continued  muscular  exertion  reduced  the 
heart's  beat  to  normal.  This  had  been  discover- 
ed by  him  only  after  repeated  examinations,  and 
during  a  period  of  rest,  the  heart  again  became 
accelerated.  There  was  nothing  in  this  case  to 
account  for  such  acceleration. 

Dr.  Mills  explained  in  extenso  the  influence 
of  the  cardiac  nerves  upon  the  heart's  action, 
dealing   mainly   with  the  sympathetic   and  vagi- 


He  spoke  also  of  embolism  in  the  coronary  arteries 
as  a  possible  cause  of  such  acceleration.  He  re- 
ferred to  blood  pressure,  as  slowing  the  heart's 
action  rather  than  accelerating  it.  Dr.  Sheard 
discussed  the  case,  and  suggested  embolism,  or 
toxic  matter  in  the  blood  as  a  possible  cause  for 
such  acceleration,  and  referred  also  in  commen- 
dation of  digitalis  as  a  method  of  treatment,  par- 
ticularly the  infusion  of  digitalis.  Dr.  Mullin 
thought  it  was  an  important  case,  and  had  direct 
bearing  upon  the  importance  of  acceleration  of  the 
heart  as  affecting  a  life  insurance  risk.  He  would 
like  to  ask  Dr.  Graham  what  influence  he  thought 
such  acceleration  of  the  heart  would  have  in  short- 
ening the  ordinary  duration  of  life.  Dr.  Milne^ 
Victoria,  also  spoke,  referring  to  a  case  of  modi- 
fied heart's  action  associated  with  tetanus,  and 
stating  that  such  cases  were  evidently  due  to  a 
close  association  between  the  nervous  and  cardiac 
action. 

The  section  then  adjourned  to  meet  at  2  o'clock. 
Charles  Sheard,  M.  D  , 

Secretary. 

SURGICAL  SECTION. 

Ottawa,  Thursday  13th,  1888. 
Morning  Session. 
Only  one  paper  was  read  at  this  session,  that  by 
Dr.  Fenwick,  of  Montreal,  upon  Retropharyngeal 
Tumors.  The  operation  is  formidable  and  its 
literature  rather  scanty.  Dr.  Cheever,  of  Boston, 
Mass.,  appears  to  have  been  the  first  who  operated 
on  these  tumors.  Velpeau  operated  in  1836  on 
a  large  tumor,  operating  by  the  mouth,  tying  the 
common  artery  first.  The  patient  died  on  the 
seventeenth  day.  Dr.  Fenwick  was  early  convinc- 
ed that  operating  from  the  outside  is  the  correct 
method.  These  tumors  are  usually  .sarcomatous 
or  cancerous,  and  in  a  large  majority  of  cases  recur. 
Dr.  Fenwick  then  proceeded  by  diagrams  to  illus- 
trate Dr.  Cheever's  method  by  cutting  from  without. 
A  long,  straight  incision  is  made,  beginning  on  a 
level  with  the  lower  border  of  the  ear,  and  extend- 
ing down  the  neck  in  the  line  of  the  great  vessels. 
If  sufficient  room  is  not  thus  given,  he  makes  a 
transverse  incision  from  the  straight  incision 
across  the  jaw.  The  jaw  is  not  divided,  the 
vessels  and  nerves  are  drawn  aside,  and  the  tumor 
enucleated  in  the  usual  way.  Czerney's  operation 
is  modified  from  Cheever's.  He  opens  the 
trachea  and  keeps  up  respiration  in  this  way 
during  the  operation.     He    divides    the   jawbone 


THE   CANADA    MEDICAL   RECORD. 


275 


between  ihe  second  and  third  molar,  and  in 
getting  down  to  the  tumor,  has  to  sacrifice  the 
cliicf  nerves  and  vessels  in  that  region.  He  then 
removes  tlie  tumor  with  a  hot  knife.  Dr.  Fenwick 
then  described  his  own  operation  by  a  carved 
incision  following  tolerably  well  tlie  line  of  the 
angle  of  the  jaw.  In  two  cases,  the  operation 
was  easy,  no  vessels  or  nerves  of  importance  were 
divided,  e.\cept  the  facial  nerve  in  one  case.  The 
bleeding  in   both  cases  was  practically  nil. 

Dr.  Sheard  thought  that  the  distinction  ought  to 
be  made  between  cancerous  and  sarcomatous 
tumors.  He  thought  cancerous  tumours,  which 
were  not  neglected,  required  a  more  serious  oper- 
ation, and  that  more  room  should  be  given,  as  they 
could  not  be  removed  solely  with  the  finger  with- 
out dissection. 

The  section  then  adjourned  until  2  o'clock  p.  m. 

R.  W.  Powell,  M.  D., 

Secretary. 
Thursday,  Sept.  13th,  1888. 

Dr.  Smith,  Montreal,  deUvered  his  paper  upon 
"Some  minute  but  important  details  in  the  man- 
agement of  the  continuous  current  in  the  treatment 
of  Fibroid  and  other  diseases  of  the  Uterus.  "  He 
insisted  upon  attention  to  the  antiseptic  treatment, 
and  upon  performing  all  the  operations  with  care. 
The  results  in  his  own  hands  had  been  very 
satisfactory.  He  recommended  the  Electrode  of 
Dr.  Inglemann  in  preference  to  Apostoli's  clay 
electrode.  The  different  forms  of  Electrode  of 
sounds  were  shown,  and  that  of  Martin  he  favored 
most,  as  being  the  least  expensive,  and,  at  the 
same  time,  serving  the  purpose.  He  referred  to 
the  necessity  of  exact  dosage,  and  the  after  care 
of  patients  where  much  electricity  had  been  used. 

This  paper  led  to  a  very  interesting  discussion 
as  to  the  field  for  which  it  was  intended  to  be 
useful.  Dr.  Trenholme,  Montreal,  favored  an 
antiseptic  method  apart  from  irrigation,  simply 
advising  that  the  vaginal  passage  be  washed  out 
with  soap  and  water,  and  a  plug  of  antiseptic  cot- 
ton left  in  contact  with  the  Cervix,  when  the  sound 
was  removed.  Other  members  took  part  in  the 
discussion. 

The  session  was  then   brought  to  a  close. 


MEDICAL   SECTION. 

Ajitrnoon  se  sion. 
Dr.     R.     P.     Howard,  Montreal,  read  an  inter, 
esting  paper  on  Opthalmoplegia  Externa,  illustra- 


ted by  diagrams.  He  spoke  of  a  case  of  Opthalmo  • 
plegia  Externa,  and  explained  as  a  cause  the  close 
association  of  the  cerebral  centres.  He  referred 
to  cases  recorded  where  both  Opthalmoplegia 
Externa  and  Interna  had  been  caused  by 
hysteria.  He  noted  also  the  association  of  this 
condition  with  locomotor  ataxia  and  pseu-  do- 
hypertrophic  muscular  paralysis.  He  was  con- 
vinced, however,  that  Opthalmoplegia  Externa 
could  exist  without  such  association.  He  also  dis- 
cussed the  relation  of  syphilis  to  this  ocular  dis- 
ease. 

The  paper  of  Dr.  Campbell,  Seaforth,  "  Myxoe- 
dema,  with  report  of  a  case,  "  was  taken  as  read, 
and  accepted. 

Dr.  Playter,  Ottawa,  read  a  paper  on  a  few  facts 
relative  to  Communicable  Diseases  in  man  and 
animals,  especially  as  brought  out  at  the  recent 
Paris  Congress  and  British  Medii  al  Association, 
referring  particularly  to  Tuberculosis.  His  paper 
was  listened  to  with  much  attention,  and  was  dis- 
cussed. 

The  Medical  Section  then  adjouned. 

Charles  Sheard,  M.  D. 
Secretary . 

SURGICAL   SECTION. 

Afternoon  session. 

Dr.  Bell,  of  Montreal,  read  a  paper  on  "  Exostosis 
Bursata,  "  in  which  he  gave  the  notes  of  a  case 
which  he  believed  to  be  the  only  one  reported  by 
an  English  speaking  surgeon.  Dr.  Shepherd, 
Montreal,  referred  to  the  great  rarity  of  the  disease 
and  drew  attention  to  the  explanation  which  was 
offered  of  the  existence  of  tioating  cartilages  in  the 
joints 

Dr.  Shepherd  followed  with  a  paper  on  Mania 
following  operations.  He  reported  six  cases. 
Dr.  Bell,  in  the  discussion  which  followed,  rela- 
ted two  cases,  in  one  of  which  he  attrbuted  mania 
to  the  use  of  Iodoform.  He  asked  if  there  were 
any  cases  on  record  due  to  Iodoform.  Dr.  Buller 
related  his  experience  of  one  case  of  mania  follow- 
ing the  operation  of  a  cataract.  Dr.  Dickson,  of 
Pembroke,  asked  Dr.  Shepherd,  if  mania  from 
Iodoform  would  be  apt  to  occur  in  the  use  of  the 
drug  when  applied  to  small  surfaces.  Dr.  Shepherd 
replied  that  the  danger  would  be  greatest  when 
Iodoform  was  applied  to  a  large  surface,  as,  for 
instance,  to  the  interior  of  a  large  abscess  cavity. 

Dr.  Buller  then  made  a  few  remarks  on  Pene- 
trating Wounds  of  the  Eye  Ball.     Dr.  Proudfoot 


216 


THE   CANADA  MEDICAL   RECORD. 


related  a  case  of  a  penetrating  woinid  of  the  eye- 
ball produced  Ijy  a  pea.  He  agreed  with  Dr. 
Buller  as  to  the  urgency  of  an  immediate  and 
prompt  treatment,  and  cleasing  the  wound.  In  re- 
ply to  Dr.  Dickson,  Dr.  Buller  advised,  for  the 
control  of  inflammation,  the  application  of  cold  to 
be  changed  to  warm  applications  with  antiseptic 
solution  of  bi-chloride  of  mercury  one  part  in  lo,- 
ooD,  and  one  or  two  doses  of  lo  or  15  grains  of 
Antipyrin. 

Dr.  J.  Stirling,  Montreal,  followed  with  a  paper 
on  some  eye  symptoms  due  to  Cerebral  Lesions. 
Dr.  Buller  said  that  in  cases  of  fracture  of  the  or- 
bital plate,  the  blindness  may  be  due  to  infiltration 
of  blood  in  the  sheath  of  the  nerve,  and  reported  a 
case  which  had  occurred  in  his  practice  of  that 
nature. 

Dr.  A.  La]ithorn  Smith's  paper  on  the  treatment 
of  Varicocele  and  Orchitis  by  the  electrical  current 
of  tension  was  then  read ;  also  a  paper  by  Dr. 
Smith  on  a  case  of  Resilient  Stricture  of  the 
Urethra  cured  by  electricity.  Dr.  Dickson 
enquired  if  Dr  Smith  had  ever  used  the  treatment 
in  neuralgia,  sciatica,  or  enlarged  prostate.  Dr. 
Buller  suggested  the  decomposition  of  water  as  an 
easier  method  of  determining  which  is  the  negative 
pole.  Dr.  Smith,  in  reply  to  Dr.  Dickson,  said 
that  the  use  of  a  continuous  current  would  probably 
prove  useful  in  the  enlargement  of  the  prostate. 
In  reply  to  Dr.  Church,  Dr.  .'^mith  said  that  his 
cases  had  been  under  observation  for  a  considera- 
ble time  and  certainly  after  a  lapse  of  three  years 
might  be  considered  cured.  Dr.  C.  Dickson, 
Kingston,  said  that  in  his  large  experience  in  the 
use  of  electricity  in  neuralgia,  he  had  found  the 
negative  pole  of  tension  often  increased  the  pain 
especially  if  any   neuritis  existed. 

J.  W.  Pickup. 

Secretary. 

GENERAL    MEETING. 

Thursday,  6  o'clock  p.  m. 
Dr.  Ross,  President,  in  the  Chair. 
The   minutes  of  the  last  session  were  read  and 
approved. 

Moved  by  Dr.  Milne,  Victoria,  B.  C,  seconded 
by  Dr.  Sweetland,  Ottawa,  that  in  view  of  the 
apparently  increasing  prevalence  of  tubercular 
disease  in  domestic  animals,  more  especially  in 
cows,  it  is  the  opinion  of  this  Association  that  it 
is  desirable  th.it  some  legislative  action  should    be 


taken  by  the  Dominion  Government  to  check  the 
progress  of  the  disease,  and  we  urge  that  the  Gov- 
ernment take  this  matter  under  their  consideration 
at  as  early  a  date  as  possible. — Carried  unani- 
mously. 

Dr.  Mullin,  seconded  by  Dr,  Smith,  that  the 
cordial  thanks  of  this  Association  be  tendered  to 
the  members  of  the  profession  in  Ottawa  for  the 
courteous  manner  in  which  they  have  treated  the 
the  Association,  and  its  members  individually 

It  was  moved  by  Dr.  Sheard,  seconded  by  Dr. 
Pickup,  that  the  thanks  of  the  Association  be 
tendered  to  the  Railway  and  Steamboat  Compa- 
nies for  travelling  privileges  accorded  to  members 

of  the  .-Association Carried. 

Dr.  Fenwick  mDved,seconded  by  Dr.  Sweetland, 
that  the  thanks  of  the  Association  be  tender- 
ed to  the  Dominion  Government  for  the  use  of 
the  Railway  Committee  Rooms  for  the  purpose 
of  holding  the  present  meeting. — Carried. 

On  motion  of  Dr.  Mullin,  Dr.  Wright,  Presi- 
dent-elect, took  the  chair. 

Dr.  Sheard,  Toronto,  in  moving  a  vote  of 
thanks  to  Dr.  Ross,  retiring  President,  said  that 
he  was  sure  that  all  the  members  of  the 
Association  appreciated  the  whole-souled  manner 
in  which  Dr.  Ross  acted  in  the  position  of 
President  of  the  Association.  Much  is  due  to 
Dr.  Ross,  for  the  success,  the  vitality  and  the 
perseverance  which  was  characterized,  and  which 
has  blessed  the  Dominion  Medical  Association, 
and  he  hoped  that  he  might  be  long  spared  to 
give  us  his  guiding  counsel. 

Dr.  Church,  Ottawa,  seconded  the  motion, 
which  was  carried  unanimously. 

Dr.  Ross  thanked  the  Association  for  the  vote 
of  thanks  tendered  him,  and  said  that  as  regards, 
the  Association  he  had  always  felt  a   very  keen 
interest,  and  had  always   endeavored  to   do  his 
share  in  supporting  its  interests.     With  reference 
to  the  coming  year,  the  President's  duties,  accor- 
ding to  our  present  regulations  only  begin  with 
his  presidence  over  the  annual  meeting  of  the 
Association.     I  may,  therefore,  be  of  some  ser- 
;  vice  to  the   Association   in   assisting  in  making 
I   the    next    annual    meeting  a    success  ;  and    as 
I  we   have  come  to  a    decision  as  regards  the  place 
I  of  meetitjg  I  hope  that  members  will  use  every 
endeavor      to    be  present,    and    to    make    the 
I  meeting     a    successful    one.        Every    exertion 
should    be    made  to   attract  a    large   number  of 
our  Canadian  graduates,  who  are  now  scattered 


THE  CANADA   MEDICAL  RECORD. 


277 


throughout  the  North-Wcstern  States  and  a 
number  oi  American  physicians  to  the  next 
annual  meeting  at  EanfT. 

Dr.  Sweetland,  Ottawa,  was  appointed  Auditor. 

On  the  motion  of  Dr.  Mullin,  Hamilton,  the 
thanks  of  the  Association  were  tendered  to  Dr. 
James  Bell,  Montreal,  for  his  valuable  services 
as  secretary. 

Tlie  twenty-first  annual  meeting  of  the  Cana- 
dian Medical  Associatimi  was  then  brought  to  a 
close. 

Jamks  ]?ei.l,  M.D. 

S'cretarjj. 


J^'/^adleM  of  Science. 


ON     THE    TRICATMENT    OF  HABITUAL 
CONSTIPATION  IN  INFANTS. 

(Eustace  Smith,  M.D.,  F.R.C.P.,  in  i?ri<.  J/f(/- 

Jour.)- Sluggishness  of  the  bowels  in  infants  is  a 
common  source  of  trouble  in  the  nursery,  and  the 
derangement  is  one  which  it  is  not  always  found 
easy  to  overcome.  Occasional  aperients  in  such 
a  case  give  only  passing  relief.  The  bowels, 
indeed,  are  unloaded  for  the  time,  but  when  the 
action  of  the  aperient  is  at  an  end,  they  are  left  no 
less  sluggish  than  before.  Habitual  constipation 
is  very  common  in  infants  who  have  been 
brought  up  by  hand  ;  and  on  inquiry,  the  trouble 
will  often  be  found  to  date  from  the  time  at  which 
bottle  feeding  was  begun.  Still,  infants  at  the 
breast  are  not  exempt  from  this  annoying  derange- 
ment A  deficiency  of  sugar  in  the  breast  milk, 
or,  as  is  sometimes  seen,  a  milk  the  curd  of  which 
makes  a  firmer  clot  than  is  common  in  human 
milk,  will  often  cause  habitual  torpor  of  the  bowels, 
which  resists  treatment  with    some   obstinacy. 

It  is,  no  doubt,  to  improper,  or  at  any  rate 
inappropriate,  feeding  that  the  bowel  trouble  is 
usually  to  be  referred.  An  excess  of  starch  in 
the  diet,  or  any  food  which  overtaxes  the  child's 
digestive  power,  and  thus  burdens  the  alimentary 
canal  with  a  large  undigested  residue,  may  set 
up  the  costive  habit.  By  such  means  a  mild 
catarrh  of  the  intestinal  mucous  membrane  is 
excited  and  maintained.  There  is  e.\cess  of  mu- 
cus, and  the  fecal  masses,  rendered  slimy  by  the 
secretion,  afford  no  sufficient  resistance  to  the 
contractions  of  the  musclar  coat  of  the  intestine, 
so  that  this  slips  ineffectually  over  their  sur- 
face. 

Another  cause  of  constipation  is  dryness  of  the 
stools.  Even  in  the  youngest  infants  the  evacua- 
tions may  sometimes  be  seen  to  consist  of  little 
round  hard  balls,  often  the  size  of  sheep  droppings, 
which  are  passed  with  difficulty  every  second  or 


third  day.  The  form  of  costivencss  is  generally 
due  to  iiisufficiency  of  lluid  taken,  'i  he  food  is 
made  too  thick,  or  the  needs  of  the  system  in  the 
matter  of  water  are  in  some  way  overlooked.  But 
whether  the  constipation  be  due  originally  to 
excess  of  mucus  or  deficiency  of  (hiid,  it  cannot 
continue  long  without  affecting  injuriously  the 
peristaltic  movement  of  the  bowels.  .\s  the  colon 
grows  accustomed  to  be  over-loaded,  the  intesti- 
nal contents  can  no  longer  exert  a  sufliciently 
stimulating  influence  upon  the  lining  membrane, 
and  the  muscular  contractions  begin  to  flag.  If 
the  infant  be  poorly  fed  and  badly  nourisiied,  this 
languor  of  muscular  contraction  may  be  aggravated 
by  actual  weakness  of  the  muscular  walls  ;  and  as 
under  these  conditions  the  bowels  are  apt  to  be  over- 
distended  by  accumulation  of  its  fecal  contents, 
the  expulsive  force  at  the  disposal  of  the  patient  is 
seriously  impaired.  Constipation,  resulting  from 
the  above  causes,  is  often  made  more  obstinate 
by  the  infant's  own  efforts  to  delay  relief.  A 
baby  whose  motions  are  habitually  costive  knows 
well  the  suffering  which  undue  distension  of  the 
sphiucter  will  entail,  and  often  yields  to  the  desire 
to  go  to  stool  only  when  it  is  no  longer  possible 
for  him  to  resist  it.  The  pain  is  sometimes 
aggravated  by  the  formation  of  little  fissures 
about  the  anus,  and  the  violent  contraction  of  the 
sphincter  set  up  by  the  ])resence  of  those  fissures 
forms  an  additional  impediment  to  free  evacuation. 

There  is  another  form  of  constipation  in  infants, 
which  we  should  be  always  vigilant  to  detect. 
This  is  the  torpidity  of  the  bowels  induced  by 
opium.  In  well-to-do  families  the  use  of  soothing 
syrups  and  other  narcotic  preparations  is  now 
less  common  than  was  at  one  time  the  case  ;  but 
now  and  then  we  find  a  baby  drugged,  for  reasons 
of  her  own,  by  an  unscrupulous  nurse,  and  show- 
ing the  earlier  symptoms  of  narcotic  poisoning. 
So  long  as  the  sedative  continues  to  be  given  the 
bowels  are  costive,  the  child  often  vomiis,  his 
relish  for  food  in  great  part  disappears,  and  he 
lies  with  pupils  firmly  contracted  in  a  dull,  heavy 
state,  from  which  he  cannot  easily  be  roused. 
In  young  babies  the  use  of  opium  seems  to  lessen 
the  action  of  the  kidneys,  the  urine  is  scanty,  and 
on  examination  of  the  surface  of  t"he  body  the 
healthy  elasticity  of  the  skin  will  be  found  to  be 
seriously  impaired.  When  pinched  up  between 
the  hnger  and  thumb  the  skin  lies  in  loose  folds 
on  the  abdomen,  or  only  slowly  recovers  its 
smoothness.  If  this  inelasticity  of  the  skin  be 
noticed  in  a  baby  whose  pupiils  are  closely  con- 
tracted, and  who  seems  habitually  heavy  and 
drowsy,  w-ith  little  relish  for  his  food,  it  is  well  to 
remember  that  these  symptoms  may  possibly  be 
due  to  the  action  of  a  narcotic. 

An  infant  whose  bowels  are  habitually  costive 
is  not  necessarily  injured  by  the  want  of  a  daily 
relief.  Often  the  child  seems  perfectly  well  in 
health,  and,  except  for  occasional  local  discom- 
fort when  he  gets  rid  of  an  unusually  large  or 
hardened  mass,  may  appear  to  suffer  no  inconve- 


278 


THE   CANADA   MEDICAL   RECORD. 


nience  at  all.  In  other  cases  there  is  flatulent 
distension  or  frequent  colicky  pain,  the  child 
sleeps  badly,  has  a  furred  tongue,  and  cares  little 
for  his  food  ;  the  motions  are  often  light  coloured 
from  undigested  curd,  and  are  passed  with  violent 
straining  efforts,  during  which  the  bowels  may 
prolapse  or  the  navel  start.  This  straining  is  a 
not  uncommon  cause  of  hernia. 

In  remedying  this  condition,  attention  to  the 
feeding  and  clothing  of  the  baby  is  of  little  less 
moment  than  the  use  of  drugs.  When  the  infant 
is  at  the  breast,  a  teaspoonful  of  syrup  given  three 
or  four  times  a  day  before  a  meal  will  often 
quickly  restore  the  normal  regularity  of  the 
bowels.  If  the  stools  are  habitually  dry  and  hard 
we  should  see  that  the  child  takes  a  sufficiency 
of  liquid  with  his  food.  In  addition,  it  is  useful 
now  and  then  to  make  him  drink  some  plain  filter- 
ed water.  In  the  case  of  a  baby  in  arms,  the 
possibility  that  the  child  may  be  thirsty  and  not 
hungry  seems  rarely  to  be  entertained  ;  but  in 
warm  weather,  when  the  skin  is  acting  freely,  the 
suffering  amongst  young  babies  from  want  of 
water  must  often  be  acute.  At  such  times  the 
urine  is  apt  to  be  scanty  and  high-coloured,  and 
may  deposit  a  streak  of  uric  acid  on  the  diaper. 
Wtien  fluid  is  supplied,  the  secretion  both  from 
the  bowels  and  the  kidneys  quickly  becomes 
more  healthy ;  and  a  dessert-spoonful  of  some 
natural  saline  aperient  water,  given  at  night,  aids 
the  return  of  their  natural  consistence  to  the 
stools. 

The  form  of  constipation  which  is  due  to-mild 
intestinal  catarrh  is  common  enough  in  young 
babies.  This  is  owing,  no  doubt,  in  great  mea- 
sure to  over-abundant  feeding  with  starchy  mat- 
ters, or  to  the  giving  of  cow's  milk  without  taking 
due  precautions  to  ensure  a  fine  division  of  the 
•curd.  Still  it  cannot  be  denied  that  we  some- 
times find  the  same  derangement  in  infants  whose 
diet  is  regulated  with  proper  care  and  judgment. 
In  them  the  intestinal  catarrh  is  frequently  the 
consequence  of  exposure,  for  the  sudden  with- 
drawal of  all  protection  from  the  lower  limbs  and 
belly  which  the  process  known  as  "  short-coating" 
too  commonly  involves,  is  a  fruitful  cause  of 
chill.  In  children  so  denuded,  the  feet  and  even 
the  legs  as  high  as  the  knees  may  be  quiet  clam- 
my to  the  touch.  Under  such  conditions  the 
susceptibility  of  the  patient  to  alternations  of 
temperature  must  be  extreme,  and  the  bowels 
are,  no  doubt,  often  kept  in  a  state  of  continued 
catarrh  from  rapidly  recurring  impressions  of 
cold. 

Where  the  constipation  is  due  to  this  cause,  our 
first  care  must  be  to  protect  the  infant's  sensative 
body  so  as  to  put  a  stop  to  the  series  of  catarrh. 
To  do  this  it  will  not  be  sufficient  to  swathe  the 
belly  in  flannel.  The  legs  and  thighs  must  also 
be  covered,  for  a  lengthened  experience  of  these 
cases  has  convinced  me  that  so  long  as  a  square 
inch  of  surface  is  left   bare  the  protection   of  the 


child  is  incomplete.  We  should  next  see  that  the 
infant's  dietary  is  regulated  with  due  regard  to  his 
powers  of  digestion.  Excess  of  starch  must  be 
corrected,  and  it  is  best  to  have  recourse  to  one 
of  the  malted  foods.  .Mellin's  food  is  especially 
valuable  in  cases  where  there  is  this  tendency  to 
constipation,  as  in  many  children  the  food  has  a 
very  gentle  laxative  effect ;  but  as  Mellin's  food 
contains  no  unconverted  starch,  and  can  do  noth- 
ing to  prevent  the  formation  of  a  dense  clot  when 
the  curd  of  milk  coagulates  in  the  child's  stomach, 
it  is  advisable,  wlien  giving  it  with  milk,  to  insure 
a  fine  division  of  the  curd  by  the  addition  of  some 
thickening  material,  such  as  barley  water.  A 
child  of  six  months  old  will  usually  digest  well  a 
good  dessert-spoonful  of  Mellin's  food,  dissolved 
in  milk,  diluted  with  a  third  part  of  barley  water. 
A  certain  variety  in  the  diet  is  of  importance  in 
all  cases  where  the  digestive  power  of  the  infant  is 
temporarily  impaired.  Therefore,  it  is  advisable 
to  order  an  additional  food,  to  be  given  alternately 
with  the  Mellin  and  milk.  Benger's  "  self  digest- 
ing food "  is  useful  for  this  purpose,  and  rarely 
disagrees.  It  must  be  given,  like  the  Mellin,  with 
cow's  milk,  but  without  the  barley  water,  for  the 
pancreatine  it  contains  has  a  digestive  action 
upon  the  curd,  and  removes  the  tendency  of  the 
latter  to  firm  coagulation.  In  addition  to  the 
above,  if  a  child  has  reached  the  age  of  ten 
months,  he  may  take  a  meal  of  veal  broth  or  beef 
tea  once  in  the  day,  and  with  this  it  is  advisable 
to  give  some  vegetable,  such  as  broccoli  or  aspar- 
agus, thoroughly  well  boiled.  At  this  age,  too, 
the  milk  for  the  morning  meal  may  be  thickened 
with  a  teaspoonful  of  fine  oatmeal,  and  sweetened 
with  a  teaspoonful  of  malt  extract.  In  the  cases 
of  many  infants  suffering  from  habitual  constipa- 
tion, the  appetite  is  very  poor,  and  great  diftrculty 
is  found  in  i)ersuading  them  to  take  a  sufficient 
quantity  of  nourishment.  This  indifference  to 
food  is  almost  invariably  associated  with  coldness 
of  the  extremities,  and  usually  disappears  when 
measures  are  taken  to  supply  necessary  warmth 
to  the  feet  and  legs. 

In  all  cases  where  an  infant's  bowels  are  habit- 
ually costive,  it  is  of  the  first  importance  to  enter 
thoroughly  into  these  questions  of  clothing  and 
diet.  In  addition,  care  should  be  taken  that  the 
bowels  are  regularly  stimulated  by  manipulations 
from  without.  The  sluggishness  of  peristaltic 
action,  which  forms  a  part  of  every  case  of  habit- 
ual constipation,  may  be  very  materially  quickened 
by  judiciously  applied  frictions.  The  nurse 
should  be  directed  to  rub  the  child's  belly  every 
morning  after  the  bath.  She  should  use  the  palm 
of  the  hand  and  ball  of  the  thumb,  and,  pressing 
gently  down  upon  the  right  side  of  the  abdomen, 
carry  the  hand  slowly  round  in  a  circular  direction, 
following  the  course  of  the  colon.  The  frictions 
may  be  continued  for  five  minutes.  In  obstinate 
cases  the  child  may  be  laid  down  upon  the  bed, 
and  the  bowels  gently  kneaded  with  the  thumbs ' 
placed  side  by  side;  but  in  this  case,    loo,  the 


THE   CANADA   MEDICAL  RECORD. 


279 


movements  should  follow  the  course  of  the  larger 
bowel. 

In  addition  to  the  above  treatment,  more  special 
measures  have  often  to  be  employed.  These  may 
be  divided  into  two  classes  :  the  class  of  sujipos- 
itories  and  injections,  and  that  of  remedies  given 
by  the  mouth. 

The  class  of  su]5positorics  and  injections  aims 
at  ])roducing  an  immediate  evacuation  of  the 
bowel,  and  in  no  way  tends  to  promote  more 
regular  action  in  the  future.  These  remedies  are, 
therefore,  useful  in  clearing  the  way  for  further 
treatment,  but  there  their  value  ends.  A  supposi- 
tory of  Castile  Soap  introduced  into  the  rectum  is  a 
time-honored  method  of  inciting  an  evacuation 
in  ihe  child.  Another  old-fashioned  plan  has 
lately  been  revived,  which  consists  in  the  injec- 
tion of  forty  or  sixty  drops  of  pure  glycerine  into 
the  lower  bowel.  In  each  case  energetic  per- 
istaltic action  of  the  alimentary  canal  is  induced, 
and  the  bowel  is  thoroughly  emptied  of  its  con- 
tents. Of  these  applications  the  action  of  tiie 
glycerine  is  very  rapid,  and  in  a  few  minutes  the 
effect  of  the  injection  is  seen.  The  soap  suppo- 
sitory acts  more  slowly. 

Injections  of  soap  and  water,  or  other  liquid, 
have  an  entirely  mechanical  action  in  relieving 
the  patient.  To  be  effectual  such  injections 
must  be  large,  consisting  of  at  least  half  a  pint 
of  fluid,  and  should  be  thrown  very  slowly  into 
the  bowel.  Still,  although  of  service  when  given 
only  occasionally,  the  frequent  use  of  large  injec- 
tions is  not  to  be  recommended  ;  indeed,  this 
method  of  treatment  is  distinctly  hurtful  in  cases 
where  the  costiveness  has  become  a  habit.  Even 
in  young  babies  great  dilatation  of  the  bowel  and 
serious  weakening  of  its  muscular  coat  have  often 
followed  the  daily  use  of  the  enema  pump. 

For  the  permanent  cure  of  habitual  constipa- 
tion remedies  given  by  the  mouth  are  greatly  to  be 
preferred,  but,  at  the  same  time,  strongly  acting 
purgatives  are  worse  than  useless.  Our  aim  should 
be  to  find  the  smallest  dose  which  will  awaken  a 
normal  degree  of  energy  of  peristaltic  action,  and 
to  give  this  dose  regularly  so  as  to  induce  a  habit 
of  daily  evacuation.  The  daily  dose  is  most  effi- 
cacious when  combined  with  a  remedy  which 
tends  to  give  tone  to  the  muscular  coat  of  the 
bowel.  For  this  purpose  a  useful  draught  is  com- 
posed of  half  a  drop  of  tincture  of  nux  vomica, 
combined  with  ten  drops  of  tincture  of  belladonna 
and  twenty  of  infusion  of  senna,  make  up  to  a 
fluid  drachm  with  infusion  of  columba.  This 
draught  should  be  given  at  first  three  times  a 
day  before  food,  but  soon  two  doses  in  the  day 
will  be  sufficient,  and  it  is  rarely  long  before  one 
dose  given  at  bed  time  has  a  sufficiently  laxative 
effect.  Our  object  is  not  to  excite  watery  evacua- 
tions, but  to  induce  as  faithful  an  imitation  as 
possible  of  a  normal  action  of  the  bowels.  The 
liquid  extract  of  cascara  is  useful  in  many  cases, 
especially  if  combined  with  tincture  of  belladonna. 


Twenty,  thirty,  or  more  drops  of  cascara  extract, 

with  ten  of  the  belladonna  tincture,  may  be  given 
with  a  few  drops  of  glycerine  in  a  little  water 
every  night.  In  the  west  of  England  a  remedy 
held  in  high  esteem  consists  of  half  a  grain  of 
suljihur,  colored  red  with  cochineal.  That  this 
apparently  insignificant  dose  is  often  efficacious, 
when  given  regularly  every  night,I  can  testify  from 
my  own  experience. 

In  cases  where  the  motions  are  dryer  than  na- 
tural, as  if  from  imperfect  secretion  of  the  intes- 
tinal glands,  the  addition  of  liquid  to  the  diet, 
already  recommended,  may  be  supplemented  by 
the  administration  of  some  saline  aperient  two  or 
three  times  a  day.  This  treatment  is  made  more 
effectual  when  the  saline  is  combined  with  small 
doses  of  nux  vomica  and  tpiinine.  For  a  baby  of 
six  months  old  five  to  ten  grains  of  sulphate  of 
soda  may  be  given  with  one  quarter  of  a  grain  of 
quinine,  half  a  drop  of  tincture  of  nux  vomica, 
and  a  minim  of  aromatic  sulphuric  acid,  in  a  tea- 
spoonful  of  water,  three  times  a  day  before  food. 
As  in  all  cases  where  the  remedy  prescribed  has 
been  chosen  with  judgment  and  given  in  ajipro- 
priate  quantity,  the  continued  administration  of 
this  draught,  so  far  from  rendering  the  bowel 
dependent  upon  the  medicine,  stimulates  it  to 
act  spontaneously,  so  that  the  dose  has  soon  to 
be  given  less  frequently,  and  in  no  long  time  can 
be  discontinued  altogether. 

By  means  such  as  the  above,  the  most  obstinate 
case  of  constipation  in  the  infant  can  be  cured 
with  little  difficulty,  but  to  be  successful  the 
treatment  must  not  be  restricted  to  mere  drug- 
giving.  The  food  of  the  child  must  be  regulated 
with  care,  his  clothing  must  be  inquired  into,  and 
his  general  management  passed  under  review. 
Where  this  is  done,  drugs  given  in  comparatively 
small  doses  will  act  with  sufficient  energy,  and 
will  soon  restore  their  normal  regularity  to  the 
bowels. 


Dysmenorrhea. — Bartholow : 

5. — Ex.  stramonii — 

Ex.  hyoscyami — 

Ex.  opii .aa  gr  vj 

M. — Et  f.  pilulas  No.  vj. 

S. — A  pill  every  three,  four  or  six  hours. 


FOR  HEADACHE. 
Dujardin-Beaumetz    recommends    the  follow- 
ing : 

R. — Caffeine gr.  iv 

Salicylate  of  sodium gr.  iv 

Hydrochlorate  of  cocaine gr.  iss 

Water f  3  ij 

Syrup f  J  vss 

M. — -Take  the  whole  at  one  dose  at  the  begin- 
ning of  the  attack. 


280 


THE   CANADA    MEDICAL   RECORD, 


NOTES  ON  ANTIPYRIN. 

It  is  not  my  intention  to  make  any  remarks  on 
the  uses  of  antipyrin  as  a  febrifuge.  Antipyrin 
has  been  long  used  for  this  purpose,  long  enough 
indeed  for  a  host  of  rivals  to  have  arisen,  one  of 
which — I  mean  antipyrin  (acetanilide) — bids  fair 
to  displace  it.  I  wish  rather  to  bring  before  the 
meeting  some  account  of  the  various  diseases  for 
which  antipyrin  has  been  used,  in  which  it  has  a 
more  or  less  specific  action,  apart  from  its  property 
of  lowering  temperature.  Antipyrin  has  been  so 
largely  used,  during  the  last  year,  more  especially 
upon  the  Continent,  that  it  runs  the  danger  of 
degenerating  into  a  universal  panacea  for  all  ills. 
So  great  in  fact  has  been  the  demand  for  the  drug, 
that  it  is  believed  that  the  supply  has  with  difficulty 
kept  pace  with  it,  and  complaints  are  now  made 
that  the  drug  is  suffering  from  over-popularity,  and 
that  its  purity  is  being  sacrificed  by  the  makers  to 
insure  a  sufficient  quantity  in  the  market. 

Antipyrin  has  been  very  largely  used  as  an 
anodyne,  and  a  claim  has  been  made  for  it  by 
Professors  Germain  See  and  Lepine  that  it  is  a 
reliable  substitute  for  morphine,  while  in  cases 
where  morphine  is  contraindicated,  such  as  advan- 
ced kidney  disease,  acute  gout,  or  certain  forms  of 
cerebral  irritation,  antipyrin  may  be  given  freely 
to  allay  pain.  It  has  the  great  advantage  over 
morphine  that  it  does  not  cause  cerebral  symptoms; 
thus  there  is  not  any  vertigo  nor  vomiting,  and 
according  to  Professor  See  the  use  of  the  drug  is 
not  followed  by  sleep  or  nerve  stimulation.  Pro- 
fessor Lepine,  however,  considers  that  antipyrin 
acts  both  as  an  anodyne  and  a  nerve  stimulant, 
so  that  though  it  relieves  pain,  it  at  the  same  time 
quickens  the  intellectual  faculties  of  the  patient, 
and  renders  him  disinclined  for  sleep. 

Taking  his  view  of  the  action  of  antipyrin  as  an 
anodyne,  we  may  say  that  it  is  diametrically 
opposed  to  morphine  in  that  it  acts  as  an  anodyne 
without  depressing  the  higher  brain  centres.  In 
only  two  cases  in  which  I  have  given  antipyrin 
has  it  caused  sleep,  and  in  these  instances  I  believe 
the  sleep  was  rather  the  result  of  relief  from  pain 
than  that  of  any  somnolent  action  of  the  drug. 
The  fact  that  antipyrin  acts  as  a  nerve  stimulant 
as  well  as  an  anodyne  is  a  decided  objection  to  its 
employment  when  we  wish  to  relieve  pain  and  at 
the  same  time  insure  sleep.  The  best  method  in 
such  is  to  follow  the  antipyrin  by  a  hypnotic,  such 
as  chloral. 

For  the  immediate  relief  of  pain  the  drug 
should  be  used  hypodermically,  and,  as  it  is  very 
soluble  in  water,  a  fresh  solution  may  be  made  by 
dissolving  one  of  the  tablets  prepared  by 
Burroughs  &  Wellcome  in  an  equal  weight  of 
water. 

The  dose  for  an  adult,  of  antipyrin  used  hypo- 
dermically to  relieve  pain  is  five  grains.  This  has 
been  calculated  by  Dr.  Frankel,  of  Berlin,  to 
be  equivalent  to  one-thirtieth  of  a  grain  of  mor- 
phine.    The  dose  may   be  repeated  if  the  pain  is 


not  relieved.  Beyond  the  pain  caused  by  the  in- 
jection, and  a  certain  feeling  of  tension  which 
lasts  a  few  seconds,  no  bad  effects  have  been 
noticed.  The  drug  usually  gives  relief  in  from 
fifteen  seconds  to  half  aminute,  and  the  effect  lasts 
for  some  hours  (si.x  to  eight  hours — Frankel). 

.•\s  an  anodyne,  antipyrin  has  been  used  chiefly 
in  herpes  zoster,  lumbago,  ataxia,  hepatic  and 
nephritic  colic,  acute  asthma,  acute  rheumatism, 
and  acute  gout. 

If  given  in  sufficiently  large  doses  it  appears 
to  give  relief  in  the  majority  of  cases.  Dr.  Fran- 
kel gave  it  in  all  cases  in  which  morphine  appear- 
ed to  be  indicated,  and  did  not  meet  with  a 
single  failure.  Dr.  Jennings,  of  Paris,  however, 
side  by  side  with  many  cases  successfully  treated 
by  antipyrin,  mentions  a  case  of  acute  gout 
which  was  influenced  by  the  drug. 

Ifgivenbythe  mouth  as  an  anodyne,  antipyrin 
must  be  used  in  large  doses  ;  thus  Professor  See 
recommends  a  dram  to  a  dram  and  a  half  in  the 
twenty-four  hours,  and  Professor  Lepine  one 
hundred  and  fifty  grains  divided  in  two  doses. 

In  rheumatism  and  gout  the  drug  appears  to 
be  both  sedative  and  curative  in  its  action  ;it  not 
only  allays  the  pain,  but  in  many  cases  shortens 
the  attack.  Profesor  See  gave  it  in  fifteen  cases 
of  hydrarthrosis,  which  had  resisted  treatment 
with  the  salicylates  and  also  counter-irritation  by 
the  actual  cautery.  In  all  these  cases  he  found 
that  swelling  and  pain  disappeared  in  a  few  days. 
Dr.  Frankel  gave  it  in  thirty-four  cases,  with  the 
result  that  in  all  but  two  there  was  amelioration 
of  the  symptoms  and  shortening  of  the  attack. 
In  fifteen  cases,  however,  a  relapse  occurred.  He 
found  that  the  average  duration  of  acute  rheuma- 
tism with  antipyrin  was  twenty-five  days,  while 
with  the  salicylate  treatment  it  was  35.2  days. 
Mr.  Raymond  Johnson  tried  antipyrin  in  four 
cases  of  acute  rheumatism,  with  the  result  that 
it  lowered  the  temperature  in  all,  but  in  only 
one  out  of  the  four  did  it  relieve  the  symptoms. 
The  three  cases  which  were  unrelieved  by  anti- 
pyrin yielded  to  treatment  with  salicylates,  while 
in  the  fourth,  where  salicylate  of  soda  had  failed 
to  relieve  the  patient,  arftipyrin  did  so. 

To  give  relief  in  acute  rheumatism  or  acute 
gout,  large  doses  of  antipyrin  must  be  given,  one 
to  two  drams  during  the  twenty-four  hours  being 
a  usual  dose.  As  a  rule  the  drug  produces  free 
sweating  and  rapid  defervescence.  In  chronic 
rheumatism  it  acts  in  allaying  the  pain  and  shor- 
tening the  course  of  the  disease.  I  have  given 
it  in  a  large  number  of  cases  of  rheumatism,  and 
in  the  majority  I  have  found  it  successful.  It 
appears  to  me  to  be  a  remedy  which  at  least 
should  be  tried  when  the  salicylates  fail  or  pro- 
duce disagreeable  after-effects,  as  they  occa- 
sionally do.  Most  of  the  cases  recorded  in  which 
antipyrin  and  the  salicylate  treatment  have  been 
used  side  by  side,  for  the  purpose  of  comparison, 
yield  either  to  the  one  or  the  other,  the  refractory 


THE  CANADA   MEDICAL   RECORD 


281 


cases  in  either  section  usually  yielding  to  the 
administration  of  the  other  drug.  I  have  not 
any  statistics  to  prove  whether  antipyrin  is  of 
use  in  preventing  the  secondary  troubles  in 
acute  rheunialisni,  such  as  endocarditis. 

Anti])yrin  has  been  used  with  great  success  in 
nervous  disorders,  and  I  believe  it  supplies  us 
with  a  specific  for  many  neuralgic  and  other 
alli.'d  complaints.  Its  success  in  »he  treatment 
of  migraine  and  cephalalgia  is  now  assured,  and 
one  rarely  takes  up  a  periodical  without  finding 
in  it  the  description  of  various  cases  which, 
after  being  more  or  less  intractable  to  remedies 
for  years,  have  yielded  to  antipyrin. 

In  Germany  and  France  especially  has  this 
drug  been  used  in  the  treatment  of  migraine,  and 
to  a  less  extent  in  England.  During  the  last  few 
months  I  have  used  it  in  the  out-patient  depart- 
ment and  in  private  practice  in  such  cases  with 
very  good  results.  As  a  rule  patients  return  after 
having  taken  the  remedy,  and  ask  pointedly  for 
some  more  of  the  same  medicine  that  they  had 
last  time,  a  fact  which  stamjis  its  value  at  once 
on  one's  mind. 

In  treating  migraine  with  this  drug,  I  believe 
the  best  plan  is  to  use  the  remedy  as  a  specific 
against  the  attacks,  and  not  to  administer  it 
continuously.  If  the  migraine  be  periodic,  or  if 
there  be  a  preliminary  aura,  the  drug  should  be 
exhibited  as  soon  as  possible  before  the  threat- 
ened attack.  Thus,  if  an  attack  be  feared  for 
the  morning,  antipyrin  should  be  given  at  night, 
and  if  the  attack  still  threatens  in  the  morning,  a 
further  dose  should  be  administered.  In  this 
way  the  attack  generally  is  aborted.  Even  if 
preliminary  warning  be  absent,  the  medicine 
taken  as  soon  as  the  attack  comes  on  either 
aborts  it  or  renders  its  symptoms  less  intense. 
In  my  experience  it  is  very  rare  for  antipyrin  to 
fail  to  influence  favorably  an  attack  of  migraine, 
and  in  this  I  am  supported  by  almost  all  of  those 
who  have  noted  on  this  drug. 

It  is  rarely  necessary  to  give  large  doses  to 
produce  the  specific  effect.  1  generally  give  five 
to  seven  grains  combined  with  alkalies  and  a 
bitter  infusion,  to  be  taken  when  an  attack 
threatens,  and  to  be  repeated,  if  necessary,  in  an 
hour.  I  find  that  somewhat  larger  doses  are 
recommended  (fifteen  to  twenty  grains),  but 
patients  rarely  complain  that  the  smaller  dose 
fails. 

I  have  found  the  drug  useful  also  in  those 
cases  of  bilious  headache,  which  often  occur 
in  patients  of  full  habit,  who  are  addicted  to  the 
too  frequent  use  of  alcohol.  These  cases,  which 
generally  occur  among  women  in  a  comfortable 
position  in  life,  yield  to  the  administration  of 
antipyrin  ;  I  had  the  satisfaction  of  hearing  a 
patient,  who  has  suffered  in  this  way  for  more 
than  ten  years,  state  that  at  last  a  remedy  had 
been  found  which  relieved  her.  Of  course  the 
remedy  does  not  touch  the  root  of  the  evil. 
In  some  cases  of  cephalalgia,  antipyrin  relieves 


for  a  time,  but  at  length  the  patient  becomes 
habituated  to  the  drug,  and  the  relief  is  less 
marked.  In  such  cases,  either  the  drug  may  be 
increased  or  antifebrin  or  some  other  of  the 
substitutes  for  antipyrin  ma)  be  used. 

As  antipyrin  has  so  marked  an  influence  over 
these  nervous  complaints,  it  seems  natural  to 
supijose  that  it  may  be  useful  in  epilepsy. 

Fraty  concludes  that  it  has  a  distinct  influence 
over  epilepsy  akin  to  that  manifested  by  the 
alkaline  bromides,  but  he  confessses  that  large 
doses  must  be  given  (one  to  two  drams  daily), 
and  that  in  a  considerable  number  of  cases  it 
has  to  be  given  up,  owing  to  the  mnliise  it  pro- 
duces. 

1  have  not  tried  the  drug  in  many  cases  of 
epilepsy,  but  I  was  not  favorably  impressed  with 
the  result  when  I  did  try  it.  As  a  sedative 
antipyrin  has  been  tried  in  cases  of  nocturnal 
emissions,  and  it  has  been  found  that  seven  to 
fifteen  grains,  administered  on  going  to  bed,, 
prevents  the  emission  in  many  cases.  It  also 
acts  in  diminishing  the  excessive  flow  of  urine, 
which  not  infrequently  accompanies  spermatorr- 
hea, and  which  arises  from  the  hyperesthesia  of 
the  nervous  system.  I  would  venture  to  think 
that  this  drug  may  be  well  worth  a  trial  in  those 
cases  which  so  often  are  found  to  exist  in  young 
men,  who  have  fallen  into  the  habit  of  masturba- 
tion at  school,  and  who,  on  coming  into  the 
world,  learn  the  evils  of  it,  and  relinquish  the 
habit,  but  in  whom  spermatorrhea  frequently 
supervenes  to  a  serious  extent.  I  have  given  it 
in  similar  cases  with  good  results,  the  best  plan 
being  to  give  ten  grains  of  antipyrin  in  combina- 
tion with  ten  grains  of  chloral  hydrate  at  bed-time, 
the  patient  usually  falling  asleep  shortly  after 
getting  into  bed,  and  remaining  asleep  without 
disturbance  till  the  morning. 

Antipyrin  was  given  by  M.  Bloch  to  a  neurotic 
man  with  a  tender  spine,  who  was  periodically 
overcome  by  attacks  of  drowsiness,  which  come 
on  after  each  meal  ;  these  were  accompanied  by 
pains  in  the  head  and  debility.  His  condition 
had  been  improved  by  the  use  of  nux  vomica  to 
some  extent  ;  but,  on  the  exhibition  of  antipyrin 
in  fifteen-grain  doses,  given  on  waking  and  at  ii 
a.  m.,  the  drowsiness  after  a  few  days  disappeared, 
and  the  remaining  nervous  symptoms  abated. 
In  this  case  it  acted  as  a  decided  nerve  stimu- 
lant. 

The  drug  has  been  strongly  recommended  in 
cases  of  chorea  by  Legroux,  who  considers  it  a 
most  rapid,  certain,  and  inoffensive  remedy.  He 
administered  it  in  six  cases,  giving  forty  to  fifty 
grains  daily.  All  his  cases  recovered  rapidly  in 
from  six  to  twenty-seven  days.  I  have  not 
had  the  opportunity  to  use  it  frequently  in 
chorea,  but  in  such  cases  as  I  have  used  it  the 
movements  diminished  rapidly.  In  one  child  to 
'ihom  I  gave  the  drug  it  had  to  be  discontinued, 
owing  to  the  cardiac  depression  which  accompa- 
nied its  use. 


282 


THE  CANADA  MEDICAL  RECORD. 


Antipyrin  has  been  used  with  -success  in  spas- 
modic nervous  disorders,  such  as  hay-fever  and 
whooping  cough.  Dr.  Bloch  tried  it  in  a  case 
of  hay-fever,  in  which  cocaine  and  the  bromides 
had  been  given  without  result.  He  gave  it  in 
thirty-grain  doses  at  the  hours  when  the  attacks 
usually  came  on,  and  found  that  the  drug  abor- 
ted the  attacks.  After  taking  antipyrin  for  some 
weeks  the  disease  disappeared  in  this  case. 

Sonnenberger,  from  an  experience  of  seventy 
cases  in  which  he  used  the  drug  in  whooping-cough, 
concludes  that  it  is  a  very  useful  remedy  in  such 
cases.  He  gave  it  to  infants  in  doses  of  one 
half  to  one  and  one  half  grains  three  times  a  day 
in  syrup  of  tolu  or  raspberry,  increasing  the  dose 
to  ten  or  fifteen  grains  for  older  children.  The 
remedy  must  be  used  systematically,  to  produce 
a  good  result  in  whooping-cough. 

In  nervous  vomiting,  especially  in  the  vomiting 
of  pregnancy,  antipyrin  is  useful.  If  the  vomit- 
ing be  periodic,  the  drug  should  be  given  a  few 
hours  before  the  usual  appearance  of  the  attack. 
In  sea-sickness  the  drug  has  been  lauded  as  a 
specific,  perhaps  only  to  have  its  day  as  most 
other  specifics  for  this  disorder  have  had.  More 
than  one  medical  man  has,  however,  recorded 
the  debt  of  gratitude  he  owes  to  this  remedy  in 
crossing  the  Atlantic. 

Antipyrin  has  been  used  as  a  hemostatic  in 
cases  of  pulmonary  hemorrhage  by  Dr.  Olikoff. 
He  made  a  solution  of  fifteen  grains  to  the  ounce 
in  water,  and  made  his  patients  breath  through 
this  for  four  or  five  respirations,  repeating  the 
use  of  it  every  half  hour.  In  all  the  six  cases 
tried,  the  hemorrhage  was  diminished.  As  a 
hemostatic  for  general  purposes,  antipyrin  is  too 
costly  a  remedy  to  be  employed  lavishly,  though 
it  has  been  recommended  for  epistaxis  and  other 
forms  of  hemorrhage.  Herpes  zoster  a]id  loco- 
motor ataxy  have  both  been  successfully  treated 
with  antipyrin.  In  locomotor  ataxy  it  appears  to 
act  in  alleviating  the  lightning  pains  and  in  giv- 
ing ease  to  the  patient  rather  than  by  altering 
the  course  of  the  malady. 

Since  antipyrin  became  a  popular  remedy, 
many  cases  in  which  the  drug  has  produced 
disagreeable  effects  have  been  recorded,  though, 
as  far  as  I  am  aware,  none  of  these  cases  has 
ended  fatally,  nor  have  there  been  any  symptoms 
which  have  lasted  more  than  a  few  hours.  The 
cases  which  I  have  collected  (more  than  twelve 
in  number)  appear  to  me  to  be  pure  examples  of 
idiosyncrasy.  They  are  usually  isolated  cases, 
occurring  amid  many  others  in  which  the  same 
quantity  of  the  drug  was  administered.  They, 
do  not  appear  to  depend  on  the  quantity  of  the 
drug  given,  for  in  one  case  four  grains,  in  another 
eight  grains,  and  in  a  third  fifteen  grains  of 
antipyrin  produced  symptoms  of  poisoning, 
though  more  than  double  the  dose  has  been  given 
in  many  hundreds  of  cases  without  bad  effects. 
There  is,  as  far  as  I  can  find,  no  special  class  of 


cases  in  which  the  administration  of  antipyrin 
is  likely  to  bring'  on  symptoms  of  poisoning  ; 
but,  as  it  appears  in  certain  individuals  to  cause 
disagreeable  symptoms,  regardless  of  dose,  we 
are  likely  to  hear  further  of  this  property  it 
possesses  from  some  of  the  large  number  of  people 
who  are  now  taking  the  drug  as  a  preventive 
against  sea-sickness. 

The  chief  symptoms  which  manifest  them- 
selves in  cases  of  poisoning  by  antipyrin  are 
certain  nervous  sensations,  such  as  restlessness, 
loss  of  memory,  a  feeling  of  general  expansion  of 
the  body,  and  a  sensation  of  great  coldness. 
These  are  followed  by  swelling  of  the  face  and 
the  appearance  of  an  erythematous  eruption 
resembling  measles — so  much  like  it,  in  fact,  that 
those  who  have  seen  cases  of  antipyrin  rash  are 
careful  to  warn  us  to  avoid  the  diagnosis  of 
measles  in  patients  taking  antipyrin. 

The  chief  points  of  difference  between  this 
rash  and  measles  are  that  it  appears  but  slightly 
on  the  f?ce,  that  its  chief  distribution  is  on  the 
extremities,  that  it  is  non-crescentic  in  distribu- 
tion. In  many  cases  it  is  not  accompanied  by 
catarrh  of  the  eyes  and  nose,  but  in  a  few  cases 
catarrh  does  occur,  and  when  present  it  must 
make  the  differential  diagnosis  very  difficult. 
Besides  these  symptoms,  antipyrin  may  cause 
diaphoresis,  feebleness  of  the  pulse,  and  gen- 
eral collapse.     Gastro  enteritis  occurs  rarely. 

The  antidote  which  removes  these  disagreeable 
effects  most  readily  is  belladonna,  given  either 
as  the  tincture  or  in  the  form  of  atropine  used 
hypodermically  (one-seventieth  of  a  grain). 


THE  SPECIFIC    TREATMENT    OF    TY- 
PHOID FEVER,  (i) 

By    WILLIAM    F.    WAUGH,     A.M.,     M.D. 

When  Klcbs  told  us  of  the  baci'lus  typl.osis  in 
1 88 1,  he  recommended  as  a  suitable  remedy  the 
benzoate  of  sodium  or  of  magnesium. 

His  reason  for  preferring  these  salts  over  car- 
bolic and  salicylic  acids,  and  other  germicidal 
remedies,  was  that  none  of  the  latter  could  be 
given  in  really  efficient  doses,  continuously,  for 
a  sufficiently  lengthy  period,  to  accomplish  the 
object,  without  causing  undesirable  and  injurious 
effects  in  the  patient.  He  recommended  that  the 
benzoates  be  used  by  inhalation,  by  gargling,  and 
given  internally  in  doses  of  320  grains  per  day. (2) 

Since  the  publication  of  Klebs'  discoveries  in 
1881.  I  have  made  use  of  the  remedies  he  sug- 
gested in  all  my  cases  f  f  typhoid  fever  up  to  last 
fall,  with  very  fair  results.  The  cases  usually  ran 
a  mild  course  :  were  free,  as  a  rule,  from  alarming 
accidents,  and  the  death-rate  was  low.  But  on 
looking  back   over  this  period,  and  taking  into 


(t)  Read  before  the  Pennsylvania  State  Medical  Society, 
June  7,   1S88. 

(2)  riiila.  Med.  7Vm£-.i,  Dec.  3,  lSSl,p.   152, 


THE   CANADA   MEDICAL   RECORD. 


28^ 


account  the  results  of  increased  care  in  nursing, 
feeding  and  wateiiing  my  cases,  together  vvitl)  the 
disuse  of  irritants  like  quinine  and  the  mineral 
acids,  ]  am  unable  to  say  tliat  tliere  was  any  im- 
provement distinctly  due  to  the  use  of  the  benzo- 
ates.  As  a  speaker  once  said,  concerning  the 
bacillus  tuberculosis:  "We  do  not  need  him;  we 
can  exi)lain  all  the  phenomena  of  the  disease 
without  him."' 

During  the  summer  of  18S7,  1  began  the  use  of 
the  sulpho-carbolate  of  zinc  in  summer  complaint, 
The  results  of  this  treatment  have  been  already 
puljlished.  Suffice  it  to  say  here  that  the  success 
wliich  ensued  was,  in  my  opinion,  clearly  due  to 
the  addition  of  this  drug  to  the  treatment. 

There  can  hardly  be  a  doubt  that  we  have  in 
summer  complaint  (using  the  word  to  cover  all 
the  varieties  of  summer  diarrhoea)  the  action  of  a 
specific  microbe  which  has  made  the  gastro-intes- 
tinal  canal  the  seat  of  its  operations  ;  and  that  the 
hot  head,  the  fever  and  the  symptoms  of  the  so- 
called  hydrencephaloid  are  due  to  the  absorption 
and  circulation  in  the  blood  oftho  poisons  gener- 
ated by  these  organisms  in  the  intestinal  canal. 

That  the  cause  of  death  is  not  exhaustion  from 
diarrhcea  in  all  cases  is  potent  to  every  observer 
who  has  seen  patients  die,  when  the  discharges 
had  been  stopped  while  the  fever  and  cerebral 
symptoms  increased. 

Several  notable  phenomena  followed  the  admin- 
istration of  sulpho-carbolate  of  zinc  in  this  dis- 
ease : 

ist.  The  irritability  of  the  stomach  was  relieved 
from  the  time  the  first  dose  was  given. 

2nd.  The  stools  at  once  changed  in  their  con- 
dition, losing  the  fetid  odor  which  previously 
characterized  them. 

3d.  The  heat  of  the  forehead  disappeared,  as 
did  that  of  the  epigastrium  ;  the  cerebral  symptoms 
improved  at  once,  and  in  case  the  fever  was 
high,  it  fell  to  near  the  normal  point. 

That  these  results  were  due  to  the  local  germi- 
cidal action  of  the  drug  is  shown  by  the  fact  that, 
when  the  discharges  partook  of  the  dysenteric  cha- 
racter, the  administration  of  the  drug  by  the  mouth 
proved  insufficient ;  but  a  speedy  cure  resulted 
when  the  zinc  salt  was  given  by  enema. 

It  was  found  that  infants  in  their  second  sum- 
mer bore  two-grain  doses  of  this  drug  very  readily, 
showing  it  to  be  far  less  irritant  than  the  ordinary 
salts  of  zinc. 

I'hese  results,  it  will  be  seen,  are  quite  consis- 
tent with  the  theory  that  the  general  symptoms  of 
summer  complaint  are  due  to  an  intoxication  of 
the  blood  with  the  products  of  the  disease- 
germs  ;  not  an  invasion  by  the  germs  them- 
selves, as,  in  that  case,  the  local  action  of  a 
germicide  m  the  intestinal  canal  could  not  ac- 
count for  the  beneficial  results. 

This  experience  in  summer  complaint  led  me  to 
give  the  same  agent  a  trial  in  typhoid  fever.  Here 
we  have  a  somewhat  similar  condition  :  a  specific 
micro-organism  inhabiting  the  intestinal  canal  and 


l)roducing  general  .symptoms.  If  the  sulpho- 
carbolate  prove  as  efficient  a  germicide  as  in  the 
other  disease,  it  will  enable  us  to  separate  the 
synijitoms  due  to  the  jioisons  generated  by  the 
disease-germs  in  the  intestinal  canal  from  those 
produced  by  those  germs  which  have  i)enetrated 
beyond  the  reach  of  germicides. 

I  fmd  on  looking  over  my  notes,  tliat  I  have 
treated  twelve  cases  with  the  zinc  salt. 

Thiee  of  these  were  diagnosed  as  incipient 
typhoid,  including  "one  in  which  Dr.  Goodman 
called  me  in  consultation,  and  i.i  which  we  agreed 
as  to  the  diagnosis.  In  these  three  cases  the  symp- 
toms disappeared  when  the  sulpho-carbolate  was 
given  ;  so  that  the  diagnosis  must  be  considered 
doubtt'ul. 

The  others  were  well  marked.  In  one  case  I 
was  called  in  the  second  week.  Repeated  hemorr- 
hages from  tiie  bowels  had  reduced  the  patient's 
strength  greatly  ;  her  ])ulse  was  very  rapid  and 
feeble;  the  temperature  rose  to  105°  ;and  her 
stomach  could  retain  nodiing.  During  the  after- 
noon following  my  first  visit  she  had  another 
hemorrhage  ;  but,  with  this  exception,  her 
improvement  was  uninterrupted  and  remarkable 
for  so  severe  a  case.  The  gastric  irritability 
disappeared  with  the  first  dose;  the  hemorrhage 
ceased,  the  stools  became  odorless,  the  diarrhcea 
stopped,  the  tympanites  subsided,  and  the  tem- 
perature never  thereafter  rose  above  102.5  °  ■ 

In  another  case,  which  I  attended  for  my  friend 
Dr.  Woodbury,  and  in  which,  I  am  informed.  Dr. 
Cleeman  coincided  as  to  the  diagnosis,  the  tem- 
perature never  rose  above  103  °  and  the  diarrhoea 
ceased  when  the  zinc  was  given.  There  were 
scarcely  any  cerebral  symptoms,  and  the  disease 
ran  an  unusually  speedy  course. 

In  one  case  the  treatment  failed  to  save  the 
patient.  This  was  a  hospital  ca?e  which  had  run 
on  into  the  third  week,  with  profuse  diarrhoea, 
repeated  intestinal  hemorrhages,  profound  pros- 
tration, and  the  gravest  cerebral  symptoms.  It 
was  with  difficulty  his  attention  could  be  roused, 
and  tor  some  time  he  had  recognized  no  one.  It 
had  been  found  necessary  to  give  him  stimulants 
hourly. 

This  was  his  condition  when  I  went  on  duty. 
All  that  a  local  germicide  could  do  was  accom- 
plished by  the  sulpho-carbolate  of  zinc  ;  the  tem- 
perature fell  2  °  ;  the  hemorrhages  were  stopped 
as  well  as  the  diarrhrea ;  and  the  frightful  fetor  of 
the  stools  disappeared.  The  man  lingered  for 
four  days — thanks  to  the  excellent  regimen 
instituted  by  my  predecessor — and  then  died, 
comatose.  In  this  case  there  was  evidently  an 
invasion  of  the  blood  by  the  typhoid  bacilli. 
This  was  the  only  death ;  and,  under  the  circum- 
stances narrated,  I  do  not  consider  that  it  should 
be  counted  in  estimating  the  value  of  the  treat- 
ment. 

Not  to  weary  you  with  the  repetition  of  case- 
histories,  I  will  sum  up  the  effects  of  the  sulpho- 


284 


TPHE  CANADA   MEDICAL   RECORD. 


carbolate  of  zinc  by  saying  that  in  every    case  its 
use  was  followed  by  : — 

1.  Relief  from  gastric  distress. 

2.  Disappearance  of  fetor  from  the  stools. 

3.  Moderation  or  stoppage  of  diarrhoea. 

4.  Ceasing  of  hemorrhage. 

5.  Ceasing  of  tympanites. 

Reduction  of  temperature  by  two  to  three  de- 
grees, witli  a  corresjionding  improvement  in  the 
cerebral  symptoms,  except  in  the  case  detailed 
above. 

There  are  some  cases  occurring  in  this  city  of 
doubtful  pathogeny,  which  are  sometimes  classed 
as  typhoid,  sometimes  as  typho-malarial.  They 
are  characterized  by  fever,  which  ranges  from 
102.5  °  in  the  morning  to  104.5  °  i"  '^'"'^  evening, 
dry  tongue,  brown  in  the  centre,  but  coated  to  the 
tip  and  edges  ;  tenderness  in  the  epigastrium,  but 
not  in  the  iliac  fossa;  ;  great  debihty,  anore.xia  and 
gastric  irritability,  but  no  diarrhoea  unless  a  laxa- 
tive is  given,  in  which  case  profuse  catharsis  en 
sues,  with  an  aggravation  of  all  the  symptoms.  I 
have  never  found  the  typhoid  spots  in  these  cases. 
Quinine  could  not  be  borne  by  the  stomach,  but 
gave  great  relief  when  given  by  suppository  in 
scruple  doses. 

In  these  cases  the  sulpho-carbolate  of  zinc,  in 
dases  of  three  to  five  grains  every  two  hours,  effects 
a  cure  so  rapidly  that  I  am  constrained  to  believe 
that  the  disease  in  question  is  due  to  a  microbic 
invasion  of  the  stomach. 

Permit  me,  in  conclusion,  to  advert  briefly  to  the 
diet  of  typhoid  fever.  About  a  year  ago  a  French 
chnician,  Du  jardinBeaumeiz,  refeiring  to  the  use 
of  milk  in  typhoid  fever,  staled  that  this  food  could 
only  nourish  through  its  water  and  salts,  as  neither 
ohe  casein  nor  the  fat  can  be  absorbed  ;and  hence 
these  substances  are  injurious.  It  struck  me  as 
tignificant  that,  although  this  statement  was  made 
sn  the  Academy  of  Medicine,  where  so  many  keen- 
iwitted  men  are  continually  on  the  look-out  for 
opportunities  to  distinguish  themselves,  and 
where,  as  in  the  case  of  Professor  Peter,  one  man 
rather  enjoys  the  prospect  of  being  arrayed  against 
the  whole  body  of  his  fellows,  not  one  was  raised 
in  defence  of  milk. 

And  yet  there  is  a  source  of  fallacy  in  the  case 
against  it,  on  which  an  argument  might  be  hung  : 
in  that  the  typhoid  process  may  not  effect  all  the 
lacteals — at  least  not  all  at  the  same  period,  and 
hence  some  absorption  may  take    place. 

Be  this  as  it  may,  the  researches  of  Vaughan  on 
tyrotoxicon  may  well  raise  a  doubt  as  to  the  pro- 
priety of  introducing  a  highly  organized  and  read- 
ily decomposed  body  like  milk  into  such  a  sink  of 
impurity  as  the  gastro-intestinal  system  of  a  ty- 
phoid patient. 

In  all  the  cases  in  the  series  reported,  prediges- 
ted  foods  were  substituted;  and  I  cannot  but  at- 
tribute much  of  the  freedom  from  tympany,  diarr- 
hoea, etc.,  to  this  cau-se  Very  little  stimulant  was 
needed  ;  in  fact,  not  more  than  was  to  be  found  in 


one  of  the  beef  preparations  in  the  market,  which 
was  given  in  the  weaker  stages. 

In  conclusion,  I  will  say  that  while  my  eight 
undoubted  cases  are  too  tew  to  afford  more  than 
an  indication  of  the  truth,  the  uniformity  of  the 
results  obtained  leads  me  to  believe  that  in  the 
sulpho-carbolate  of  zinc  we  have  probably  a  rem- 
edy for  typhoid  more  nearly  specific  than  any 
heretofore  proposed — in  that  its  use  is  a  legitimate 
deduction  from  the  pathology  of  the  disease. 

The  food  preparations  most  used  in  this  series 
of  cases  were  Carnrick's  soluble  food,  with  liquid 
peptonoids  or  Rudisch's  sarco-peptones ;  and, 
i  when  slight  stimulation  was  indicated.  Bovine  was 
added  to  the  proceeding.  In  addition  to  these, 
the  white  of  egg  was  given  in  the  raw  state,  mixed 
with  cold  water  and  a  little  pepsin  added.  In  one 
case  Wells  and  Richardson's  lactated  food  was 
used.— Phila.   Times. 


LACTIC  ACID  AND  DIET  IN  INFANTII,E 
DIARRHCEA. 

By   Fr.\nk  Whitfield    Sh.wv,  M.D.,  Physician   to  the 
Brooklyn  City  Dispensary. 

Less  than  two  years  ago,  Hayem,  of  Paris,  pre- 
sented to  the  Academy  of  Medicine  in  that  city  a 
report  on  the  use  of  lactic  acid  in  the  green 
diarrhoea  of  children.  In  the  preparation  of  this 
work  he  had  been  assisted  by  his  interne,  Lesage, 
whose  particular  share  in  it  had  been  the  develop- 
ment of  some  pure  gelatin  cultivations  of  a  germ 
which  Hayem  had  discovered  as  being  present  in 
the  vomited  and  rectal  discharges  of  this  variety 
of  diarrhoea.  He  said  he  had  established  beyond 
the  possibility  of  a  doubt,  by  clinical  experiment, 
the  direct  relation  of  this  germ  to  the  green 
color,  and  as  such  he  claimed  for  it  the  right  of 
discovery. 

However,  soon  after  his  report  was  published, 
this  claim  was  contested  by  Dimaschino, 
who  said  that,  three  years  before  he  had  discovered 
this  same  microbe,  had  shown  its  relation  to  green 
diarrhosa,  and  had  presented  to  the  Biological 
Society  some  micro-photographs  of  it. 

Hayem  admitted  his  priority  to  the  microscopi- 
cal discovery,  but  still  claimed  as  his  own  the  cre- 
dit for  showing  the  proper  relation  of  the  bacillus 
to  the  particular  from  of  diarrhea.  He  stated 
that  Damaschino  had  gone  no  further  than  ni-rely 
to  recognize  the  germ,  and  then  cited  the  experi- 
ments which  Lesage  had  made  of  introducing  into 
the  intestinal  tract  of  healthy  animals  some  pure 
cuhivations,  and  producing  by  them  a  characte- 
ristic green  diarrhoea.  He  also  showed  that  the 
discharges  were  contagious. 

The  microbes,  which  are  rod-sliaped  and  can 
exist  only  in  an  alkaline  medium,  show  a  dis])Osi- 
tion  to  bunch  themselves  into  groups,  and  their 
number  is  in  direct  re'ation  to  the  severity  of  the 
attack. 

These  are,  therefore,  the  first  successful  attempts 
to  establish  the    parasitic  origin  of  at  least   one 


TIIF,   CANADA   MEDICAL   RECORD. 


285 


form  of  diarrhcea,  as  probably  also  they  are  the 
first  efforts  to  treat  the  disorder  according  to 
germicidal  method.  .Since  then,  in  this  country, 
that  attention  has  not  been  given  to  the  experi- 
ments which  the  conclusions  would  seem  to 
warrant. 

It  was  my  privilege,  soon  after  the  report  of 
Hayem  was  published,  to  have  an  opportunity  of 
testing  clinically  in  dispensaiy  work  the  statements 
made  by  him.  After  using  the  acid  in  the  green 
form  of  diarrhrca  for  a  short  time,  the  suggestion 
1  resented  itself  of  trying  the  effect  of  it  in  all  the 
vaiieties  of  diarrhaa  without  reference  to  the  color 
of  the  stouls.  The  idea  of  the  universal  application 
of  germicides  to  diarrhua  was  slrengthenfd 
by  the  paper,  a  few  months  later,  of  Dr.  Wm. 
Booker,  read  before  the  International  Medical 
Congress  at  Washington,  on  the  different  forms  of 
bacteria  found  in  the  discharges  of  summer 
diarrhcea.  He  stated  that  twelve  varieties  had 
been  isolated,  eleven  being  bacilli  and  one  belong- 
ing to  the  variety  cocci.  He  gave  their  action  on 
milk  as  follows  :  "  Some  coagulated  milk  with  acid 
reaction  and  evolution  of  gas  ;  one  caused  coagu- 
lation with  alkaline  reaction  ;  one  gave  the  milk 
a  peptonized  appearance ;  and  other  varieties 
caused  no  perceptible  change." 

On  account  of  its  simplicity  as  well  as  its 
elegance,  the  employment  of  this  universal  acid 
treatiTient  was  a  very  easy  one,  and  the  results 
were  such  as  to  leave  no  doubt  as  to  its  usefulness. 
The  trial  began  during  the  summer  of  1S87  and 
has  been  continued  during  the  present  summer, 
ever  one  hundred  patients  receiving  the  treat- 
n  ent. 

The  age  of  the  patients  varied  from  ten  weeks 
to  twenty  four  months,  and  there  was  great  variety 
in  the  severity.  The  stools,  which  ranged  from 
three  to  twenty  daily,  presented  all  the  varieties 
found  in  the  different  forms  of  diarrhcea.  They 
were  the  watery-mucous,  the  yellow  widi  coagula- 
ted casein,  the  slightly  greenish  with  mucus,  casein, 
and  sometimes  blood,  and  the  distinctly  green.  In 
very  few  cases  of  the  green  diarrhcea  so  treated 
was  there  failure  to  afford  some  relief,  and  many 
of  the  recoveries  were  certainly  remarkable.  But, 
while  the  trial  confirmed  the  conclusions  of  Hayem 
as  to  green  diarrhoea,  it  also  established  the  use- 
fulness of  the  acid  in  the  other  varieties. 

The  significant  features  in  support  of  lactic  acid 
are  these  :  It  not  only  relieves  the  diarrhcea,  but 
it  also  acts  beneficially  for  the  vomiting,  fever, 
and  restlessness.  It  changes  also  the  very  offen- 
sive odor  of  the  stools. 

The  voiniting  is  controlled  within  a  few  hours 
so  completely  that  the  child  can  begin  to  take 
nourishment,  and,  aUIiough  it  may  subsequently 
occur  at  intervals,  a  continuance  of  the  treatment 
soon  stops  it.  Again,  the  fever  which  attends 
every  case  of  any  severity  is  reduced  by  it.  To 
not  a  single  child  in  the  one  hundred  cases  was 
any  antipyretic  given,  the  fever  usually  subsiding 
before  the  diarrhrea  had  fully  stopped.      Attending 


the  reduction  of  temperature  there  was  shown  a 
disposition  to  sleep,  and  the  intestinal  pain, 
which  was  often  severe,  received  no  other  medica- 
tion than  the  acid.  To  none  of  them  was  opium 
given  in  any  form. 

Within  a  period  varying  from  twelve  to  seventy- 
two  hours,  the  discharges  would  begin  to  change, 
the  greenish  becoming  less  watery  and  assuming 
a  yellow  color,  while  the  watery-yellow  and  some- 
times bloody  hada  greater  consistence  without  the 
unpleasant  odor. 

'I'he  general  results  have  been  so  satisfactory 
that  all  astringent  and  alkaline  remedies  have 
been  abandoned,  lactic  acid  alone  now  being  given, 
no  matter  what  variety  of  diarrhoea  presents 
itself. 

But  as  the  children  so  treated  came  largely  from 
the  tenement  houses,  where  crowding,  heat,  poor 
ventilation,  and  improper  food  are  iinportant 
factors,  it  was  found  advisable  to  adopt  some 
form  of  dietetic  measure  in  connection  with  the 
acid.  In  a  monograph  on  the  treatment  of  the 
diseases  of  children,  read  by  Dr.  Jacobi  in  1879,  a 
valuable  suggestion  is  given  concerning  the  feed- 
ing of  children.  The  frequency  of  diarrhcea  in 
children  fed  wholly  on  breast  milk  had  already 
presented  itself,  and  for  a  considerable  time  it 
had  seemed  contrary  to  reason  to  so  continue 
feeding,  although  good  authorities  advised,  when- 
ever possible,  to  insist  upon  a  diet  wholly  of  breast 
milk.  This  was  done,  and  the  results  were  no 
better,  while  in  children  somewhat  older  who  had 
begun  to  take  other  foods,  there  was  usually  a 
benefit  when  these  were  alternated  with  mother's 
milk.  An  exclusive  diet,  either  of  breast  milk  or 
prepared  food,  did  not  seem  to  give  good  results, 
and  the  question  was  not  satisfactorily  answered 
until  the  method  employed  by  Dr.  Jacobi  was 
tried.  In  his  monograph  he  states  that  even 
normal  mother's  milk  contains  fat  that  is  not 
digested,  and  that  when  diarrhoea  occurs,  if  lumps 
are  found  in  the  passages,  they  are  not  wholly 
undigested  casein,  but,  on  the  contrary,  are  mostly 
fat,  and  probably  remnants  of  intestinal  epithelium. 
These  fats  are  olein,  margarin,  and  stearin.  Fatty 
acid  in  abundance  is  a  common  cause  of  derange- 
ment of  digestion  and  assimilation,  and  it  impedes- 
the  normal  secretion  of  other  digestive  fluids. 

He  then  quotes  the  conclusions  of  Wegscheider 
concerning  the  fat  in  breast  milk  :  "  Fat  can  not  1  e 
completely  absorbed  :  one  part  leaves  the  intestines 
in  a  saponified  condition  ;  a  second  part  as  free 
fatty  acid ;  a  third  as  fat  in  an  unchanged  condi- 
tion." From  this  he  concludes  that  one  precaution 
to  observe  is  to  guard  against  food  too  rich  in  fat. 
As  the  mother's  milk  is  best  when  it  can  be  tolera- 
ted, he  endeavors  to  make  tliis  possible  by  diluting 
it  with  some  liquid  farinaceous  food.  To  do  this, 
he  suggests  preceding  the  nursing  by  one  or  two 
teaspoonfuls  of  barley-water.  Instead,  however, 
of  the  barley-water,  some  of  the  prepared  foods 
w  re  tried  according  to  this  princijile,  and  the 
results  were  beneficial,  due.  probably,  to  the  small 


286 


THE   CANADA    MEDICAL   RECORD. 


percentage  of  fat  which  they  have  been  shown  to 
contain.  There  was  less  troublesome  casein  to 
act  as  an  intestinal  irritant,  and,  when  they  were 
taken  in  connection  with  the  lactic  acid,  recovery 
was  usually  speedy.  This  dietic  precaution  has 
been  adopted,  and  is  recommended,  whenever 
practical,  in  either  variety  of  exclusive  diet. 

The  size  and  frequency  of  the  dose  of  lactic  acid 
varies  entirely  with  the  age  of  the  patient  and  with 
the  number  of  discharges.  A  two-per-cent.  solu- 
tion is  usually  ordered.  The  following  is  the 
formula  advised  by  Dr.  Hayem  : 

R  Pure  lactic  acid 3   ss.; 

Syrup , ,...      3  j: 

Water 3  iij.  M. 

Each  drachm  of  the  solution  contains  about  one 
drop  of  pure  lactic  acid. 

For  a  child  under  twelve  months,  half  a  teaspoon- 
ful  every  hour  is  sufficient.  If  the  discharges  are 
very  frequent,  a  teaspoonful  may  be  given  every 
hour  for  six  doses, changing  them  to  half  a  teaspoon- 
ful. For  over  twelve  months  a  teaspoonful  every 
hour  is  the  ordinary  dose.  Dr.  Hayem  recommends 
its  use  one  day  after  the  diarrhcea  has  stopped. 
The  large  dose  at  first  suggested  in  the  report  do 
not  appear  to  be  necessary,  and  there  is  danger,  if 
it  is  given  in  larger  quantities,  of  causing  irritation 
of  the  buccal  mucous  membrane.  It  is  best  to 
dilute  even  these  small  doses,  as  otherwise  there  is 
a  decided  acid  taste,  not  unpleasant,  however. 

Other  germicides  have  been  suggested  and  tried, 
such  as  salicylate  of  sodium  and  naphthaline  ;  but 
lactic  acid,  while  possessing  all  the  curative  pro- 
perties of  the  others,  has  additional  advantages  : 

1.  It  is  more  palatable  than  salicylate  of  sodium 
or  naphthaline,  more  readily  tolerated,  and  simpler 
to  administer. 

2.  It  controls  vomiting,  and  permits  the  earlier 
use  of  food. 

3.  Under  it,  temperature  is  reduced  and  intesti- 
nal pain  quieted. 

4.  Restlessness  is  overcome,  and  sleep  rendered 
possible  without  the  use  of  opiates. 

327  Greene  Avenue,  Brooklyn. 
KY.  Med.  Journal. 


THE  USE  OF  ANTIPYRIN  DURING 
LABOR. 

Although  it  is  written,  "  In  sorrow  thou  shalt 
bring  forth  children,  "it  is  the  laudable  aim  of  the 
obstetrician  of  to-day  to  mitigate,  in  so  far  as  he  is 
able,  the  pangs  of  childbirth.  The  means  to  this 
end,  to  which  we  may  resort  without  damage  to 
either  the  mother  or  tiie  child,  are  few  in  number, 
and  the  most  valuable  of  all  justly  finds  its  chief 
rank  after    the  completion  of  the  first  stage  of 

labor The  excellent  results  yielded  me  by 

antipyrine  in  dysmenorrhcea  and  others  affections, 
where  it  is  a  question  of  neive  pain,  have  led  me 
during  the  i)ast  year  to  test  it  during  the  first  stage 
of  labor,  and  my  results  have  been  sufticiently 
gratifying  to  justify  me  in  asking  other  obstetri- 
cians to  try  the  drug.     Possibly  it  has  been  simi- 


larly used  by  others,  but  if  such  be  the  case  I 
have  seen  no  record  of  experience.  My  habit  in 
regard  to  the  administration  of  the  drug  is  to  give 
fifteen  grains  well  diluted,  and  preferably  with 
some  stimulant,  such  as  the  aromatic  spirits  of 
ammonia,  and  to  repeat  the  dose  in  one  hour 
thereafter.  In  two  hours  after  the  second  dose  the 
patient  receives  ten  grains,  and  so  on  every  two 
hours  if  needed.  The  chloral  mixture  I  admin'ster, 
as  has  always  been  my  custom,  in  fifteen-grain 
doses  every  three-quarters  of  an  hour  till  three  or 
four  doses  have  been  received.  The  result  of  this 
combination  has  been  to  nullify  the  pains  so  much 
as  to  be  in  two  instances  scarcely  perceptible, 
and  in  others  simply  uncomfortable.  The  progress 
of  labor  has  not  been  at  all  interfered  with,  and 
neither  the  mother  nor  the  child  have  presented 
evidence  of  injury  from  the  administration  of  the 
antipyrine. 

I  report  this  experience  thus  briefly,  in  order 
that  others  observers  may  test  the  validity  of  my 
results.  Should  there  be  concurrence  of  opinion, 
the  first  stage  of  labor  will  be  rendered  practi- 
cally painless  by  antipyrine,  even  as  the  second 
and  the  third  may  at  any  time  be  made  through 
resort  to  chloroform. — I)r.  Egbert  H.  Gnidiii,  in 
iVeic   York  Medical  Journal. 

Dysmenorrhe.^. — Calvin  : 

1^. — Tr.  gelsemii — 

Tr.    camphrte — 

Tr.  opii  camphoratfe  aa  3  ij 

M.  S. — Thirty  drops  every   two    hours  p.  r.  n. 


TRE.AT.MENT  OF  CARBUNCLE. 

I  have  tried  the  expectant  treatment  of  carbun- 
cle recommended  by  Paget ;  but  find  it  so  long, 
tedious,  and  painful  to  my  patients  that  I  have  com- 
pletely discarded -it.  The  treatment  by  excision 
and  scraping  is  too  severe  to  be  generally  adopted 
in  private  practice,  although  it  has  been  apparently 
very  successful. 

I  have  adopted  the  following  for  the  last  three 
years,  to  which  I  have  added  the  hypodermic 
injection  of  cocaine.  I  inject  into  the  carbuncle 
hypodermically  half  a  grain  of  hydrochlorate  of 
cocaine,  and  wait  about  five  minutes  until  the  skin 
is  quite  anesthetic  ;  then  I  make  a  small  incision 
into  the  centre  of  the  carbuncle  with  a  tenotomy 
knife,  and  insert  a  small  sharp  piece  of  potassa 
fusa,  and  then  push  it  home.  Afterward  apiece  of 
belladonna  plaster  is  cut  circular,  a  little  larger 
than  the  carbuncle,  and  placed  over  it.  The  plas- 
ter serves  the  double  purpose  of  retaining  the  caus- 
tic and  of  alleviating  the  jiain.  This  is  kept  on  for 
eight  hours,  and  then  it  is  taken  off,  and  hot  lin- 
seed poultices  are  applied  for  the  same  length  of 
time.  The  result  is  that  the  patient  always  reco- 
vers about  three  days  after  the  commencement  of 
the  treatment,  which  in  this  way  is  carried  out 
almost  painlessly.  — Robert  Main,  M.  D.,  British 
Med.  Journal. 


TUE   CANADA   MEDICAL    RECORD. 


287 


VOMITING  IN   PREGNANCY   A  SIGN    OF 
rilK  SEX  OF  THE  CHILD. 

WlNI'IKLD,  AkK. 

Ed.  RiiviEw. —  It  would  bea  source  of  pleasure 
to  most  prospective  lathers  and  mothers  to  be 
able  to  tell,  or  even  to  know  with  approximate 
certiinty,  what  sex  their  child  will  be.  At  one 
time  the  number  of  foetal  heart-sounds  to  the 
minute  was  thought  to  be  an  index,  but  this  sign 
has  been  proven  to  be  rather  unreliable. 

Some  years  ago,  my  attention  was  called  to 
morning  sickness  as  a  sign  of  the  sex  of  the  fojtus, 
and  as  substantiating    this  I  will  cite  the  follow- 

A  woman,  carrying  her  first  child,  was  so  ill 
from  "  morning  sickness  "  during  the  first  four 
months  of  pregnancy,  as  to  be  entirely  unfit  for 
household  duty.  The  child  when  born  was  found 
to  be  a  female.  The  second  pregnancy  was 
similar  to  the  first,  a  female  child  being  born. 

During  her  third  pregnancy  my  jiatient  was 
not  sick  in  the  least,  and  would  not  believe  that 
she  had  conceived  till  she  felt  the  movements  of 
the  child.  This  one  proved  to  bea  boy.  During 
the  next  two  pregnancies  no  sickness  occurred, 
and  male  children  were  born.  During  her  sixth 
pregnancy  she  was  greatly  annoyed  by  morning 
sickness,  and  a  girl  was  born.  I  foretold  the  sex 
of  the  seventh,  a  boy,  by  the  absence  of  vomiting, 
and  the  eighth,  a  girl,  by  the  presence  of  vomit- 
ing. 

In  searching  the  literature  at  my  command, 
I  find  Cazeaux  and  Tarnier,  in  the  last  edition  of 
their  great  work  on  obstetrics,  say  it  is  a  sign  of 
some  importance,  and  Priestley  in  "  Reynold's 
System  of  Medicine  "  refers  to  a  physician,  who 
claimed  to  be  able  to  foretell  the  sex  of  the  child 
by  the  absence  or  presence  of  vomiting  during 
pregnancy. 

I  would  be  glad  to  hear  from  other  readers  of 
the  Review  upon  this  subject. 

Cheves  Bevill. 


Till:  Canada  Mhdical  Record 

A  Monthly  Journal  of  Medicine  and  burgerv- 


The  doctor  who  selfishly  and  unwisely  sits  in 
his  office,  or  ''knocks  around  town,"  lazily,  and 
never  attends  at  home  or  abroad  the  convocations 
of  his  brethren,  thus  putting  himself  in  a  position 
for  receiving  and  imparling  information,  exchang- 
ing views  and  experiences,  rubbing  off  rough  cor- 
ners, and  brushing  out  the  mental  cobwebs  from  the 
darker  areas  of  his  mind,  made  dark  by  the  ab- 
sence of  the  light  reflected  from  other's  works 
against  the  best  interests  of  himself  and  his 
patients,  in  that  he  is  likely  to  be  come  rusty  and 
slow  as  thinker,  a  laggard,  a  sluggard,  a  nairow, 
one-idead,  dogmatic,  snarling,  misanthropic, 
dyspeptic  crank. 

Go  where  you  will  in  any  community,  and  you 
will  find  the  men  who  are  the  busiest,  the  most 
thoughtful,  the  bcbt  students,  the  happiest,  the 
leaders  in  the  front  rank,  are  the  ones  who  are 
never  too  busy  to  attend  their  home  societies 
regularly,  and  get  away  to  a  distant  meeting  at 
least  once  or  twice  a  year. 


EDITORS  : 

FRANCIS    W.CAMPBELL,   M.A..  M.D.,  L.K.C.P.  LOHD 
Kditor  and  Pioprietor. 

ASSISTANT  EDITOR: 

A.  LAPTHORN  SMITH,  B.A..  M.D.,  MR.C  S.  Eng.,  F.0.8. 

LONDON. 

SUBSCHII'TION    TWO    nol.LAIiS    PEU    ANND.M. 

All  comvmnications  and  Fjichtivqf.s  must  t>e  addressed  Co 
the  Edilors,  Orawer356,  Post   Office,  J/nnlreat. 


MON'TREAL,  SEPTEMBER,  1888. 

THE  CODE  OF  ETHICS  OF  THE   AMER- 
ICAN   MEDICAL    ASSOCIATION 

Art.    V. —  Duties  of  physicians  in  cases  of  inter- 
ference. 

1.  Medicine  is  a  liberal  profession,  and  those 
admitted  into  its  ranks  should  found  their  expec- 
tations of  practice  upon  the  extent  of  their  qualifi- 
cations, not  on  intrigue  or  artifice. 

2.  A  physician,  in  his  intercourse  with  a  patient 
under  the  care  of  another  practitioner,  should 
observe  the  strictest  caution  and  reserve.  No 
meddling  inquiries  should  be  made — no  disinge- 
nuous hints  given  relative  to  the  nature  and  treat- 
ment of  his  disorder;  nor  any  course  of  conduct 
pursued  that  may  directly  or  indirectly  tend  to 
diminish  the  trust  reposed  in  the  physician  em- 
ployed. 

3.  The  same  circumspection  and  reserve  should 
be  observed  when,  from  motives  of  business  or 
friendship,  a  physician  is  prompted  to  visit  an 
individual  who  is  under  the  direction  of  another 
practitioner.  Indeed,  such  visits  should  be 
avoided,  except  under  peculiar  circumstances  ;  and 
when  they  are  made,  no  particular  inquiries  should 
be  instituted  relative  to  the  nature  of  the  disease, 
or  the  remedies  employed,  iiut  the  topics  of  con- 
versation should  be  as  foreign  to  the  case  as  cir- 
cumstances will  admit. 

4.  A  physician  ought  not  to  take  charge  of  or 
prescribe  for  a  patient  who  has  recently  been  under 
the  care  of  another  member  of  the  faculty  in  the 
same  illness,  except  in  cases  of  sudden  emergency, 
or  in  consultation  with  the  physician  previously  in 
attendance,   or  when  the  latter  has  relinquished 


288 


THE   CANADA   MEDICAL   RECORD, 


the  case,  or  been  regularly  notified  that  his  ser- 
vices are  no  longer  desired.  Under  such  circum- 
stances no  unjust  and  illiberal  insinuations  should 
be  thrown  out  in  relation  to  the  conduct  or  prac- 
tice previously  pursued,  which  should  be  justified 
as  far  as  candor  and  regard  for  truth  and  probity 
will  permit ;  for  it  often  happens  that  patients 
become  dissatisfied  when  they  do  not  experience 
immediate  relief,  and,  as  many  diseases  are  natu- 
rally protracted,  the  want  of  success  in  the  first 
stage  of  treatment  affords  no  evidence  of  a  lack  of 
professional  knowledge  and  skill. 

5.  When  a  physician  is  called  to  an  urgent  case, 
because  the  family  attendant  is  not  at  hand,  he 
ought,  unless  his  assistance  in  consultation  be  de- 
sired, to  resign  the  care  of  the  patient  to  the  latter 
immediately  on  his  arrival. 

6.  It  often  happens  in  cases  of  sudden  illness, 
or  of  recent  accidents  and  injuries,  owing  to  the 
alarm  and  anxiety  of  friends,  that  a  number  of 
physicians  are  simultaneously  sent  for.  Under 
these  circumstance?,  courtesy  should  assign  the 
patient  to  the  first  who  arrives,  who  should  select 
from  those  present  any  additional  assistance  that 
he  may  deem  necessary.  In  all  such  cases,  how- 
ever, the  practitioner  who  ofliciates  should  request 
the  family  physician,  if  there  be  one,  to  be  called, 
and,  unless  his  further  attendance  be  requested, 
should  resign  the  case  to  the  latter  on  his  arri- 
val. 

7.  When  a  physician  is  called  to  the  patient  of 
another  piactitioner,*in  in  consequence  of  the 
sickness  or  absence  of  the  latter,  he  ought  on  the 
return  or  recovery  of  the  regular  attendant,  and 
with  the  consent  of  the  patient,  to  surrender  the 
case. 

8.  A  physician,  when  visiting  a  sick  person  in 
the  country,  may  be  desired  to  see  a  neighboring 
patient  who  is  under  the  regular  direction  of  an- 
other physician,  in  consequence  of  some  sudden 
change  or  aggravation  of  symptoms.  The  conduct 
to  be  pursued  on  such  an  occasion  is  to  give  advice 
adapted  to  present  circumstances  ;  to  interfere  no 
further  than  is  absolutely  necessary  with  the  gene- 
ral plan  of  treatment ;  to  assume  no  future  direc- 
tion unless  it  be  expressly  desired  ;  and,  in  this 
last  case,  to  request  an  immediate  consultaiion 
with  the  practitioner  previously  emjiluyed. 

g.   A  wealthy  physician  should  not  give  advice 

*The  cxpreb-iion,  •' pnticnt  of  another  practitionci,"  is  understood  to 
mean  a  patient  who  m:.y  have  been  under  the  charge  of  another  practi- 
tioner at  the  time  of  the  attack  of  sickness,  or  departure  from  home  of 
the  latter,  or  who  may  have  called  for  his  attendance  during  his  absence 
or  sickness,  or  in  any  other  manner  given  it  to  be  understood  that  he  re- 
garded the  said  physicion  as  his  regular  medical  attendant, 


gj-atis  to  the  affluent ;  because  his  doing  so  is  an 
injury  to  his  professional  brethren.  The  office  of 
a  physician  can  never  be  supported  as  an  exclu- 
sively beneficent  one  ;  and  it  is  defrauding,  in  some 
degree,  the  common  funds  for  its  support,  when 
fees  are  dispensed  with,  which  might  justly  be 
claimed. 

TO.  When  a  physician  who  has  been  engaged 
to  attenJ  a  case  of  midwifery  is  absent  and  another 
is  sent  for,  if  delivery  is  accomplished  during  the 
attendance  of  the  latter,  he  is  entitled  to  the  fee, 
but  should  resign  the  patient  to  the  practitioner 
first  fugaged. 


REVIEW. 

^1  practical  treatise  on  Materia  Medica  and  Thera- 
peutics. Bv  Robert  Bartholow,  M.A., 
M.D.,  LL.D.,  Professor  of  Materia  Medica 
and  General  Therapeutics  in  Jefferson  Medical 
College,  New  York :  D.  Appleton  &  Co., 
1887. 

Of  the  many  medical  writers  of  which  the 
United  States  can  boast,  there  are  few,  if  any,  of 
a  more  practical  turn  of  mind  than  the  author 
of  this  volume.  In  whatever  direction  his 
investigations  may  proceed,  there  is  but  one 
object  they  have  in  view,  and  that  is,  that  they 
shall  lead  to  practical  results.  He  is,  more- 
over, no  skeptic  as  regards  the  power  of  medi- 
cine to  produce  results  ;  on  the  contrary,  he  is  a 
firm  believer  on  the  therapeutics  of  medicine. 
With  such  qualifications,  Dr.  Bartholow  could 
not  but  make  this  volume  a  valuable  one,  and  it 
is  valuable  not  only  to  students  but  to  practi- 
tioners. 


WM.  R.  WARNER  &  CO.,  PHILADELPHIA^ 

Win.  R.  Warner  &  Co.  have  issued  the  follow- 
ing notice  to  Physicians  : 

We  take  this  method  of  denouncing  the  cir- 
culation of  certain  erroneous  reports  as  being  the 
outcome  of  ignorance  or  malice: 

We  have  no  connection  with  the  firm  of  H.  H. 
Warner  &  Co.,  of  Rochester,  who  make'' Safe 
Remedies  "  and  other  patent  medicines. 

Our  advertising  is  to  the  Medical  Profession, 
and  pills  and  products  (Warner  &  Co's.)  have 
been  used  and  held  in  high  esteem  by  the  most 
eminent  Doctors  during  the  past  thirty  years,  in 
the  United  States  and  in  foreign  countries. 

The  therapeutic  value  of  a  remedy  is  ascer- 
tained by  the  medica  practitioners,  and  it  is  the 
province  of  the  manufacuiring  chemist  to  prepare 
the  various  medicinal  preparations,  in  the  most  cor- 
rect, compatible,  palatable,  and  convenient 
manner  by  the  aid  of  skill  acquired  by  years  of 
practice  and  experience. 

It  seems  to  be  necessary  to  specify  AVm.  R. 
Warner  &  Co.'s  Pills  and  Bromo  Soda  with  Caf- 
feine to  obtain  what  you  want. 


Canada  medical  record 

K 
11 

C358 
V. 15-16 


GERSTS